Effectiveness Intraarticular Corticosteroid

Study Overview
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Brief Summary
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The purpose of this study is to compare the small and large dose of corticosteroid used in intraarticular injection of wrist.

Detailed Description
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Background / Objectives: The optimal dose of corticosteroid to be used in intraarticular injection is not well established. The objective of this study is to compare the effectiveness and tolerance in the medium-term between small and large dose of triamcinolone hexacetonide (TH) used in intraarticular injection (IAI) of medium size joint of patients with rheumatoid arthritis (RA). Materials/Methods: A controlled, randomized, prospective, double-blind study will be realized in patients with RA. It will be evaluated 60 wrists joints (representing medium size joints) from the outpatient clinics at the Rheumatology Division UNIFESP, Brazil. Inclusion criteria were: patients with established RA, age between 18 and 65 years, disease modifying anti-rheumatic drugs (DMARDs) stable for at least 3 months, synovitis in wrist with pain visual analogic scale (VAS) between 4 and 8cm. Patients with overlap syndromes, polyarticular synovitis, diabetes mellitus or uncontrolled hypertension and those with suspected local or systemic infection were excluded. Patients will be randomized (Clapboard randomization) in two groups of 30 patients each: group 1 (high dose) is injected with 40mg (2ml) of TH and group 2 (small dose) was injected 20mg (1ml). Only one joint is injected by patient (IAI blindly). Evaluation will be conducted by a blinded observer at five times: baseline (T0), one week (T1), four (T4), eight (T8) and twelve (T12) weeks and the following assessment instruments were used: visual analogue scale for pain and swollen (VAS 0-10cm); wrist goniometry; chronic disease activity index (CDAI). Side effects and related events were reported in a medical questionnaire. The level of statistical significance was 5%.

Official Title
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Effectiveness and Tolerance Infiltration Intraarticular Corticosteroid According to Dose

Conditions
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Rheumatoid Arthritis

Intervention / Treatment
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* Drug: Triamcinolone hexacetonide
* Drug: Triamcinolone hexacetonide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients with established RA age between 18 and 65 years disease modifying anti-rheumatic drugs (DMARDs) stable for at least 3 months synovitis in wrist with pain visual analogic scale (VAS) between 4 and 8cm Exclusion Criteria: patients with overlap syndromes polyarticular synovitis diabetes mellitus or uncontrolled hypertension and those with suspected local or systemic infection

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: high dose<br>intraarticular wrist injection of 40mg, 2ml | Drug: Triamcinolone hexacetonide<br>* High dose means 40mg or 2ml of triamcinolone hexacetonide<br>|
| Active Comparator: low dose<br>intraarticular wrist injection of 20mg, 1ml. | Drug: Triamcinolone hexacetonide<br>* Low dose means 20mg or 1 ml of triamcinolone hexacetonide<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analog scale (VAS) |  | up to 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| chronic disease activity index (CDAI) |  | up to 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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injection, arthritis, corticosteroid