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Intra-articular glucocorticoid injections should not be neglected in the remission targeted treatment of early rheumatoid arthritis: a post hoc analysis from the NEO-RACo trial


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14

 

  1. Department of Internal Medicine, University of Turku and Turku University Hospital, Finland. laura.kuusalo@utu.fi
  2. South-Karelia Central Hospital, Lappeenranta, Finland.
  3. Unit of Primary Health Care, University of Helsinki and Helsinki University Hospital; Department of General Practice, University of Helsinki; and Unit of Primary Health Care, Kuopio University Hospital, Finland.
  4. Department of Medicine, Oulu University Hospital, Finland.
  5. Jyväskylä Central Hospital, Jyväskylä, Finland.
  6. Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Finland.
  7. Department of Medicine, Kuopio University Hospital, Finland.
  8. Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Finland.
  9. Department of Internal Medicine, University of Turku and Turku University Hospital, Finland.
  10. ORTON Orthopaedic Hospital, Helsinki, Finland.
  11. Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Finland.
  12. Satakunta Central Hospital, Rauma, Finland.
  13. Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Finland.
  14. Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital; and School of Medicine, University of Tampere, Finland.

for the NEO-RACo Study Group

CER9298
2016 Vol.34, N°6
PI 1038, PF 1044
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PMID: 27494516 [PubMed]

Received: 27/01/2016
Accepted : 26/05/2016
In Press: 02/08/2016
Published: 28/11/2016

Abstract

OBJECTIVES:
To study the effects of neglecting intra-articular glucocorticoid injections (IAGCIs) into swollen joints in early rheumatoid arthritis (RA).
METHODS:
Ninety-nine patients with early, DMARD naive RA were treated, aiming at remission, with methotrexate, sulfasalazine, hydroxychloroquine, low-dose oral prednisolone and, when needed, IAGCIs for 2 years, and randomised to receive infliximab or placebo from weeks 4 to 26. During each of the 15 study visits, patients were scored retrospectively 0.2-0.4 points (depending on the number of non-injected joints) if IAGCIs to all swollen joints were not given. Patients were divided into tertiles by their cumulative scores for neglected injections (CSNI) over 24 months. 28-joint disease activity score (DAS28) area under the curve (AUC) between 0–24 months, remission rates, changes in quality of life, and radiological changes during the follow-up were assessed. Trends across tertiles of CSNI were tested with generalised linear models.
RESULTS:
Higher CSNI was associated with lower strict remission rates (p=0.005), and lower quality of life (p=0.004) at 24 months, and higher DAS28 AUC (p<0.001) during the follow-up. At 24 months, DAS28 remission rates were 90%, 93% and 76% (p=0.081), and strict remission rates were 74%, 77% and 39% by tertiles of CSNI. No significant differences were observed in radiological progression (p=0.089). IAGCIs were well tolerated.
CONCLUSIONS:
Neglecting IAGCIs into swollen joints is associated with lower remission rates, higher disease activity, and lower quality of life. Hence, IAGCIs should be used as an integral part of the targeted treatment of early RA.

Rheumatology Article