Safety and efficacy of intra-articular anti-tumor necrosis factor α agents compared to corticosteroids in a treat-to-target strategy in patients with inflammatory arthritis and monoarthritis flare

Abstract

The aim of this study was to assess safety and efficacy of ultrasonography (US)-guided intra-articular injections using tumor necrosis factor (TNF) blockers compared to corticosteroids in rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients, experiencing refractory monoarthritis despite the current systemic therapy. Eighty-two patients were randomized to receive three intra-articular injections monthly of either corticosteroid or TNF blockers. Primary endpoints were the safety and an improvement greater than 20% for visual analogic scales of involved joint pain in patients injected with anti-TNFα. Further clinical, US, and magnetic resonance imaging (MRI) evaluations were considered secondary endpoints. Intra-articular TNF blockers are a safe strategy, determining a significant reduction of patient and physician reported clinical outcomes and US/MRI scores, in RA and PsA patients, when compared to intra-articular injections of corticosteroids. US guidance excluded the possibility to inject the drug in the wrong site, maximizing local effects, reducing systemic effects, and increasing the safety of the procedure. Patients with inflammatory monoarthritis could be successfully treated with US-guided intra-articular TNF blockers that are a safe and well tolerated procedure, to achieve a longstanding clinical and radiological good clinical response and/or disease remission.

Prevalence of type 2 diabetes and impaired fasting glucose in patients affected by rheumatoid arthritis

“…[ 1 – 3 ] The deeper knowledge of pathophysiological mechanisms, the growing use of a treat-to-target management as well as the availability of powerful drugs strongly increased the percentage of patients achieving clinical remission and, consequently, reduced the percentage of those experiencing radiographic progression. [ 4 – 7 ] However, a significant proportion of patients may still develop associated complications and several studies demonstrated a close association between RA and cardiometabolic comorbidity. [ 8 – 10 ] To date, during RA, the leading cause of death are major cardiovascular events (CVEs); for this reason, growing research efforts are focusing on improving the management of these nonarticular outcomes.…”

Temporomandibular joint arthritis in juvenile idiopathic arthritis, now what?

“…IA therapy with tumor necrosis factor inhibitors into large joints has shown some effectiveness, e.g. [ 57 , 58 ], even among patients who have failed IACI [ 59 ], and may be equivalent to if not superior than some forms of IA corticosteroids [ 60 – 62 ]. There is a single case report of 8 IA injections of infliximab administered to the TMJ over 36 weeks in an adult patient with psoriatic arthritis who had previously failed therapy with systemic infliximab as well as local IACI [ 63 ].…”

“…Unfortunately, studies in children with JIA have not been able to replicate this success [ 55 ]. The dose that can be administered into the TMJ of a child may be a limiting factor; the study by Carubbi et al (2016) demonstrated superiority of TNFi over CS only in large joints [ 62 ]. Additionally, the subject selection of JIA patients refractory to traditional and biologic DMARDs plus IA CS is one that is not ideal for the assessment of the effectiveness of IA infliximab.…”

Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study

“…During RA, the therapeutic strategies are aimed at preventing joint destruction by using synthetic disease modifying antirheumatic drugs (sDMARDs) as well as biologic agents [2–5]. In addition, a growing body of evidence is focused on the development of associated comorbidities and their management in rheumatic patients [6–8].…”