Efficacy and Safety of Intra-Articular Therapy with Methotrexate in Large Volume of Glucose Injection on Knee Synovitis in Patients with Ankylosing Spondylitis

Rui Wu

doi:10.4172/2161-1149.1000133

Abstract

Objective: To evaluate efficacy and safety of intra-articular therapy with methotrexate (MTX) in large volume of 10% glucose injection (GS) in ankylosing spondylitis (AS) patients with knee synovitis. Methods: As patients with knee synovitis (n=90) were randomly divided into three groups. 50 patients in MTX/GS group were treated with intra-articular injection of MTX (15 mg)in 10% GS (20 ml) every week for 8 times, while 20 patients in GS group with intra-articular injection of 10% GS (20 ml) every week for 8 times, and 20 patients in control group without injection. All the patients received ibuprofen sustained release tablets 0.3 twice daily and Sulphasalazine 1 g twice daily. Same dose of MTX (15 mg once weekly) were given orally to the patients in GS group and control group. At the beginning of the treatment and after 4, 8 and 24 weeks, all the patients underwent a clinical evaluation, measuring maximum flexion-extension angle, knee pain with visual analog scale (VAS), swelling with joint circumference, global assessment (ASA20, PGA, BASMI,BASDAI, BASFI). Erythrocyte sedimentation rate (ESR) and C-reactive protein were tested. Results: Joint pain, range of joint movement, circumference of swollen joint, ESR, CRP, patient’s global assessment(PGA) in MTX/GS group are significantly improved after 4 weeks of treatment in comparison with baseline and other groups at same time point (P<0.01-0.05). Adverse reactions in MTX/GS group were less than other groups. No serious adverse events occurred in all the patients. Axial symptoms were no significant difference in three groups. At all-time point, MTX/GS group had better improvement in ASA20, BASMI, BASFI than other groups without statistic difference. No serious adverse events occurred in all the patients. Adverse reactions in MTX/GS group were less than other groups. Conclusion: Compared to MTX orally taken, the repeated intra-articular injections of MTX glucose solution can suppress knee synovitis earlier and safely in AS patients. The intra-articular therapy of MTX/GS is another option in refractory monoarthritis.

Highlights

Some patients with inflamed arthritis can’t respond effectively to routine anti-rheumatic therapy
Randomization was achieved through a computerized randomization/enrollment system. 90 enrolled patients were randomly assigned into three groups. 50 patients in MTX/glucose injection (GS) group were treated with intra-articular injection of MTX (15 mg) in 10% Glucose solution (20 ml) every week for 8 times, while 20 patients in GS group with intra-articular injection of 10% Glucose solution (20 ml) every week for 8 times, and 20 patients in control group without injection
After 4 weeks of treatment, maximum flexion-extension angle, pain scores of knee joint, circumference of swollen joint, Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were significantly improved compared to baseline in MTX/GS group (P

Summary

Introduction

Some patients with inflamed arthritis can’t respond effectively to routine anti-rheumatic therapy. Considering adverse effects and cost with aggressive systemic therapy, target intra–articular therapy in mono-oligoarthritis might be more effective and less harmful. Intraarticular injection can convey the drug directly to the inflamed joint area and avoid major systemic side effects. Since 2005, we have conducted intra-articular therapy with MTX (10-20 mg) in large volume (20-50 ml) glucose solution in some patients with refractory arthritis. Most of these patients responded well to the therapy. In order to provide clinicians with the highest level of evidence and evaluate the efficacy and safety of this intra-articular therapy, we conducted a 24week trial in 90 ankylosing spondylitis (AS) patients with single knee synovitis since Nov. 2006

Methods

Results

Conclusion