Comparison of the effectiveness on intra-articular and subcutaneous TNF inhibitor in rheumatoid arthritis patients

Abstract

The objective of this study is to evaluate the efficacy of single intra-articular (IA) injection of tumor necrosis factor α (TNFα) inhibitor in knee joints comparing with subcutaneous injection in rheumatoid arthritis (RA) patients. Forty-eight RA patients with 73 knee arthritis were divided into three groups, group A: received a single injection of TNF inhibitor into knee joints; group B: received regular subcutaneous injection; and group C: received both of the regimen as groups A and B. Ultrasound, erythrocyte sedimentation rate, C-reactive protein (CRP), patients' global visual analogue scale (VAS), and 28-joint Disease Activity Score (DAS28) were collected pre- and post-therapy 4 weeks. The results of the study are as follows: (1) CRP, VAS, and DAS28 of all groups improved significantly post-therapy (p < 0.05); (2) After therapy, synovial hypertrophy (SH) decreased significantly from 4.40 ± 1.86 mm to 2.74 ± 1.88 mm (p < 0.05) and power Doppler (PD) signal decreased significantly from 2.63 ± 0.75 to 1.50 ± 0.93 (p < 0.01) in group A. Synovial effusion (SE), SH, and PD showed no significant improvement in group B. SE decreased significantly from 9.84 ± 4.70 mm to 5.89 ± 4.47 mm (p < 0.05), SH decreased significantly from 4.52 ± 1.97 mm to 2.49 ± 1.73 mm (p < 0.01), and PD decreased significantly from 2.46 ± 0.66 to 1.38 ± 1.04 (p < 0.01) in group C; and (3) The improvement rate of SH and PD in both groups A and C was obviously higher than that of group B (p < 0.05). Single IA injection of TNFα inhibitor was an effective treatment in improvement of SH and PD of knee joints than subcutaneous injection in RA patients.

Quantitatively Modeling Factors that Influence the Therapeutic Doses of Antibodies

“…[28][29][30] Similarly, for cytokine-neutralizing antibodies in the treatment of autoimmune diseases, whether or not the local injection of antibodies could yield a better effect than the systemic administration has been a long-standing debate. 31,32 The immune system is very dynamic. Constant exchanges and communications occur across anatomical locations.…”

A Translational Study of TNF-Alpha Antagonists as an Adjunctive Therapy for Preventing Hemophilic Arthropathy

“…After aspiration of the synovial fluid, a dose of anti-TNFα (etanercept, 25 mg per joint, a dose similar to that in RA patient as reported [20]) was directly injected into the joint space for patients receiving anti-TNFα therapy.…”

“…Ultrasonic examinations were performed with a real-time scanner (Philip EPIQ5, Ultrasound system, Royal Dutch Philips Electronics Ltd., Amsterdam, The Netherlands) equipped with a multi-frequency liner matrix array transducer (L5-12 MHz), using a widely described standardized scanning technique [21]. A modified Ultrasound scoring system [22,23] which was based on HEAD-US and incorporated with two parameters, joint effusion and synovial hypertrophy with angiogenesis from Melchiorre's system [20] was used. All ultrasound examinations were carried out in a dark room with a stable temperature of 22 • C. Patients rested for at least 15 min before the ultrasound examination and were asked to avoid caffeine, tea, alcohol, sports, and smoking for 8 h until the examination.…”

“…Intra-articular administration of tumor necrosis factor α (TNFα) inhibitor has been shown effective for the treatment of rheumatoid arthritis [20,27] with potential less systemic adverse effects of anti-TNFα [11]. To extend our in vivo finding in the hemophilia mouse model, a proof of concept study was performed where anti-TNFα was administered directly intra-articularly.…”

Course correction of adjuvant arthritis with cryopreserved multipotent mesenchymal stromal cells

“…For example, topical glucocorticoid therapy reduces inflammatory activity in joint tissues by reducing cellular infiltration and expression of proinflammatory cytokines that induce synovitis (Savvidou et al, 2019). And local administration of tumor necrosis factor inhibitors leads to a significant reduction in the proliferation of synovial tissue cells (Zhang & Ma, 2018). Despite of the presence of a large number of antirheumatoid drugs on the world pharmaceutical market, as well as certain successes in the development of various protocols for their combined application, rheumatoid arthritis therapy remains a relevant task.…”