Exploring the clinical benefit with intra-articular injections of anti-TNF agent in patients with rheumatoid arthritis

Abstract

Objective To observe the efficacy of intra-articular(IA)blockade of TNF-α by 3 etanercept injections in patients with rheumatoid arthritis(RA). Methods Eighteen moderate activity RA patients with resistant knee synovitis underwent three monthly IA injection of etanercept(25mg). The primary outcomes were visual analogue scale of target knee general health(VAS- TKGH) and VAS target knee Pain Score, and we also collected diameter of target knee joint, VAS fatigue Score, Health Assessment Questionnaire(HAQ), the 28-joint based disease activity score(DAS28)and joint fluid volume, which were all assessed at baseline and every four weeks after IA injection. Results All those 18 patients completed the treatment with the average disease duration of was(84.7± 54.1)months. After each IA injection, VAS- TKGH was significantly improved than baseline(P= 0.03,0.02, 0.02). and VAS target knee pain score was also significantly improved than baseline(P= 0.03,0.00,0.00). After 3rd IA injection,VAS- TKGH was further reduced compared with those after 1st and 2nd IA injection(P = 0.02,0.03);while, VAS target knee pain score was further reduced after 3rd IA injection(P= 0.00). Knee joint diameter, VAS fatigue score, HAQ and DAS 28 were significantly lower after 1st IA injection than baseline(P= 0.03,0.02,0.03). After 2nd IA injection, VAS fatigue score,HAQ,and DAS28 were significantly further improved compared to treatment once(P= 0.00,0.02,0.02);after 3rd IA injection,HAQ and DAS28 were further improved compared to those after 2nd IA injection(P= 0.01,0.02). Joint fluid volume was significantly decreased after 2nd IA injection(P= 0.01). Conclusion The tailor approach of intra- articular injections of anti- TNF agent might benefit RA patients who had resistant synovitis, and the side effect was rare. However, the sample was small and further observation is needed. Key words: Arthritis, rheumatoid; Repeators, tumor necrosis factor, type Ⅱ