Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Short- and Long-Term Effect of Unguided, Intra-Articular Injections with Betamethasone In Early Rheumatoid Arthritis. Impact of Joint Area, Repeated Injections, MRI Findings, Anti-CCP, IgM-RF and CRP.

Hetland1,  Merete L., Ostergaard2,  Mikkel, Ejbjerg3,  Bo J., Jacobsen4,  Søren, Stengaard-Pedersen5,  Kristian, Junker6,  Peter, Lottenburger6,  Tine

Copenhagen University Hospital at Glostrup, on behalf of DANBIO, Copenhagen, Denmark
Odense, Denmark
Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
University Hospital, Silkeborg, Denmark
University of Southern Denmark, Graasten, Denmark
Copenhagen University Hospital in Glostrup, Glostrup, Denmark
Hospital at Slagelse, Slagelse, Denmark
Rigshospitalet - 4242, Copenhagen, Denmark
Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
Odense University Hospital, Odense C, Denmark
Viborg Hospital, Viborg, Denmark
Denmark
Aarhus University Hospital, Aarhus, Denmark

Background/Purpose:

To investigate in rheumatoid arthritis (RA) patients the short- and long-term efficacy of unguided intra-articularly injections with betamethasone, and the impact of joint area, repeated injections, magnetic resonance imaging (MRI) pathology, anti-cyclic citrullinated peptides (anti-CCP) and IgM-rheumatoid factor (RF) status on long-term efficacy.

Methods:

160 patients with early RA (<6 months' duration) received intra-articular betamethasone in all (max 4) swollen joints at each visit (2 week intervals for 8 wks, then every 4 wks) in combination with step-up DMARDs during 2 years. This was part of the CIMESTRA trial (1–2).

Short-term efficacy was assessed by EULAR good-response. Long-term efficacy by Kaplan-Meier plots of the joint-injection-survival (i.e. the time-span between injection and renewed synovitis).

Potential predictors of joint-injection-survival were tested.

Results:

1373 joints (wrists, knees, MCP, shoulders, ankles, PIP, elbows, MTP) were injected. Of these, 531 were 2nd injections in a previously injected joint, and 262 were 3rd. At baseline, the median DAS28 was 5.5 (IQR: 4.6–6.2), and the numbers of injections/dose of betamethasone given were: 4(3–4)/4 (3–4), declining to 0(0–2)/0 (0–1.5) at the following visits. At week 2, 4 and 6, respectively, 50.0%, 58.1% and 61.7% had achieved a good EULAR response.

After 1 and 2 years, respectively, 62.3%(95% C.I. 58.1–66.9%) and 55.5%(51.1–60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-years' joint-injection-survival, longest for the PIP-joints (73.7%(79.4–95.3%), p<0.01.

2-year joint survival was higher for 1st injections 56.6%(53.7–59.8%) than for 2nd 43.4%(38.4–49.0%) and 3rd injections 31.3%(25.0–39.3%), p<0.0001.

The cumulated dose of betamethasone after 2 years was: 11ml (IQR 7–17ml). The median intraarticular betamethasone dose during the first 2 years corresponded to less than 1 mg prednisolone per day.

Adverse events were mild and transient. High MRI synovitis score of MCP joints and anti-CCP were associated with poorer joint-injection-survival, whereas CRP and IgM-RF were not.

Conclusion:

In early RA, intra-articular unguided injections of betamethasone in small and large peripheral joints together with DMARD treatment resulted in very rapid, effective and long-lasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.

References:

(1)Hetland, ML et al. Arthritis Rheum 2006; 54:1401–9.

(2)Hetland, ML et al. Ann Rheum Dis 2008: 67; 815–22.

To cite this abstract, please use the following information:
Hetland, Merete L., Ostergaard, Mikkel, Ejbjerg, Bo J., Jacobsen, Søren, Stengaard-Pedersen, Kristian, Junker, Peter, et al; Short- and Long-Term Effect of Unguided, Intra-Articular Injections with Betamethasone In Early Rheumatoid Arthritis. Impact of Joint Area, Repeated Injections, MRI Findings, Anti-CCP, IgM-RF and CRP. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1258
DOI:

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