SAT0041 EFFECT OF INTRA-ARTICULAR GLUCOCORTICOID INJECTION ON RADIOGRAPHIC DAMAGE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: J. H. Koh, H. N. Lee, S. G. Lee
Journal: Annals of the Rheumatic Diseases (2020)

Background: Intra-articular glucocorticoid injection (IAGI) has been used as part of a treat-to-target strategy in patients with rheumatoid arthritis (RA). However, recent studies revealed that repeated intra-articular triamcinolone injection into knees with osteoarthritis resulted in significant greater cartilage volume loss after two years. Limited knowledge exists about the long-term efficacy of IAGI in RA, assessed by radiographic changes. Objectives: To investigate whether IAGI have an additional benefit on achieving remission or low disease activity (REM/LDA) after 3 month, and radiographic progression over the next two years. Additionally, we identified the factors associated with early achievement of REM/LDA and radiographic progression. Methods: We performed a retrospective study of RA patients who had active arthritis in the hand or wrist joints and received IAGI adjunct to disease modifying anti-rheumatic drugs, compared with those never had received IAGI. Short-term efficacy was assessed by changes of disease activity score in 28 joints (DAS28) after 3 months and long-term efficacy by changes of Sharp score of hand radiographs (HSS) taken before and two years after the onset of active arthritis. The radiographic progression was defined as ΔHSS/year ≥ 1.5. Conditional logistic regression analysis was used to identify predictors for radiographic progression. Results: We identified 116 RA patients who received IAGI on the hand or wrist joints and 102 IAGI-naïve patients. After 3 months after active arthritis, 61% patients treated with IAGI and 39% of IAGI naïve patients achieved low disease activity or remission ( P = 0.009). In the next two year, 45% of patients with IAGI and 34% of IAGI-naive patients were radiographically progressed ( P = 0.114). The ΔHSS/year of patients received IAGI was 1.0 (Interquartile ranges [IQR], 0–3.8), while that of IAGI-naïve patients was 0 (IQR, 0–2.5) ( P = 0.005). After adjusting disease duration, baseline HSS and 3-month DAS28, IAGI and wrist joint involvement were associated with radiographic progression. Conclusion: IAGI given in the hand and wrist joints of patients with RA were associated with short-term control of disease activity, however, long-term structural damage in the subsequent two years. Wrist joint arthritis had higher potential for radiographic progression, which should be carefully monitored. References: [1] Hetland ML, Ostergaard M, Ejbjerg B, Jacobsen S, Stengaard-Pedersen K, Junker P, Lottenburger T, Hansen I, Andersen LS, Tarp U et al : Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP . Annals of the rheumatic diseases 2012, 71 (6):851-856. [2] McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ: Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial . Jama 2017, 317 (19):1967-1975. Acknowledgments : This work was supported by a grant from the National Research foundation of Korea [NRF-2018R1D1A1B07045491]. Disclosure of Interests: None declared