[Intra-articular therapy with infliximab in psoriatic arthritis: efficacy and safety in refractory monoarthritis].

Abstract

OBJECTIVE:

To evaluate efficacy and safety of intra-articular therapy (IA) with infliximab (IFX), in patients with psoriatic arthritis (PsA) and refractory monoarthritis.

METHODS:

Four male and 1 female aged from 25 to 71 years and disease duration from 1 to 25 years, affected by PsA (CASPAR criteria) were observed . All patients were treated with immunomodulators (methotrexate, leflunomide, cyclosporin A), 3/5 with concomitant steroids, 4/5 with NSAID's. Only 1 patient were treated with IFX 5 mg/kg IV every 6 weeks. Before the IFX injection an amount of synovial fluid was aspired from the inflamed site and the anti-TNF injection was echographic guided. Patients were evaluated at regular intervals through clinical and echographic examination and retreated in case of flare.

RESULTS:

At follow-up visit after 7 days, in all patients treated with the first injection was detected total regression of the inflammation and no new inflamed synovial fluid was observed; power doppler examination shows reduction of local vascularization. Two patients experienced full remission after 6 months and only one injection, 1 patient (arthritis of the wrist) was in remission after 2 injections (3 months of interval). In 2 patients with knee arthritis and important synovial hypertrophy good results obtained after the first injection were not maintained afterwards and second injection was ineffective: these patients were evaluated for surgical intervention.

CONCLUSIONS:

Local injections of IFX were safe and well tolerated in all patients. The efficacy in short term was observed in all cases; our supposition is that presence of synovial hypertrophy is cause of worsening.

• Authors: S Bello, C Bonali, L Serafino, P Di Giuseppe, A Minosi, N Terlizzi
• Journal: Reumatismo (Reumatismo) 2010 Jan-Mar Vol. 62 Issue 1 Pg. 46-50 ISSN: 0048-7449 [Print] Italy
• Vernacular Title: Terapia intra-articolare con infliximab nell'artrite psoriasica: valutazione di efficacia e tollerabilità nel trattamento della monoartrite refrattaria.
• PMID: 20390117 (Publication Type: Case Reports, Evaluation Study, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antirheumatic Agents
• Infliximab

Topics

• Adult
• Aged
• Antibodies, Monoclonal (administration & dosage, therapeutic use)
• Antirheumatic Agents (administration & dosage, therapeutic use)
• Arthritis, Psoriatic (diagnostic imaging, drug therapy)
• Female
• Follow-Up Studies
• Humans
• Infliximab
• Injections, Intra-Articular
• Male
• Middle Aged
• Remission Induction
• Time Factors
• Treatment Outcome
• Ultrasonography