BACKGROUND: Intra-articular triamcinolone in combination with DMARDs may be able to achieve faster and tighter control of disease activity in early rheumatoid arthritis that may be the key to preventing or minimizing later deformities. OBJECTIVE: To compare the efficacy of a combination of Disease Modifying Anti-Rheumatoid Drugs (DMARDs) with Intra-articular Glucocorticoids versus only DMARDs in a group of patients with early Rheumatoid Arthritis (RA). METHODS:Fifty patients diagnosed as Rheumatoid Arthritis (RA) by American Rheumatology Association (ARA) criteria (1987) with disease duration less than two years were randomized into two groups. The Control group received a combination of Methotrexate 15 mg daily with Sulfasalazine 2 gm daily for 3 months and the Study group received the above combination along with Intra-articular injections of Triamcinolone acetate (40 mg per ml) in each of the swollen joints at the start of the study. Outcome was assessed in terms of Disease Activity Score (DAS-28), American College of Rheumatology (ACR) 20/50/70 criteria and number of rescue medications used at the end of 3 months. RESULTS: The study group had significant reductions in DAS 28 scores (3.39 versus 4.99 in control group) and significantly more subjects achieved the ACR 20/50/70 criteria at the end of 3 months (100/60/36% versus 84/20/0%) Secondary end-points like tender and swollen joint count, ESR, early morning stiffness, health assessment questionnaire (HAQ) scores and general health status were significantly reduced in the study group. Also, significantly lesser rescue medications were needed in the study group. CONCLUSION: Combination of DMARDs with Intra-articular corticosteroids is significantly better than DMARDs alone in early RA.
RCT Entities:
BACKGROUND: Intra-articular triamcinolone in combination with DMARDs may be able to achieve faster and tighter control of disease activity in early rheumatoid arthritis that may be the key to preventing or minimizing later deformities. OBJECTIVE: To compare the efficacy of a combination of Disease Modifying Anti-Rheumatoid Drugs (DMARDs) with Intra-articular Glucocorticoids versus only DMARDs in a group of patients with early Rheumatoid Arthritis (RA). METHODS: Fifty patients diagnosed as Rheumatoid Arthritis (RA) by American Rheumatology Association (ARA) criteria (1987) with disease duration less than two years were randomized into two groups. The Control group received a combination of Methotrexate 15 mg daily with Sulfasalazine 2 gm daily for 3 months and the Study group received the above combination along with Intra-articular injections of Triamcinolone acetate (40 mg per ml) in each of the swollen joints at the start of the study. Outcome was assessed in terms of Disease Activity Score (DAS-28), American College of Rheumatology (ACR) 20/50/70 criteria and number of rescue medications used at the end of 3 months. RESULTS: The study group had significant reductions in DAS 28 scores (3.39 versus 4.99 in control group) and significantly more subjects achieved the ACR 20/50/70 criteria at the end of 3 months (100/60/36% versus 84/20/0%) Secondary end-points like tender and swollen joint count, ESR, early morning stiffness, health assessment questionnaire (HAQ) scores and general health status were significantly reduced in the study group. Also, significantly lesser rescue medications were needed in the study group. CONCLUSION: Combination of DMARDs with Intra-articular corticosteroids is significantly better than DMARDs alone in early RA.
Authors: Antonio Barile; Alice La Marra; Francesco Arrigoni; Silvia Mariani; Luigi Zugaro; Alessandra Splendiani; Ernesto Di Cesare; Alfonso Reginelli; Marcello Zappia; Luca Brunese; Ejona Duka; Giampaolo Carrafiello; Carlo Masciocchi Journal: Br J Radiol Date: 2016-07-07 Impact factor: 3.039
Authors: Andrea Darzi; Manale Harfouche; Thurayya Arayssi; Samar Alemadi; Khalid A Alnaqbi; Humeira Badsha; Farida Al Balushi; Bassel Elzorkany; Hussein Halabi; Mohammed Hamoudeh; Wissam Hazer; Basel Masri; Mohammed A Omair; Imad Uthman; Nelly Ziade; Jasvinder A Singh; Robin Christiansen; Peter Tugwell; Holger J Schünemann; Elie A Akl Journal: Health Qual Life Outcomes Date: 2017-09-21 Impact factor: 3.186