title: Outcome predictors of intra-articular glucocorticoid treatment for knee synovitis in patients with rheumatoid arthritis - a prospective cohort study.
abstract: BACKGROUND
  Intra-articular glucocorticoid treatment (IAGC) is widely used for symptom relief in arthritis. However, knowledge of factors predicting treatment outcome is limited. The aim of the present study was to identify response predictors of IAGC for knee synovitis in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  In this study 121 RA patients with synovitis of the knee were treated with intra-articular injections of 20 mg triamcinolone hexacetonide. They were followed for six months and the rate of clinical relapse was studied. Non-responders (relapse within 6 months) and responders were compared regarding patient characteristics and knee joint damage as determined by the Larsen-Dale index. In addition, matched samples of serum and synovial fluid were analysed for factors reflecting the inflammatory process (C-reactive protein, interleukin 6, tumour necrosis factor alpha, vascular endothelial growth factor), joint tissue turnover (cartilage oligomeric matrix protein, metalloproteinase 3), and autoimmunity (antinuclear antibodies, antibodies against citrullinated peptides, rheumatoid factor).
  
  
  RESULTS
  During the observation period, 48 knees relapsed (40%). Non-responders had more radiographic joint damage than responders (P = 0.002) and the pre-treatment vascular endothelial growth factor (VEGF) level in synovial fluid was significantly higher in non-responders (P = 0.002).
  
  
  CONCLUSIONS
  Joint destruction is associated with poor outcome of IAGC for knee synovitis in RA. In addition, higher levels of VEGF in synovial fluid are found in non-responders, suggesting that locally produced VEGF is a biomarker for recurrence of synovial hyperplasia and the risk for arthritis relapse.
authors.forename: Tomas
authors.initials: T
authors.lastname: Weitoft
authors.forename: Johan
authors.initials: J
authors.lastname: Rönnelid
authors.forename: Ann
authors.initials: A
authors.lastname: Knight
authors.forename: Jörgen
authors.initials: J
authors.lastname: Lysholm
authors.forename: Tore
authors.initials: T
authors.lastname: Saxne
authors.forename: Anders
authors.initials: A
authors.lastname: Larsson
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000378:metabolism; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects* / Q000473:pathology; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013582:Synovial Fluid / Q000378:metabolism; D013585:Synovitis / Q000188:drug therapy*; D013997:Time Factors; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D042461:Vascular Endothelial Growth Factor A / Q000097:blood / Q000378:metabolism
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide