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Outcome predictors of intra-articular glucocorticoid treatment for knee synovitis in patients with rheumatoid arthritis - a prospective cohort study.

AbstractINTRODUCTION:
Intra-articular glucocorticoid treatment (IAGC) is widely used for symptom relief in arthritis. However, knowledge of factors predicting treatment outcome is limited. The aim of the present study was to identify response predictors of IAGC for knee synovitis in patients with rheumatoid arthritis (RA).
METHODS:
In this study 121 RA patients with synovitis of the knee were treated with intra-articular injections of 20 mg triamcinolone hexacetonide. They were followed for six months and the rate of clinical relapse was studied. Non-responders (relapse within 6 months) and responders were compared regarding patient characteristics and knee joint damage as determined by the Larsen-Dale index. In addition, matched samples of serum and synovial fluid were analysed for factors reflecting the inflammatory process (C-reactive protein, interleukin 6, tumour necrosis factor alpha, vascular endothelial growth factor), joint tissue turnover (cartilage oligomeric matrix protein, metalloproteinase 3), and autoimmunity (antinuclear antibodies, antibodies against citrullinated peptides, rheumatoid factor).
RESULTS:
During the observation period, 48 knees relapsed (40%). Non-responders had more radiographic joint damage than responders (P = 0.002) and the pre-treatment vascular endothelial growth factor (VEGF) level in synovial fluid was significantly higher in non-responders (P = 0.002).
CONCLUSIONS:
Joint destruction is associated with poor outcome of IAGC for knee synovitis in RA. In addition, higher levels of VEGF in synovial fluid are found in non-responders, suggesting that locally produced VEGF is a biomarker for recurrence of synovial hyperplasia and the risk for arthritis relapse.
AuthorsTomas Weitoft, Johan Rönnelid, Ann Knight, Jörgen Lysholm, Tore Saxne, Anders Larsson
JournalArthritis research & therapy (Arthritis Res Ther) Vol. 16 Issue 3 Pg. R129 ( 2014) ISSN: 1478-6362 [Electronic] England
PMID24950951 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Inflammatory Agents
  • Biomarkers
  • Glucocorticoids
  • Vascular Endothelial Growth Factor A
  • Triamcinolone Acetonide
  • triamcinolone hexacetonide
Topics
  • Adult
  • Aged
  • Anti-Inflammatory Agents (administration & dosage, therapeutic use)
  • Arthritis, Rheumatoid (drug therapy, metabolism)
  • Biomarkers (blood, metabolism)
  • Glucocorticoids (administration & dosage, therapeutic use)
  • Humans
  • Injections, Intra-Articular
  • Knee Joint (drug effects, pathology)
  • Logistic Models
  • Middle Aged
  • Multivariate Analysis
  • Outcome Assessment (Health Care) (methods, statistics & numerical data)
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Synovial Fluid (metabolism)
  • Synovitis (drug therapy)
  • Time Factors
  • Triamcinolone Acetonide (administration & dosage, analogs & derivatives, therapeutic use)
  • Vascular Endothelial Growth Factor A (blood, metabolism)

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