Prospective Longitudinal Effects of Intra-articular Corticosteroid Injection on Synovial Fluid Oxygen

Study Overview
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Brief Summary
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Inflammatory arthritis such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are characterized by synovial inflammation of joints, potentially leading to joint destruction and functional disability. Inflamed joints have lower oxygen levels. Studying how oxygen level within the joint affect inflammation may lead to new treatments for patients with arthritis. Anti-inflammatory corticosteroid injection into the joint is well tolerated and widely used in clinical practice but its effects on oxygen level within joints is unknown. Therefore, patients who require corticosteroid injection into the joint as routine clinical care will have biological samples collected before and after the injection. This will give new information to put into context the biological effects within the joint, and accelerate development of new treatment approaches in the future.

Official Title
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Prospective Longitudinal Effects of Intra-articular Corticosteroid Injection on Synovial Fluid Oxygen

Conditions
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Rheumatoid Arthritis, Psoriatic Arthritis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant is willing and able to give informed consent for participation in the study. Male or Female, aged 18 years or above. Fulfil American College of Rheumatology/European League Against Rheumatism criteria (ACR/EULAR) 2010 Rheumatoid Arthritis Classification Criteria or fulfil Classification Criteria for Psoriatic Arthritis 2006 (CASPAR). Participant has been selected for intra-articular corticosteroid injection as part of their routine clinical care. Selected joint for biopsy must be minimum Grade 2 synovial thickening for large joint (knee) and medium joint (wrist), or minimum Grade 3 synovial thickening for small joint (metacarpophalangeal). Exclusion Criteria: Current enrolment in any other clinical study involving an investigational study treatment. Intramuscular, intravenous or intra-articular administration of corticosteroid within 4 weeks prior to baseline visit. Oral corticosteroid > 10 mg/day prednisolone or equivalent within 4 weeks prior to baseline visit. Oral corticosteroid dose not stable for at least 4 weeks prior to baseline visit. Oral non-steroidal anti-inflammatory drugs (including aspirin > 75 mg/ day and selective-cyclooxygenase inhibitors) dose not stable for at least 4 weeks prior to baseline visit. Disease modifying anti-rheumatic drugs (DMARDs) dose not stable for at least 4 weeks prior to baseline visit. History of septic arthritis. Participants on warfarin, heparin, low molecular weight heparin, direct oral anticoagulants. Oral anti-platelet agents are permitted. History of haemophilia.

Ages Eligible for Study
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Minimum Age: 18 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Rheumatoid arthritis and psoriatic arthritis<br>Patients with rheumatoid arthritis or psoriatic arthritis, who require an intra-articular corticosteroid injection | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effects of intra-articular corticosteroid injection on joint oxygen tension in patients with rheumatoid and psoriatic arthritis | Change from Baseline Synovial fluid partial pressure of oxygen at Day 28 | Day 28 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effects of intra-articular corticosteroid injection on joint hypoxia in patients with rheumatoid and psoriatic arthritis | Hypoxia-inducible factor 1α (HIF-1α) protein levels in synovial tissues | Day 1 and 28 | 
| Effects of intra-articular corticosteroid injection on synovial fibroblast protein expression | Change from baseline protein expression levels in synovial fibroblasts at Day 28 | Day 28 | 
| Effects of intra-articular corticosteroid injection on patient satisfaction | Treatment Satisfaction Questionnaire (TSQM)© | Day 28 |