Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP

Merete Lund Hetland; Mikkel Østergaard; Bo Ejbjerg; Søren Jacobsen; Kristian Stengaard-Pedersen; Peter Junker; Tine Lottenburger; Ib Tønder Hansen; Lis Smedegaard Andersen; Ulrik Tarp; Anders Svendsen; Jens Kristian Pedersen; Henrik Skjødt; Torkell Ellingsen; Hanne Lindegaard; Jan Pødenphant; Kim Hørslev-Petersen; CIMESTRA study Group

doi:10.1136/annrheumdis-2011-200632

Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP

Merete Lund Hetland, Mikkel Østergaard, Bo Ejbjerg, Søren Jacobsen, Kristian Stengaard-Pedersen, Peter Junker, Tine Lottenburger, Ib Tønder Hansen, Lis Smedegaard Andersen, Ulrik Tarp, Anders Svendsen, Jens Kristian Pedersen, Henrik Skjødt, Torkell Ellingsen, Hanne Lindegaard, Jan Pødenphant, Kim Hørslev-Petersen, CIMESTRA study Group

59 Citations (Scopus)

Abstract

OBJECTIVE: To investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthritis (RA).METHODS: During 2 years of follow-up in the CIMESTRA trial, 160 patients received intra-articular betamethasone in up to four swollen joints/visit in combination with disease-modifying antirheumatic drugs. Short-term efficacy was assessed by EULAR good response. Long-term efficacy by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested.RESULTS: 1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders, wrists) were injected during 2 years. 531 Joints received a second injection, and 262 a third. At baseline, the median numbers of injections (dose of betamethasone) was 4 (28 mg), declining to 0 (0 mg) at subsequent visits. At weeks 2, 4 and 6, 50.0%, 58.1% and 61.7% had achieved a EULAR good response. After 1 and 2 years, respectively, 62.3% (95% CI 58.1% to 66.9%) and 55.5% (51.1% to 60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-year joint injection survival, longest for the PIP joints: 73.7% (79.4% to 95.3%). 2-Year joint injection survival was higher for first injections: 56.6% (53.7% to 59.8%) than for the second: 43.4% (38.4% to 49.0%) and the third: 31.3% (25.0% to 39.3%). Adverse events were mild and transient. A high MRI synovitis score of MCP joints and anti-CCP-negativity were associated with poorer joint injection survival, whereas IgM-RF and C-reactive protein were not.CONCLUSION: In early RA, intra-articular injections of betamethasone in small and large peripheral joints resulted in rapid, effective and longlasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	71
Pages (from-to)	851-6
Number of pages	5
ISSN	0003-4967
DOIs	https://doi.org/10.1136/annrheumdis-2011-200632
Publication status	Published - Jun 2012

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Hetland, M. L., Østergaard, M., Ejbjerg, B., Jacobsen, S., Stengaard-Pedersen, K., Junker, P., Lottenburger, T., Hansen, I. T., Andersen, L. S., Tarp, U., Svendsen, A., Pedersen, J. K., Skjødt, H., Ellingsen, T., Lindegaard, H., Pødenphant, J., Hørslev-Petersen, K., & CIMESTRA study Group (2012). Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP. Annals of the Rheumatic Diseases, 71, 851-6. https://doi.org/10.1136/annrheumdis-2011-200632

Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis : impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP. / Hetland, Merete Lund ; Østergaard, Mikkel; Ejbjerg, Bo et al.

In: Annals of the Rheumatic Diseases, Vol. 71, 06.2012, p. 851-6.

Research output: Contribution to journal › Journal article › Research › peer-review

Hetland, ML , Østergaard, M, Ejbjerg, B, Jacobsen, S, Stengaard-Pedersen, K, Junker, P, Lottenburger, T, Hansen, IT, Andersen, LS, Tarp, U, Svendsen, A, Pedersen, JK, Skjødt, H, Ellingsen, T, Lindegaard, H, Pødenphant, J, Hørslev-Petersen, K & CIMESTRA study Group 2012, 'Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP', Annals of the Rheumatic Diseases, vol. 71, pp. 851-6. https://doi.org/10.1136/annrheumdis-2011-200632

Hetland ML , Østergaard M, Ejbjerg B, Jacobsen S, Stengaard-Pedersen K, Junker P et al. Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP. Annals of the Rheumatic Diseases. 2012 Jun;71:851-6. doi: 10.1136/annrheumdis-2011-200632

@article{da6227bd2599494cbd5108252c1fbde7,

title = "Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP",

abstract = "OBJECTIVE: To investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthritis (RA).METHODS: During 2 years of follow-up in the CIMESTRA trial, 160 patients received intra-articular betamethasone in up to four swollen joints/visit in combination with disease-modifying antirheumatic drugs. Short-term efficacy was assessed by EULAR good response. Long-term efficacy by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested.RESULTS: 1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders, wrists) were injected during 2 years. 531 Joints received a second injection, and 262 a third. At baseline, the median numbers of injections (dose of betamethasone) was 4 (28 mg), declining to 0 (0 mg) at subsequent visits. At weeks 2, 4 and 6, 50.0%, 58.1% and 61.7% had achieved a EULAR good response. After 1 and 2 years, respectively, 62.3% (95% CI 58.1% to 66.9%) and 55.5% (51.1% to 60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-year joint injection survival, longest for the PIP joints: 73.7% (79.4% to 95.3%). 2-Year joint injection survival was higher for first injections: 56.6% (53.7% to 59.8%) than for the second: 43.4% (38.4% to 49.0%) and the third: 31.3% (25.0% to 39.3%). Adverse events were mild and transient. A high MRI synovitis score of MCP joints and anti-CCP-negativity were associated with poorer joint injection survival, whereas IgM-RF and C-reactive protein were not.CONCLUSION: In early RA, intra-articular injections of betamethasone in small and large peripheral joints resulted in rapid, effective and longlasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.",

author = "Hetland, {Merete Lund} and Mikkel {\O}stergaard and Bo Ejbjerg and S{\o}ren Jacobsen and Kristian Stengaard-Pedersen and Peter Junker and Tine Lottenburger and Hansen, {Ib T{\o}nder} and Andersen, {Lis Smedegaard} and Ulrik Tarp and Anders Svendsen and Pedersen, {Jens Kristian} and Henrik Skj{\o}dt and Torkell Ellingsen and Hanne Lindegaard and Jan P{\o}denphant and Kim H{\o}rslev-Petersen and Mikkel {\O}stergaard",

year = "2012",

month = jun,

doi = "10.1136/annrheumdis-2011-200632",

language = "English",

volume = "71",

pages = "851--6",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "B M J Group",

}

TY - JOUR

T1 - Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis

T2 - impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP

AU - Hetland, Merete Lund

AU - Østergaard, Mikkel

AU - Ejbjerg, Bo

AU - Jacobsen, Søren

AU - Stengaard-Pedersen, Kristian

AU - Junker, Peter

AU - Lottenburger, Tine

AU - Hansen, Ib Tønder

AU - Andersen, Lis Smedegaard

AU - Tarp, Ulrik

AU - Svendsen, Anders

AU - Pedersen, Jens Kristian

AU - Skjødt, Henrik

AU - Ellingsen, Torkell

AU - Lindegaard, Hanne

AU - Pødenphant, Jan

AU - Hørslev-Petersen, Kim

AU - CIMESTRA study Group

PY - 2012/6

Y1 - 2012/6

N2 - OBJECTIVE: To investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthritis (RA).METHODS: During 2 years of follow-up in the CIMESTRA trial, 160 patients received intra-articular betamethasone in up to four swollen joints/visit in combination with disease-modifying antirheumatic drugs. Short-term efficacy was assessed by EULAR good response. Long-term efficacy by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested.RESULTS: 1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders, wrists) were injected during 2 years. 531 Joints received a second injection, and 262 a third. At baseline, the median numbers of injections (dose of betamethasone) was 4 (28 mg), declining to 0 (0 mg) at subsequent visits. At weeks 2, 4 and 6, 50.0%, 58.1% and 61.7% had achieved a EULAR good response. After 1 and 2 years, respectively, 62.3% (95% CI 58.1% to 66.9%) and 55.5% (51.1% to 60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-year joint injection survival, longest for the PIP joints: 73.7% (79.4% to 95.3%). 2-Year joint injection survival was higher for first injections: 56.6% (53.7% to 59.8%) than for the second: 43.4% (38.4% to 49.0%) and the third: 31.3% (25.0% to 39.3%). Adverse events were mild and transient. A high MRI synovitis score of MCP joints and anti-CCP-negativity were associated with poorer joint injection survival, whereas IgM-RF and C-reactive protein were not.CONCLUSION: In early RA, intra-articular injections of betamethasone in small and large peripheral joints resulted in rapid, effective and longlasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.

AB - OBJECTIVE: To investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthritis (RA).METHODS: During 2 years of follow-up in the CIMESTRA trial, 160 patients received intra-articular betamethasone in up to four swollen joints/visit in combination with disease-modifying antirheumatic drugs. Short-term efficacy was assessed by EULAR good response. Long-term efficacy by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested.RESULTS: 1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders, wrists) were injected during 2 years. 531 Joints received a second injection, and 262 a third. At baseline, the median numbers of injections (dose of betamethasone) was 4 (28 mg), declining to 0 (0 mg) at subsequent visits. At weeks 2, 4 and 6, 50.0%, 58.1% and 61.7% had achieved a EULAR good response. After 1 and 2 years, respectively, 62.3% (95% CI 58.1% to 66.9%) and 55.5% (51.1% to 60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-year joint injection survival, longest for the PIP joints: 73.7% (79.4% to 95.3%). 2-Year joint injection survival was higher for first injections: 56.6% (53.7% to 59.8%) than for the second: 43.4% (38.4% to 49.0%) and the third: 31.3% (25.0% to 39.3%). Adverse events were mild and transient. A high MRI synovitis score of MCP joints and anti-CCP-negativity were associated with poorer joint injection survival, whereas IgM-RF and C-reactive protein were not.CONCLUSION: In early RA, intra-articular injections of betamethasone in small and large peripheral joints resulted in rapid, effective and longlasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.

U2 - 10.1136/annrheumdis-2011-200632

DO - 10.1136/annrheumdis-2011-200632

M3 - Journal article

C2 - 22302316

SN - 0003-4967

VL - 71

SP - 851

EP - 856

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

ER -