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Title: Monoarticular corticosteroid injection versus systemic administration in the treatment of rheumatoid arthritis patients: a randomized double-blind controlled study
Authors: Konai, Monique Sayuri [UNIFESP]
Furtado, Rita Nely Vilar [UNIFESP]
Santos, M. F. dos
Natour, Jamil [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Keywords: Rheumatoid arthritis
intraarticular injection and synovitis
Issue Date: 1-Mar-2009
Publisher: Clinical & Exper Rheumatology
Citation: Clinical And Experimental Rheumatology. Pisa: Clinical & Exper Rheumatology, v. 27, n. 2, p. 214-221, 2009.
Abstract: Objective To compare the efficacy and safety of intraarticular glucocorticoid injection to its system-is use for treatment of knee synovitis in rheumatoid patients.Methods A randomized double-blind controlled study was conducted including 60 patients with RA. Patients were randomized to receive either a single intraarticular knee injection with triamcinolone hexacetonide 60 mg (3 ml) and xylocaine chloride 2% (1 ml) associated to a single intramuscular injection of I ml of xylocaine chloride 2% (IAI group) or 1 ml of xylocaine chloride 2% by intraarticular injection and et intramuscular injection of triamcinolone acetonide 60 mg (3 nil) and xylocaine chloride 2% (1 ml) (IM group). All patients were blindfolded for the procedure. Evaluations were performed at baseline and 1, 4, 8 and 12 weeks post-intervention. The following instruments were used: VAS for knee pain, as primary outcome, VAS for knee morning stiffness and edema; the ACR 20, 50 and 70% improvement criteria; knee circumference and goniometry; Likert's scale of improvement; daily use of oral glucocorticoid and NSAIDs, blood pressure and adverse effects.Results Patients in the IAI group had significantly better results for VAS for knee pain, edema and morning stiffness as well as for improvement evaluation after intervention according to the patient (p<0.001) and physician (p=0.02).Conclusion Our results demonstrate that intraarticular injection with glucocorticoids is superior to its systemic use for the management of monoarticular synovitis in rheumatoid patients. The intraarticular approach showed better results in teens of local inflammatory variables and improvement evaluation. by the patient and physician.
ISSN: 0392-856X
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