OBJECTIVE: To investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthritis (RA). METHODS: During 2 years of follow-up in the CIMESTRA trial, 160 patients receivedintra-articular betamethasone in up to four swollen joints/visit in combination with disease-modifying antirheumatic drugs. Short-term efficacy was assessed by EULAR good response. Long-term efficacy by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested. RESULTS:1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders, wrists) were injected during 2 years. 531 Joints received a second injection, and 262 a third. At baseline, the median numbers of injections (dose of betamethasone) was 4 (28 mg), declining to 0 (0 mg) at subsequent visits. At weeks 2, 4 and 6, 50.0%, 58.1% and 61.7% had achieved a EULAR good response. After 1 and 2 years, respectively, 62.3% (95% CI 58.1% to 66.9%) and 55.5% (51.1% to 60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-year joint injection survival, longest for the PIP joints: 73.7% (79.4% to 95.3%). 2-Year joint injection survival was higher for first injections: 56.6% (53.7% to 59.8%) than for the second: 43.4% (38.4% to 49.0%) and the third: 31.3% (25.0% to 39.3%). Adverse events were mild and transient. A high MRI synovitis score of MCP joints and anti-CCP-negativity were associated with poorer joint injection survival, whereas IgM-RF and C-reactive protein were not. CONCLUSION: In early RA, intra-articular injections of betamethasone in small and large peripheral joints resulted in rapid, effective and longlasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.
RCT Entities:
OBJECTIVE: To investigate the short-term and long-term efficacy of intra-articularbetamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthritis (RA). METHODS: During 2 years of follow-up in the CIMESTRA trial, 160 patients received intra-articularbetamethasone in up to four swollen joints/visit in combination with disease-modifying antirheumatic drugs. Short-term efficacy was assessed by EULAR good response. Long-term efficacy by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested. RESULTS: 1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders, wrists) were injected during 2 years. 531 Joints received a second injection, and 262 a third. At baseline, the median numbers of injections (dose of betamethasone) was 4 (28 mg), declining to 0 (0 mg) at subsequent visits. At weeks 2, 4 and 6, 50.0%, 58.1% and 61.7% had achieved a EULAR good response. After 1 and 2 years, respectively, 62.3% (95% CI 58.1% to 66.9%) and 55.5% (51.1% to 60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-year joint injection survival, longest for the PIP joints: 73.7% (79.4% to 95.3%). 2-Year joint injection survival was higher for first injections: 56.6% (53.7% to 59.8%) than for the second: 43.4% (38.4% to 49.0%) and the third: 31.3% (25.0% to 39.3%). Adverse events were mild and transient. A high MRI synovitis score of MCP joints and anti-CCP-negativity were associated with poorer joint injection survival, whereas IgM-RF and C-reactive protein were not. CONCLUSION: In early RA, intra-articular injections of betamethasone in small and large peripheral joints resulted in rapid, effective and longlasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.
Authors: Olivia Min Yi Leow; Lee Kean Lim; Pei Ling Ooi; Lynette Pei Chi Shek; Elizabeth You Ning Ang; Mary Beth Son Journal: Singapore Med J Date: 2014-05 Impact factor: 1.858
Authors: Francesco Carubbi; Luigi Zugaro; Paola Cipriani; Armando Conchiglia; Lorenzo Gregori; Cristino Danniballe; Maria Letizia Pistoia; Vasiliki Liakouli; Piero Ruscitti; Francesco Ciccia; Giovanni Triolo; Carlo Masciocchi; Roberto Giacomelli Journal: Int J Immunopathol Pharmacol Date: 2015-12-18 Impact factor: 3.219
Authors: Signe Møller-Bisgaard; Kim Hørslev-Petersen; Bo Ejbjerg; Merete Lund Hetland; Lykke Midtbøll Ørnbjerg; Daniel Glinatsi; Jakob Møller; Mikael Boesen; Robin Christensen; Kristian Stengaard-Pedersen; Ole Rintek Madsen; Bente Jensen; Jan Alexander Villadsen; Ellen-Margrethe Hauge; Philip Bennett; Oliver Hendricks; Karsten Asmussen; Marcin Kowalski; Hanne Lindegaard; Sabrina Mai Nielsen; Henning Bliddal; Niels Steen Krogh; Torkell Ellingsen; Agnete H Nielsen; Lone Balding; Anne Grethe Jurik; Henrik S Thomsen; Mikkel Østergaard Journal: JAMA Date: 2019-02-05 Impact factor: 56.272
Authors: Tomas Weitoft; Johan Rönnelid; Ann Knight; Jörgen Lysholm; Tore Saxne; Anders Larsson Journal: Arthritis Res Ther Date: 2014-06-20 Impact factor: 5.156
Authors: Christian Gytz Ammitzbøll; Rudi Steffensen; Martin Bøgsted; Kim Hørslev-Petersen; Merete L Hetland; Peter Junker; Julia S Johansen; Jan Pødenphant; Mikkel Østergaard; Torkell Ellingsen; Kristian Stengaard-Pedersen Journal: Arthritis Res Ther Date: 2014-10-31 Impact factor: 5.156
Authors: Marloes Tenten-Diepenmaat; Marike van der Leeden; Thea P M Vliet Vlieland; Joost Dekker Journal: J Foot Ankle Res Date: 2018-07-04 Impact factor: 2.303