Effect of ultrasound‐guided, peritendinous injections of adalimumab and anakinra in chronic Achilles tendinopathy: a pilot study

Abstract

A new review suggested that an inflammatory process may be related to the development of tendinopathy and that the inflammation may also play a role in chronic tendinopathy. Hitherto, peritendinous injections of glucocorticosteroids have been used to reduce the inflammation. In an attempt to reduce the possible side effects and the high frequency of relapse of symptoms after local treatments with glucocorticosteroids, new anti-inflammatory treatments were tested. Ultrasound-guided, peritendinous injections of adalimumab (tumor necrosis factor -alpha blocker) and anakinra (interleukin-1 receptor antagonist) were evaluated with regard to reducing pain, tendon thickness, and the blood flow in chronic Achilles tendinopathy. We found in this small pilot study that peritendinous injections of adalimumab had a significant effect on pain sensation at rest in chronic Achilles tendinopathy. Adalimumab had no effect on tendon thickness and contrary to all expectation, the tendon thickness in the anakinra-treated patients increased significantly after 12 weeks. Adalimumab showed a significant tendency to reduce the blood flow in the tendon over 12 weeks, whereas anakinra had no effect on the blood flow.

Tendons – time to revisit inflammation

“…This evidence extends to tendinopathy in many locations including patellar tendinopathy17 49 50 and lateral epicondylitis 5152 Using an US-guided approach, Fredberg et al 49 demonstrated benefit at 4 weeks, but the non-imaging approach adopted by DaCruz et al 53 failed to show a benefit.…”

Tendons: Time to Revisit Inflammation?

“…In this small study, it was found that adalimumab injections had a significant effect on pain sensitisation at rest in chronic Achilles tendinopathy and reduced blood flow at 12 weeks. 50 Use of these agents in a systemic manner is not straightforward and has not yet been studied. They are expensive (approximately £10 000 per inflammatory arthritis patient treated per calendar year).…”

Targeting Inflammation in Rotator Cuff Tendon Degeneration and Repair

“…18 In a pilot study, peritendinous injection of adalimumab, a monoclonal TNFα antibody, was administered to the Achilles of symptomatic athletes. 87 Walking and resting pain was reduced over the 12 week course of treatment and tendon thickness remained constant, while blood flow decreased. In a rat rotator cuff repair model, blockade of TNFα using pegylated TNF receptor type 1 improved the biomechanical strength and reduced pro-inflammatory macrophages at early time points (< 4 weeks).…”

“…In the aforementioned athlete study, the investigators also applied anakinra, a recombinant form of interleukin-1 receptor antagonist (IL-1ra), to treat Achilles tendinopathy. 87 However, it was not as effective as the TNFα inhibitor. Suppressing IL-1 did not significantly reduce pain or blood flow and increased tendon thickness after 12 weeks of treatment.…”