Polyarticular corticosteroid injection versus systemic administration in treatment of rheumatoid arthritis patients: a randomized controlled study

OBJECTIVE: To study the effectiveness and side effects of polyarticular corticosteroid injection compared to systemic administration in patients with rheumatoid arthritis (RA), and to examine the differential response to injection among joints. METHODS: Sixty-nine RA patients presenting with 6-12 swollen joints were enrolled to participate in a randomized trial consisting of polyarticular injection in 6-8 swollen joints of intraarticular (IA) triamcinolone hexacetonide (IA group) or intramuscular (IM) mini-pulse therapy with triamcinolone acetonide in equivalent doses (IM group). Blind examination at baseline (T0), Weeks 1 (T1), 4 (T4), 12 (T12), and 24 (T24) postintervention included American College of Rheumatology improvement criteria ACR20%, 50% and 70%, visual analog scale for articular pain, pain on movement, joint count, range of motion, morning stiffness, quality of life (Medical Outcome Study Short Form-36), use of nonsteroidal antiinflammatory drugs and oral corticosteroid, blood pressure, adverse effects, calls to the physician, and hospital visits. RESULTS: Significantly better results were observed for IA compared to IM patients as follows: ACR20% (61.7% vs 28.5% at T1; 73.5% vs 42.8% at T4), ACR50% (29.4% vs 5.7% at T1; 44.1% vs 20% at T4), ACR70% (11.7% vs 0% at T1), patient's evaluation of disease activity, lower tender joint count, lower blood pressure, lower number of adverse effects, calls to the physician, and hospital visits (p < 0.05). Less significant adrenocorticotropic hormone reduction was observed for IA group at T4 and T12 (p < 0.05). Elbows and metacarpophalangeal joints had the best response to corticosteroid injection. CONCLUSION: In the short term, polyarticular IA injection was better than IM corticosteroid, as shown by ACR improvement criteria and number of adverse effects.