Effect of intra-articular tumor necrosis factor inhibitor injection by ultrasound in patients with mo-derate to severe rheumatoid arthritis

Abstract

Objective To investigate the effect of intra-articular tumor necrosis factor (TNF) inhibitor injection in patients with moderate to severe rheumatoid arthritis (RA) and values of power Doppler ultrasonography in evaluating effect of intra-articular injection. Methods RA patients with arthritis in knee and/or elbow and/or ankle referred to the Department of Rheumatology in the First Affiliated Hospital of Xi'an Jiaotong University were enrolled to receive intra-articular injection with 50 mg or 25 mg of recombinant human tumor necrosis factor-α receptor Ⅱ: IgG Fc fusion protein(TNFR: Fc) for injection after synovial fluid aspiration. Evaluation of visual analogue scale for pain of the involved joints, erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and 28-joint disease activity score (DAS28) were performed before and after intra-articular TNFR: Fc injection. Synovial hypertrophy, power Doppler signal and joint effusion were analyzed and graded by ultrasound before and after intra-articular TNFR: Fc injection. Comparisons of continuous data between groups was made by t test. The data that were not normally distributed was analyzed by Mann-Whitney U rank sum test. Results Fifty-four patients with RA [6 men and 48 women, mean age (52±11) years, mean duration of disease (7±3) years] were included in this study. A significant decrease in visual analogue scale for pain of the involved joints (t=2.630, P=0.018; t=2.160, P=0.043), ESR (t=2.094, P=0.030; Z=-2.242, P=0.030), CRP (Z=-2.199, P=0.030; Z=-3.337, P=0.001) and DAS28 (t=3.579, P=0.002; t=5.538, P=0.000) were observed after one month of injection of 50 mg or 25 mg of TNFR: Fc. Synovial hypertrophy (t=2.175, P=0.036;t=2.280, P=0.030) power Doppler signal (t=2.500, P=0.020; Z=-2.504, P=0.013) and joint effusion (Z=-1.790, P=0.042; t=2.230, P=0.027) were reduced significantly after one month of intra-articular TNFR: Fc injection in knee. Synovial hypertrophy (t=2.180, P=0.034; t=2.480, P=0.030) and power Doppler signal (t=2.681, P=0.020; t=5.482, P=0.000) were also reduced significantly after one month of intra-articular TNFR: Fc injection in elbow and ankle. Conclusion Intra-articular TNFR: Fc injection is an effective and safe treatment in RA patients with monoarthritis. Ultrasound may be an objective and valid method in evaluating the effect of intra-articular TNF inhibitor injection in RA patients. Key words: Arthritis, rheumatoid; Ultrasonography, Doppler, color; Tumor necrosis factor inhibitors; Intra-articular injection