Efficacy and safety of combining intra-articular methylprednisolone and anti-TNF agent to achieve prolonged remission in patients with recurrent inflammatory monoarthritis.
AffiliationDepartment of Rheumatology, Waterford Regional Hospital, Waterford, Ireland., firstname.lastname@example.org
Anti-Inflammatory Agents/*administration & dosage
Antibodies, Monoclonal/*administration & dosage
Antibodies, Monoclonal, Humanized
Drug Therapy, Combination
Immunoglobulin G/administration & dosage
Isoxazoles/administration & dosage
Knee Joint/drug effects/immunology
Methylprednisolone/*administration & dosage
Receptors, Tumor Necrosis Factor/administration & dosage
Recurrence/prevention & control
Tumor Necrosis Factor-alpha/*antagonists & inhibitors
MetadataShow full item record
CitationJoint Bone Spine. 2010 May;77(3):232-4. Epub 2010 Apr 3.
JournalJoint, bone, spine : revue du rhumatisme
AbstractOBJECTIVE: 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.