The rheumatoid knee before and after arthrocentesis and Prednisolone injection: Evaluation by Gd-enhanced MRI

Abstract

In patients with rheumatoid arthritis, intraarticular injection of corticosteroids is an accepted means of treating a symptomatic joint. It has previously been impossible to precisely quantitate the effects of these injections on synovial effusion and pannus. Magnetic resonance imaging (MRI) is a safe, effective means of evaluating joint anatomy, and the use of intravenous gadolinium (Gd)-containing contrast allows clear differentiation of fluid from abnormal synovial tissue. The current study utilized MRI and Gd-labeled diethylene-triamene pentacetic acid (Gd-DTPA) contrast to evaluate serial changes in 6 knees of 6 patients with rheumatoid arthritis, following arthrocentesis and intraarticular injection of prednisolone. One week after the corticosteroid was injected, 2 patients had reduction of pannus width to 20% and 68% of baseline measurements. In these same individuals, follow-up sagittal views showed decreases of total effusion and fluid-plus-pannus width. The other 4 patients, who were followed for 4 weeks, had minimal changes in fluid and synovium. Gd-DTPA-enhanced MRI permits precise assessment of effects of intraarticular injections on synovial fluid and pannus in the rheumatoid knee.

Intra-articular corticosteroids in the treatment of juvenile idiopathic arthritis: Safety, efficacy, and features affecting outcome. A comprehensive review of the literature

“… 34 In a second study in adults with RA, two out of six subjects had reduction in pannus width and decrease in total synovial fluid volume following IACI to the knee, while the other four subjects had minimal changes in fluid and synovium over the four week follow-up period. 35 More recently, Boesen and colleagues demonstrated no improvement by either ultrasound or MRI four weeks after intra-articular injection of the wrist with 40 mg methylprednisolone in 12 patients with wrist disease resistant to DMARD therapy. 36 It may be possible that the absence of response seen was related to the use of an inferior steroid preparation for intra-articular deposition, however, the systemic nature of the disease may also have contributed to the poor response seen to localized therapy.…”

Gadolinium contrast agent is of limited value for magnetic resonance imaging assessment of synovial hypertrophy in hemophiliacs

“…MRI, with its high soft-tissue contrast, can detect synovial hypertrophy. Intravenous administration of gadolinium contrast agent (hereafter often simply referred to as gadolinium) enhances hypertrophic synovia in MR images, and it has been used to assess the activity and the volume of synovial hypertrophy in patients with rheumatoid arthritis (11,12,(25)(26)(27). However, there are few reports concerning the value of gadolinium in the evaluation of hemophilic arthropathy (23,31).…”

Die Bedeutung von intraartikulären Glukokortikoidinjektionen für das Outcome nach 3 Monaten bei polyartikulär aktiver rheumatoider Arthritis

“…Eine generalisierte Osteoporose wird bei intraartikulärer Gabe nicht beobachtet [7]. Trotzdem die intraartikuläre Injektionsbehandlung von aktiven Gelenken bei RA und insbesondere auch bei der juvenilen Arthritis in der Praxis viel eingesetzt wird [2,4,19,21] und sich in experimentellen Untersuchungen als wirksame antientzündliche Maßnahme bewährt hat [1,17,20], ist die Anzahl von kontrollierten Untersuchungen zu dieser Behandlungsart gering. In einer kontrollierten Studie [11] wurde eine signifikant bessere Reduktion der Krankheitsaktivität bis zu 24 Wochen durch polyartikuläre intraartikuläre Injektionen von Triamcinolonhexacetonid im Vergleich zu systemisch in der gleichen Dosis gegebenen Triamcinolonacetonid gefunden.…”