Intra-articular corticoid injection induces circulating glucocorticoid bioactivity and systemic immune activation in juvenile idiopathic arthritis.

Abstract

OBJECTIVE:

To study the systemic effects of intra-articular (IA) glucocorticoid (GC) injections in juvenile idiopathic arthritis (JIA).

METHODS:

The study group comprised 21 JIA patients being treated with IA methylprednisolone [MP (n = 15) or MP plus triamcinolone hexacetonide (THA) (n = 6)] prescribed on clinical indications. The systemic effect of MP was assessed by measuring circulating glucocorticoid bioactivity (GBA) with a recombinant cell transactivation assay 7 and 24 h after the IA injections, and after 2 months. The systemic immunological responses were studied with a novel assay for testing patient serum-induced changes in the secretion of interferon (IFN)-γ and interleukin (IL)-5 from target cells.

RESULTS:

Administration of IA GC induced serum GBA (p = 0.001) and suppressed circulating cortisol levels (p = 0.002) 7 h after the injection. Serum withdrawn 24 h after the IA injection induced less IL-5 secretion from mitogen-activated target cells when compared with pre-treatment sera (p = 0.036). This decrease in target cell T helper (Th)2 response (IL-5) was MP dose related (r = -0.550, p = 0.018). High IL-5 secretion from target cells prior to the IA injections was associated with good clinical outcome at 2 months, seen as a low number of active (p = 0.044) and restricted joints (p = 0.049).

CONCLUSION:

IA GC injections have systemic effects that are reflected in the serum as an immediate elevation of GBA, a decrease of endogenous cortisol as well as a suppressive effect of patient serum on target cell IL-5 secretion. These systemic effects may play a role in the attenuation of disease activity.

• Authors: H Rintamäki, K Tamm, O Vaarala, M Sidoroff, V Honkanen, T Raivio, Oa Jänne, K-L Kolho
• Journal: Scandinavian journal of rheumatology (Scand J Rheumatol) Vol. 40 Issue 5 Pg. 347-53 ( 2011) ISSN: 1502-7732 [Electronic] England
• PMID: 21619491 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents
• Glucocorticoids
• Interleukin-5
• Interferon-gamma
• Triamcinolone Acetonide
• triamcinolone hexacetonide
• Hydrocortisone
• Methylprednisolone

Topics

• Adolescent
• Anti-Inflammatory Agents (administration & dosage)
• Arthritis, Juvenile (drug therapy, immunology)
• Child
• Female
• Glucocorticoids (administration & dosage, blood)
• Humans
• Hydrocortisone (blood)
• Immune System (drug effects)
• Injections, Intra-Articular
• Interferon-gamma (blood, metabolism)
• Interleukin-5 (blood, metabolism)
• Male
• Methylprednisolone (administration & dosage, immunology)
• Prospective Studies
• Th2 Cells (drug effects)
• Treatment Outcome
• Triamcinolone Acetonide (administration & dosage, analogs & derivatives)