AB0438\u2005A STUDY COMPARING EFFICACY OF INTRA-ARTICULAR STEROID (IAS) VS INTRAARTICULAR SCLEROSANT IN PATIENTS WITH PERSISTENT SYNOVITIS OF KNEE IN RHEUMATOID ARTHRITIS

Abstract

Background: Chronic persistent synovitis is commonly seen in inflammatory arthritis like RA where despite adequate DMARD therapy, few joints are chronically inflamed. They are the reason for increasing morbidity and poor functional status in these patients. Some patients show persistent synovitis despite intra-articular steroids and hence they is need to identify other drugs like sclerosant which can be of use in improving pain and functional status. Objectives: To compare the efficacy of Intra-articular steroid versus sclerosant in rheumatoid arthritis (RA) with persistent synovitis despite optimum dose of csDMARDS and to determine, if sclerosant is superior/non-inferior to steroids. Methods: This is a single blinded-observational pilot study, conducted in Institute of Rheumatology, Madras Medical College for a period of 1 year. 20 patients with persistent synovitis (knees) despite optimum DMARD therapy are recruited as per inclusion and exclusion criteria. Disease and joint related activity and functional status are documented. Ethical committee approved the study. After getting written informed consent patients were randomized into two groups (A and B). Group A received IAS (Triamcinolone Acetonide) and group B received sclerosant (1% Polidocanol). They are assessed at 1, 4, 12 and 24 week and various parameters documented. The results are analysed with SPSS v22 software.Inclusion Criteria: 1. RA diagnosis according to ACR/EULAR2010 criteria in the age between 20 and 70years with persistent synovitis of knee. 2.Patients not willing for biological therapy. Exclusion Criteria: 1.Age <20->70yrs. 2. Pregnant & Lactating women. 3. Severe co-morbidities, clotting disorders and local infections. 4. Contraindications for intra-articular procedure. 5. Osteoarthritis and other arthritis and CTD. 6 Recent intra-articular injection within 3months. Results: 40 patients were recruited for the study, with 20 in each group. 45% patients in group A and 65% patients in group B, showed significant improvement in DAS28, CRP, VAS pain and function. VAS scores improved within 1 week and no adverse effects were noted. Both the interventions found to be effective in reducing the pre operative VAS pain and function scores. However, Mean VAS Scores after 1 week of sclerosant injection found to be lesser than that of steroid group and the difference was statistically significant (p<0.05). Conclusion: Intra-articular sclerosant (1%Polidocanol) is non-inferior to steroids in patients with persistent knee synovitis. It could be used as an effective alternative to steroids considering their side effect profile. References [1] Use of objective measure of articular stiffness to record changes in finger joints after intra-articular injection of corticosteroid, annals of rheumatic diseases, 1997: 56:71-73 [2] Intra-articular injection with triamcilone hexacetonide in patients with rheumatoid arthritis: prospective assessment of goniometry and joint inflammation parameters. Rita Nely Vilar Furtado et al, Revista Brasileira de Reumatologia 2017:57(2):115-121 [3] Zulian F, Martini G, Gobber D, Agosto C, Gigante C, ZacchelloF. Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis. Rheumatology (Oxford). 2003; 42:1254–9.7. [4] Hochberg MC, Chang RW, Dwosh I, Lindsey S, Pincus T, WolfeF. The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum. 1992; 35:498–502.9. Disclosure of Interests: None declared