1258 - Short- and Long-Term Effect of Unguided, Intra-Articular Injections with Betamethasone In Early Rheumatoid Arthritis. Impact of Joint Area, Repeated Injections, MRI Findings, Anti-CCP, IgM-RF and CRP

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Merete L. Hetland1, Mikkel Østergaard2, Bo J. Ejbjerg3, Søren Jacobsen4, Kristian Stengaard-Pedersen5, Peter Junker6, Tine Lottenburger6, Ib Hansen7, Lis Smedegaard Andersen8, Ulrik Tarp9, Anders Svendsen10, Jens Kristian Pedersen6, Henrik Skjødt11, Torkell Ellingsen12, Hanne M. Lindegaard6 and Kim Hørslev-Petersen13, 1Copenhagen University Hospital at Glostrup, on behalf of DANBIO, Copenhagen, Denmark, 2Copenhagen University Hospital in Glostrup, Glostrup, Denmark, 3Hospital at Slagelse, Slagelse, Denmark, 4Copenhagen University Hospital, Copenhagen, Denmark, 5Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, 6Odense University Hospital, Odense C, Denmark, 7Viborg Hospital, Viborg, Denmark, 8Denmark, 9Aarhus University Hospital, Aarhus, Denmark, 10Odense, Denmark, 11Copenhagen University Hospital at Glostrup, Copenhagen, Denmark, 12University Hospital, Silkeborg, Denmark, 13University of Southern Denmark, Graasten, Denmark
Presentation Number: 1258

Background/Purpose: 

To investigate in rheumatoid arthritis (RA) patients the short- and long-term efficacy of unguided intra-articularly injections with betamethasone, and the impact of joint area, repeated injections, magnetic resonance imaging (MRI) pathology, anti-cyclic citrullinated peptides (anti-CCP) and IgM-rheumatoid factor (RF) status on long-term efficacy.

Method: 

160 patients with early RA (<6 months' duration) received intra-articular betamethasone in all (max 4) swollen joints at each visit (2 week intervals for 8 wks, then every 4 wks) in combination with step-up DMARDs during 2 years. This was part of the CIMESTRA trial (1-2).

Short-term efficacy was assessed by EULAR good-response. Long-term efficacy by Kaplan-Meier plots of the joint-injection-survival (i.e. the time-span between injection and renewed synovitis).

Potential predictors of joint-injection-survival were tested.

Result: 

1373 joints (wrists, knees, MCP, shoulders, ankles, PIP, elbows, MTP) were injected. Of these, 531 were 2nd injections in a previously injected joint, and 262 were 3rd. At baseline, the median DAS28 was 5.5 (IQR: 4.6-6.2), and the numbers of injections/dose of betamethasone given were: 4(3-4)/4 (3-4), declining to 0(0-2)/0 (0-1.5) at the following visits. At week 2, 4 and 6, respectively, 50.0%, 58.1% and 61.7% had achieved a good EULAR response.

After 1 and 2 years, respectively, 62.3%(95% C.I. 58.1-66.9%) and 55.5%(51.1-60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-years’ joint-injection-survival, longest for the PIP-joints (73.7%(79.4-95.3%), p<0.01.

2-year joint survival was higher for 1st injections 56.6%(53.7-59.8%) than for 2nd 43.4%(38.4-49.0%) and 3rd injections 31.3%(25.0-39.3%), p<0.0001. 

The cumulated dose of betamethasone after 2 years was: 11ml (IQR 7-17ml). The median intraarticular betamethasone dose during the first 2 years corresponded to less than 1 mg prednisolone per day.

Adverse events were mild and transient. High MRI synovitis score of MCP joints and anti-CCP were associated with poorer joint-injection-survival, whereas CRP and IgM-RF were not.

Conclusion: 

In early RA, intra-articular unguided injections of betamethasone in small and large peripheral joints together with DMARD treatment resulted in very rapid, effective and long-lasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.

References: (1) Hetland ML et al. Arthritis Rheum 2006; 54:1401-9.

(2) Hetland ML et al. Ann Rheum Dis 2008: 67; 815-22.


Keywords: clinical trials, glucocorticoids and rheumatoid arthritis, treatment

Disclosure: M. L. Hetland, None; M. Østergaard, None; B. J. Ejbjerg, None; S. Jacobsen, None; K. Stengaard-Pedersen, None; P. Junker, None; T. Lottenburger, None; I. Hansen, None; L. S. Andersen, None; U. Tarp, None; A. Svendsen, None; J. K. Pedersen, None; H. Skjødt, None; T. Ellingsen, None; H. M. Lindegaard, None; K. Hørslev-Petersen, None.