早期类风湿关节炎靶向治疗中关节内注射倍他米松的短期和长期疗效：关节面积、重复注射、MRI 结果、抗 CCP、IgM-RF 和 CRP 的影响。
Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP.
机构信息
Department of Rheumatology, Glostrup Hospital, Glostrup, Denmark.
出版信息
Ann Rheum Dis. 2012 Jun;71(6):851-6. doi: 10.1136/annrheumdis-2011-200632. Epub 2012 Feb 1.
OBJECTIVE
To investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthritis (RA).
METHODS
During 2 years of follow-up in the CIMESTRA trial, 160 patients received intra-articular betamethasone in up to four swollen joints/visit in combination with disease-modifying antirheumatic drugs. Short-term efficacy was assessed by EULAR good response. Long-term efficacy by Kaplan-Meier plots of the joint injection survival (ie, the time between injection and renewed flare). Potential predictors of joint injection survival were tested.
RESULTS
1373 Unique joints (ankles, elbows, knees, metacarpophalangeal (MCP), metatarsophalangeal, proximal interphalangeal (PIP), shoulders, wrists) were injected during 2 years. 531 Joints received a second injection, and 262 a third. At baseline, the median numbers of injections (dose of betamethasone) was 4 (28 mg), declining to 0 (0 mg) at subsequent visits. At weeks 2, 4 and 6, 50.0%, 58.1% and 61.7% had achieved a EULAR good response. After 1 and 2 years, respectively, 62.3% (95% CI 58.1% to 66.9%) and 55.5% (51.1% to 60.3%) of the joints injected at baseline had not relapsed. All joint areas had good 2-year joint injection survival, longest for the PIP joints: 73.7% (79.4% to 95.3%). 2-Year joint injection survival was higher for first injections: 56.6% (53.7% to 59.8%) than for the second: 43.4% (38.4% to 49.0%) and the third: 31.3% (25.0% to 39.3%). Adverse events were mild and transient. A high MRI synovitis score of MCP joints and anti-CCP-negativity were associated with poorer joint injection survival, whereas IgM-RF and C-reactive protein were not.
CONCLUSION
In early RA, intra-articular injections of betamethasone in small and large peripheral joints resulted in rapid, effective and longlasting inflammatory control. The cumulative dose of betamethasone was low, and the injections were well tolerated.
目的
研究关节内注射倍他米松治疗早期类风湿关节炎（RA）的短期和长期疗效，以及关节面积、重复注射、MRI 病理、抗环瓜氨酸肽（CCP）和免疫球蛋白 M 类风湿因子（IgM-RF）状态对其的影响。
方法
在 CIMESTRA 试验的 2 年随访期间，160 名患者在最多 4 个肿胀关节/就诊时接受关节内倍他米松注射，同时使用改善病情的抗风湿药物。通过 EULAR 良好反应评估短期疗效。通过关节注射生存时间（即注射与再次发作之间的时间）的 Kaplan-Meier 图评估长期疗效。对关节注射生存的潜在预测因素进行了检验。
结果
2 年内共注射了 1373 个独特关节（踝关节、肘关节、膝关节、掌指关节、跖趾关节、近指间关节、肩关节、腕关节）。531 个关节接受了第二次注射，262 个关节接受了第三次注射。基线时，中位数注射次数（倍他米松剂量）为 4（28mg），随后就诊时降至 0（0mg）。在第 2、4 和 6 周时，分别有 50.0%、58.1%和 61.7%的患者达到 EULAR 良好反应。1 年和 2 年后，分别有 62.3%（95%CI 58.1%至 66.9%）和 55.5%（51.1%至 60.3%）的基线关节未复发。所有关节区域的 2 年关节注射生存率均较好，最长的是 PIP 关节：73.7%（79.4%至 95.3%）。首次注射的 2 年关节注射生存率较高：56.6%（53.7%至 59.8%），而第二次注射为 43.4%（38.4%至 49.0%），第三次注射为 31.3%（25.0%至 39.3%）。不良事件轻微且短暂。MCP 关节的高 MRI 滑膜炎评分和抗 CCP 阴性与较差的关节注射生存率相关，而 IgM-RF 和 C 反应蛋白则不然。
结论
在早期 RA 中，小关节和大关节的关节内注射倍他米松可迅速、有效且持久地控制炎症。倍他米松的累积剂量较低，且注射耐受良好。
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