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Background:Refractory mono-oligo-arthritis is still a challenging clinical situation in rheumatoid arthritis. Intra-articular corticosteroids are the first-line therapy; however, their efficacy is rather varying and many patients experience relapses within 6 months after injection.(1)Intra-articular anti-TNF has the potential of being less toxic and cost effective compared to its systemic usage.(2)Recent evidences have shown a reduction in the synthesis of either the T helper 1 cytokines or in the interleukin-6/17 axis cytokines at joint level following intra-articular injection of etanercept.(3)Objectives:Our aim was to evaluate the safety and efficacy of intra-articular injection of etanercept in patients with rheumatoid arthritis.Methods:This study included 23 rheumatoid arthritis patients diagnosed according to the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) 2010 diagnostic criteria for RA(4), who suffered from flare of activity in one joint. Patients were selected from the outpatient clinic and the in-patient section of Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University Hospitals, Egypt. The degree of swelling and tenderness of the affected joint was evaluated on a score (0-3) and the degree of pain was assessed by using visual analog scale (VAS). Musculoskeletal ultrasound (MSUS) examination was done to assess synovitis which was evaluated on two axes, longitudinal and transverse and was semiquantitivaly scored on a (0-3) scale, synovial vascularity was assessed using power Doppler and it was semi-quantitativaly scored on a (0-3) scale,Follow-up:Patients were examined both clinically (degree of swelling, degree of tenderness and VAS), and by MSUS on weeks: 1, 4 and 12 after injection.Results:No serious or life-threatening adverse effects were noticed in any patient during the follow-up periods and up till the end of the study except for temporary local soreness during the injection, there was a significant improvement of VAS, tenderness and swelling scores after 1-weekp<0.002 and 1-monthp<0.003 follow-up periods, but there was insignificant change after 3 monthsp=0.116, by MSUS, there was an insignificant change in synovitisp=0.112, but a significant change was found in power Doppler after 1-weekp= 0.046 and no significant changes were detected further.Conclusion:Intra-articular injection of etanercept is a safe and an encouraging treatment modality in managing refractory mono-arthritis in rheumatoid arthritis patients. Further researches are needed to study the use of repeated injection of etanercept to get more sustained effects.References:[1]Schumacher HR and Chen LX (2005):Injectable corticosteroids in treatment of arthritis of the knee. Am J Med. 118(11):1208-14.[2]Haroon M and O‘Gradaigh D (2010):Efficacy and safety of combining intra-articular methylprednisolone and anti-TNF agent to achieve prolonged remission in patients with recurrent inflammatory monoarthritis. Joint Bone Spine. 77(3):232-4.[3]Fiocco U, Sfriso P, Oliviero F, et al (2013):Blockade of intra-articularTNF in peripheral spondyloarthritis: Its relevance to clinical scores, quantitative imaging and synovial fluid and synovial tissue biomarkers.Joint Bone Spine. 80(2):165-70.[4]Smolen JS, Landewé R, Bijlsma J, et al (2017):EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum dis. 76(6):960-77.Disclosure of Interests:None declared

BackgroundPlatelet rich plasma (PRP) therapy is a simple, low-cost and minimally invasive method that provides a natural concentrate of autologous blood growth factors (GFs) that can be used to enhance tissue regeneration (1). Recent evidences have shown that PRP can be helpful as an osteoarthritis (OA) therapeutic tool by intra-articular injection (2). Hyaluronic acid (HA)is widely used therapy for relief of OA pain and stiffness by intraarticular injection. In addition, there is a sufficient evidence for being significant disease-modifying effects (3,4).Objectivesour aim was to compare the clinical efficacy of platelet-rich plasma with that of hyaluronic acid viscosupplementation.MethodsThis study included forty patients with knee osteoarthritis. These patients were selected from the outpatient clinic of Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University. Patients were randomly divided into two groups. The first group consisted of 20 patients treated by using intraarticular injection of 2 ml autologous PRP (PRP group).The second group consisted of 20 patients they were treated by using intraarticular injections of low molecular weight (hyaluronic acid [HA]) (32mg/2mL) of HA (HA group). All patients received 3 injections with one week interval (3) For Follow up: The subjective clinical outcome were measured at baseline, 1, 3, 6 and 12 months after the last treatment dose using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the 11-point pain intensity Numeric Rating Scale (NRS) (5).ResultsAt 1,3 months' follow-up, the PRP and LW HA groups showed an improvement, with non-significant difference between the two groups. However after 6 months follow up there was significant improvement in PRP group than HA group (P<0.005). The follow up after 12 months reveled subsided improvement than that was at 6 months. Nevertheless, this subsidence was less in PRP group.ConclusionsAutologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects observed.ReferencesWasterlain A, Braun HJ and Dragoo JL (2012): Contents and Formulations of Platelet-Rich Plasma. Oper Tech Orthop. 22(1): 33–42.Arnoczky S, Delos D and Rodeo S (2011): What Is Platelet-Rich Plasma? Oper Tech Sports Med. 19(3): 142–8.Cerza F, Carnì S, Carcangiu A, et al (2012): Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis. Am J Sports Med. 40(12): 2822–7.Filardo G, Kon E, Di Martino A, et al (2012): Platelet-rich plasma versus hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord 2012; 13(1): 229.Altman R, and Bloch (1986): Criteria for the classification and reporting of osteoarthritis of the knee joint. Diagnostic and Therapeutic Cri...