title: Intra articular injection with corticosteroids in patients with recent onset rheumatoid arthritis: subanalyses from the BeSt study.
abstract: To investigate the association between intra-articular (IA) large joint corticosteroid injections and clinical outcomes in patients with recent onset rheumatoid arthritis (RA). We compared pain (visual analog scale (VAS)), the Disease Activity Score (44 joints) (DAS), and swollen and tender joint counts before and after IA injection. Using linear mixed models (LMM), the DAS and the Health Assessment Questionnaire (HAQ) score over time were compared in IA injected versus noninjected patients. In year 1, 93 joints were injected in 44 patients treated with initial methotrexate monotherapy and 16 in patients treated with initial combination therapy (p < 0.01). Three months later, swelling and tenderness were resolved in 58-50 % of the injected joints; but within 12 months after the injection, swelling recurred in 14 % and tenderness in 41 % of the injected joints. Mean (SD) DAS decreased from 4.0 (1.4) before to 3.2 (1.2) 3 months after injection (p < 0.01) and VAS for pain from 49 (26) to 40 (27) (p < 0.01). LMM showed a higher DAS and HAQ in patients injected in year 0-1 compared to those not injected, but no difference in subsequent years, and similar treatment adjustments. Eight-year radiographs showed similar damage in injected joints (17 %) and noninjected joints (14 %). IA corticosteroid injections are associated with symptom relief, sometimes only temporarily, in 50 % of cases. Initially DAS significantly improved, but over time DAS and HAQ were similar in injected versus non-injected patients. After 8 years there was no difference in joint damage.
authors.affiliation: Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands, e.gvozdenovic@lumc.nl.
authors.forename: Emilia
authors.initials: E
authors.lastname: Gvozdenović
authors.forename: Linda
authors.initials: L
authors.lastname: Dirven
authors.forename: Marianne
authors.initials: M
authors.lastname: van den Broek
authors.forename: K Huub
authors.initials: KH
authors.lastname: Han
authors.forename: Esmeralda T H
authors.initials: ET
authors.lastname: Molenaar
authors.forename: Robert B M
authors.initials: RB
authors.lastname: Landewé
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D007596:Joints / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D010147:Pain Measurement; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D008727:Methotrexate