Menon Nitin, Kothari S Y, Gogna Arun, Sharma Rajendra
J Assoc Physicians India. 2014 Aug;62(8):673-6.
Intra-articular triamcinolone in combination with DMARDs may be able to achieve faster and tighter control of disease activity in early rheumatoid arthritis that may be the key to preventing or minimizing later deformities.
To compare the efficacy of a combination of Disease Modifying Anti-Rheumatoid Drugs (DMARDs) with Intra-articular Glucocorticoids versus only DMARDs in a group of patients with early Rheumatoid Arthritis (RA).
Fifty patients diagnosed as Rheumatoid Arthritis (RA) by American Rheumatology Association (ARA) criteria (1987) with disease duration less than two years were randomized into two groups. The Control group received a combination of Methotrexate 15 mg daily with Sulfasalazine 2 gm daily for 3 months and the Study group received the above combination along with Intra-articular injections of Triamcinolone acetate (40 mg per ml) in each of the swollen joints at the start of the study. Outcome was assessed in terms of Disease Activity Score (DAS-28), American College of Rheumatology (ACR) 20/50/70 criteria and number of rescue medications used at the end of 3 months.
The study group had significant reductions in DAS 28 scores (3.39 versus 4.99 in control group) and significantly more subjects achieved the ACR 20/50/70 criteria at the end of 3 months (100/60/36% versus 84/20/0%) Secondary end-points like tender and swollen joint count, ESR, early morning stiffness, health assessment questionnaire (HAQ) scores and general health status were significantly reduced in the study group. Also, significantly lesser rescue medications were needed in the study group.
Combination of DMARDs with Intra-articular corticosteroids is significantly better than DMARDs alone in early RA.
关节腔内注射曲安奈德联合改善病情抗风湿药（DMARDs）或许能够在早期类风湿关节炎中更快、更严格地控制疾病活动，这可能是预防或尽量减少后期畸形的关键。
比较在一组早期类风湿关节炎（RA）患者中，改善病情抗风湿药（DMARDs）与关节内糖皮质激素联合使用和仅使用DMARDs的疗效。
将50例根据美国风湿病学会（ARA）1987年标准诊断为类风湿关节炎（RA）且病程少于两年的患者随机分为两组。对照组每日服用甲氨蝶呤15mg联合柳氮磺胺吡啶2g，持续3个月；研究组在研究开始时除接受上述联合治疗外，还在每个肿胀关节内注射醋酸曲安奈德（40mg/ml）。根据疾病活动评分（DAS-28）、美国风湿病学会（ACR）20/50/70标准以及3个月末使用的急救药物数量评估结果。
研究组的DAS 28评分显著降低（对照组为4.99，研究组为3.39），并且在3个月末达到ACR 20/50/70标准的受试者显著更多（分别为100/60/36%和84/20/0%）。研究组的次要终点，如压痛和肿胀关节计数、红细胞沉降率（ESR）、晨僵、健康评估问卷（HAQ）评分和总体健康状况均显著降低。此外，研究组所需的急救药物也显著减少。
在早期类风湿关节炎中，DMARDs与关节内糖皮质激素联合使用显著优于单独使用DMARDs。
