Glucocorticoid Injection Appears Helpful in Rheumatoid Arthritis
From Medscape Medical news
By David Douglas
NEW YORK (Reuters Health) Dec 08 - Intra-articular glucocorticoid injections appear to protect cartilage in patients with rheumatoid arthritis (RA), Swedish researchers report in the December issue of Annals of the Rheumatic Diseases. In addition, subsequent bed rest seems to improve results.
Dr. Tomas Weitoft of Gavle Hospital and colleagues note that such treatment is routinely given to RA patients with synovitis. However, there is some concern that this may lead to cartilage breakdown. Another unresolved question is whether joint immobilization leads to better treatment outcome.
To investigate, the researchers studied 20 patients with RA and knee synovitis. They were randomized to treatment with a single glucocorticoid injection followed by 24 hours of bed rest or of normal activity.
Levels of cartilage oligomeric matrix protein (COMP) -- a marker of cartilage turnover -- decreased in both groups, but significantly more so in the resting patients. Serum osteocalcin levels decreased significantly and similarly in both groups, indicating a reduction in bone formation.
In light of these findings, the researchers conclude that the treatment apparently reduces cartilage breakdown. Moreover, they add that the greater drop in serum COMP seen in the resting group may reflect lower clearance from the joint cavity.
If needed, such injections may be given more frequently than the recommended every three months, because they "may be chondroprotective and the suppression of the hypothalamic- pituitary-adrenal is short-termed and reversible," Dr. Weitoft told Reuters Health.
However, he added, "a need for very frequent injections may indicate an uncontrolled disease and other changes of medication should be considered."
Ann Rheum Dis 2005;64:1750 -1753.
By David Douglas
NEW YORK (Reuters Health) Dec 08 - Intra-articular glucocorticoid injections appear to protect cartilage in patients with rheumatoid arthritis (RA), Swedish researchers report in the December issue of Annals of the Rheumatic Diseases. In addition, subsequent bed rest seems to improve results.
Dr. Tomas Weitoft of Gavle Hospital and colleagues note that such treatment is routinely given to RA patients with synovitis. However, there is some concern that this may lead to cartilage breakdown. Another unresolved question is whether joint immobilization leads to better treatment outcome.
To investigate, the researchers studied 20 patients with RA and knee synovitis. They were randomized to treatment with a single glucocorticoid injection followed by 24 hours of bed rest or of normal activity.
Levels of cartilage oligomeric matrix protein (COMP) -- a marker of cartilage turnover -- decreased in both groups, but significantly more so in the resting patients. Serum osteocalcin levels decreased significantly and similarly in both groups, indicating a reduction in bone formation.
In light of these findings, the researchers conclude that the treatment apparently reduces cartilage breakdown. Moreover, they add that the greater drop in serum COMP seen in the resting group may reflect lower clearance from the joint cavity.
If needed, such injections may be given more frequently than the recommended every three months, because they "may be chondroprotective and the suppression of the hypothalamic- pituitary-adrenal is short-termed and reversible," Dr. Weitoft told Reuters Health.
However, he added, "a need for very frequent injections may indicate an uncontrolled disease and other changes of medication should be considered."
Ann Rheum Dis 2005;64:1750 -1753.
posted by Ricardo Pocurull at 6:42 AM
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