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    Efficacy and safety of combining intra-articular methylprednisolone and anti-TNF agent to achieve prolonged remission in patients with recurrent inflammatory monoarthritis.

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    Authors
    Haroon, Muhammad
    O'Gradaigh, Donncha
    Affiliation
    Department of Rheumatology, Waterford Regional Hospital, Waterford, Ireland., mharoon301@hotmail.com
    Issue Date
    2012-02-01T10:52:20Z
    MeSH
    Adult
    Anti-Inflammatory Agents/*administration & dosage
    Antibodies, Monoclonal/*administration & dosage
    Antibodies, Monoclonal, Humanized
    Arthritis/*drug therapy/immunology
    Drug Therapy, Combination
    Female
    Follow-Up Studies
    Humans
    Immunoglobulin G/administration & dosage
    Injections, Intra-Articular
    Isoxazoles/administration & dosage
    Knee Joint/drug effects/immunology
    Male
    Methylprednisolone/*administration & dosage
    Middle Aged
    Receptors, Tumor Necrosis Factor/administration & dosage
    Recurrence/prevention & control
    Remission Induction
    Tumor Necrosis Factor-alpha/*antagonists & inhibitors
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    Citation
    Joint Bone Spine. 2010 May;77(3):232-4. Epub 2010 Apr 3.
    Journal
    Joint, bone, spine : revue du rhumatisme
    URI
    http://hdl.handle.net/10147/207950
    DOI
    10.1016/j.jbspin.2010.02.008
    PubMed ID
    20363657
    Abstract
    OBJECTIVE: To control local inflammation, the role of intra-articular corticosteroid is well established; similarly, with time there are more reports on the experience of intra-articular anti-TNF agent for localized joint inflammation. The aim of this study was to assess the safety, local tolerability and clinical response after combining intra-articular administration of corticosteroids and anti-TNF agents for recurrent inflammatory monoarthritis. METHODS: Patients with recurrent monoarthritis of the knee were recruited from our inflammatory arthritis clinics. These patients required intra-articular corticosteroids every 8-12 weeks, with good short-term results. Five such consecutive patients were invited to partake in this study. Patients were maintained on their baseline immunosuppressive therapy. After aspiration of knee joint, the involved joint was injected with 80mg of methylprednisolone mixed with 5ml of lignocaine 1%; this was followed by the injection of an anti-TNF agent. RESULTS: In majority of our patients (three out of five), combining anti-TNF agent and methylprednisolone led to prolonged anti-inflammatory response, and these patients remain in remission to date (mean follow-up of 12 months). These responders were noted to be naive to anti-TNF therapy. Conversely, the remaining two patients were found to be on baseline systemic anti-TNF therapy, and both of them failed to respond either partly or completely. CONCLUSION: Combining intra-articular corticosteroid and anti-TNF agent has proved to be safe in our cohort of patients. We conclude that in particular subset of patients who suffer from recurrent inflammatory monoarthritis or oligoarthritis, combination therapy of intra-articular corticosteroids and anti-TNF agents appears attractive and promising.
    Language
    eng
    ISSN
    1778-7254 (Electronic)
    1297-319X (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jbspin.2010.02.008
    Scopus Count
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    University Hospital Waterford

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