Intra-articular injections of triamcinolone hexacetonide in rheumatoid
          arthritis: short and long-term improvement predictors

Furtado, Rita Nely Vilar; Machado, Flavia Soares; Luz, Karine Rodrigues da; Santos, Marla Francisca dos; Konai, Monique Sayuri; Lopes, Roberta Vilela; Natour, Jamil

doi:10.1016/j.rbr.2014.08.017

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Revista Brasileira de Reumatologia

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Sumário

Original articles • Rev. Bras. Reumatol. 55 (3) • May-Jun 2015 • https://doi.org/10.1016/j.rbr.2014.08.017 copy

Intra-articular injections of triamcinolone hexacetonide in rheumatoid arthritis: short and long-term improvement predictors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

Identify good response predictors to intra-articular injection (IAI) with triamcinolone hexacetonide (TH).

Methods:

This study was carried out in rheumatoid arthritis (RA) patients (American College of Rheumatology criteria) submitted to IAI (mono, pauci or polyarticular injection).

Assessment:

a “blinded” observer prospectively evaluated joints at one week (T1), four weeks (T4), twelve weeks (T12) and 24 weeks (T24) after IAI. Outcome measurements included Visual Analogue Scale (0-10 cm) at rest, in movement and for swollen joints. Clinical, demographic and variables related to injection at baseline were analyzed according to IAI response.

Results:

We studied 289 patients with RA (635 joints) with a mean age of 48.7 years (±10.68), 48.5% of them Caucasians, VAS for global pain = 6.52 (±1.73). Under univariate analysis, the variables relating the best responses following IAI (improvement > 70%) were: “elbow and metacarpophalangeal (MCP) IAI, and functional class II”. Under multivariate analysis, “males” and “non-whites” were the predictors with the best response to IAI at T4, while “elbow and MCP IAI”, “polyarticular injection”, “use of methotrexate” and “higher total dose of TH” obtained the best response at T24.

Conclusion:

Several predictors of good response to IAI in patients with RA were identified. The best-response predictors for TH IAI of long term were “inject elbow and MCP IAI” and “perform polyarticular injection”.

Injection; Triamcinolone hexacetonide; Arthritis rheumatoid; Predictions

Variables
Age in years, mean (± SD)	47.6 (± 10.81)
Disease duration in years, mean (± SD)	11.2 (± 8.23)
Women:men ratio	9:1
Global pain, VAS mean (± SD)	6.52 (± 1.73)
White skin color n (%)	308 (48.5)
Functional class II N (%)/III n (%)	368 (58.0)/267 (42.0)
Using methotrexate n (%)	469 (73.9)
Using leflunomide n (%)	103 (1.2)
Using chloroquine n (%)	164 (25.8)
Using immunobiological drugs n (%)	1 (0.2)
Using oral corticosteroid n (%)	467 (73.5)
Rheumatoid factor positivity n (%)	411 (64.7)
Extra-articular disease n (%)	71 (11.2)
Previous IAIC n (%)	300 (47.2)
Polyarticular injection n (%)	312 (49.1)
Image-guided IAIC n (%)	90 (14.2)
Radioisotopes in IAIC n (%)	30 (4.7)
Number of joints injected :
Shoulder n (%)	35 (5.5%)
Elbow n (%)	48 (7.6%)
Wrist n (%)	160 (25.2%)
MCP n (%)	142 (22.4%)
Knee n (%)	152 (23.9%)
Ankle n (%)	98 (15.4%)

Patientes and joints evaluated from T0 to :
T4	289/635 joints
T12	185/403 joints
T24	35/313 joints

	VASmv Improvement (%)	VASr Improvement (%)		VASs Improvement (%)
	T4	T24	T4	T24	T4	T24
Baseline predictors	50-70	>70	50-70	>70	50-70	>70	50-70	>70	50-70	>70	50-70	>70
IAIC in elbow	-	+	-	-	-	-	-	-	-	+	-	+
IAIC in wrist	-	-	-	-	-	+	+	-	-	-	-	-
IAIC in MCP	-	-	-	+	-	-	-	+	-	+	-	+
IAIC in knee	-	+	+	-	-	+	-	-	-	-	-	+
Size of TH dose per IAIC (1/2/3)	-	-	-	+ (3)	-	+ (3)	-	+ (3)	-	+ (3)	-	+ (3)
Polyarticular injection	-	-	-	+	-	-	-	+	-	+	-	+
Total TH dose per patient (H/L)	-	-	-	+ (H)	-	-	-	+ (H)	-	+ (H)	-	+ (H)
Age (H/L)	-	-	-	+ (L)	-	-	-	-	-	-	-	-
Gender (fem/male)	-	-	-	-	-	-	-	-	-	-	-	-
Skin color (W/NW)	-	-	-	+ (NW)	-	-	-	+ (NW)	-	-	-	-
Functional class (2/ 3)	-	-	-	+ (2)	-	-	-	+ (2)	-	-	-	+ (2)
Extra-articular disease (Y/N)	-	-	-	+ (Y)	-	-	-	-	-	-	-	-
Disease duration (H/L)	-	+ (H)	-	-	-	-	+ (L)	-	-	-	-	-
Use of chloroquine (Y/N)	-	-	-	-	-	-	-	-	-	-	-	-
MTX (H/L dosage)	-	-	-	-	+ (H)	+ (H)	-	-	-	-	-	-
Use of LFU (Y/N)	-	-	-	+ (Y)	-	-	-	+ (S)	-	+ (N)	-	+ (N)
Total number of DMARDS (H/L)	-	-	-	-	-	-	-	-	-	+ (H)	-	-
Previous IAIC (Y/N)	-	-	-	-	-	-	-	-	-	-	-	-
Use of NSAIDS (Y/N)	+ (N)	-	-	-	-	-	-	-	-	+ (Y)	-	-
Dose of OC (H/L)	-	-	-	-	-	-	+ (H)	+ (L)	-	-	-	-

Variables	T4	T24
	OR	P	OR	p
Joint type (compared to the knee)
1. Elbow	NS	NS	4.4	0.008
2. Wrist	0.59	0.03	NS	NS
3. MCP	0.46	0.002	2.75	< 0.001
4. Shoulder	NS	NS	NS	NS
5. Ankle	0.55	0.03	NS	NS
Poly-injection (yes/no)	0.26	< 0.001	2.37	0.02
Sex (male/female)	2.19	0.008	NS	NS
Skin color (non-white/white)	2.47	< 0.001	0.55	0.04
Rheumatoid factor (yes/no)	NS	NS	0.34	< 0.001
Functional class (3/2)	NS	NS	0.42	0.003
Chloroquine (yes/no)	0.61	0.03	0.52	0.03
MTX (yes/no)	NS	NS	1.90	0.013
Use of oral corticosteroid	NS	NS	0.95	0.02
Total Dose of TH	0.99	< 0.001	1.00	0.02

Sociedade Brasileira de Reumatologia Av Brigadeiro Luiz Antonio, 2466 - Cj 93., 01402-000 São Paulo - SP, Tel./Fax: 55 11 3289 7165 - São Paulo - SP - Brazil
E-mail: sbre@terra.com.br

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[1] * Corresponding author. E-mail: jnatour@unifesp.br (J. Natour).