Intra-articular therapy with infliximab in psoriatic arthritis: efficacy and safety in refractory monoarthritis

Abstract

Objective: To evaluate efficacy and safety of intra-articular therapy (IA) with infliximab (IFX), in patients with psoriatic arthritis (PsA) and refractory monoarthritis. Methods: Four male and 1 female aged from 25 to 71 years and disease duration from 1 to 25 years, affected by PsA (CASPAR criteria) were observed . All patients were treated with immunomodulators (methotrexate, leflunomide, cyclosporin A), 3/5 with concomitant steroids, 4/5 with NSAID’s. Only 1 patient were treated with IFX 5 mg/kg IV every 6 weeks. Before the IFX injection an amount of synovial fluid was aspired from the inflamed site and the anti-TNF injection was echographic guided. Patients were evaluated at regular intervals through clinical and echographic examination and retreated in case of flare. Results: At follow-up visit after 7 days, in all patients treated with the first injection was detected total regression of the inflammation and no new inflamed synovial fluid was observed; power doppler examination shows reduction of local vascularization. Two patients experienced full remission after 6 months and only one injection, 1 patient (arthritis of the wrist) was in remission after 2 injections (3 months of interval). In 2 patients with knee arthritis and important synovial hypertrophy good results obtained after the first injection were not maintained afterwards and second injection was ineffective: these patients were evaluated for surgical intervention. Conclusions: Local injections of IFX were safe and well tolerated in all patients. The efficacy in short term was observed in all cases; our supposition is that presence of synovial hypertrophy is cause of worsening

Safety and efficacy of intra-articular anti-tumor necrosis factor α agents compared to corticosteroids in a treat-to-target strategy in patients with inflammatory arthritis and monoarthritis flare

“…50 Several studies concerning the use of intra-articular anti-TNFα agents have been published so far but results are not conclusive, with a wide range of clinical response and differences in the study design. 11–22…”

“…However only conflicting results are available in literature. [11][12][13][14][15][16][17][18][19][20][21][22] At present, both magnetic resonance imaging (MRI) and ultrasonography (US) are established methods to evaluate the severity of monoarthtitis flares in these conditions; [23][24][25][26] furthermore, US improves the performance of intra-articular injections overcoming technical problems such as the correct position of the needle and the aspiration of joint effusion. 27 In fact it is well know that only in 50% of intra-articular injections is the drug placed in the right place and this strongly decreases the efficacy of these procedures.…”

Systemic and intra-articular anti-inflammatory therapy of temporomandibular joint arthritis in children with juvenile idiopathic arthritis

“…22 There have also been scattered reports of IA delivery of TNFi to treat inflammatory arthritic conditions, including JIA. For example, Bello et al 26 reported on 5 adults with psoriatic arthritis who responded to IA infliximab, and Conti et al 27 reported good responses in 9 of 10 subjects with rheumatoid or psoriatic arthritis receiving IA infliximab. Unlike IACS, the TNFi were not designed for depot injections; indeed, improvements in systemic symptoms and inflammatory markers have also been observed with local TNFi injections.…”

“…Unlike IACS, the TNFi were not designed for depot injections; indeed, improvements in systemic symptoms and inflammatory markers have also been observed with local TNFi injections. 26,28 The comparative effectiveness of IA TNFi versus IACS is unclear. A RCT comparing IA etanercept to IA betamethasone showed etanercept to be superior, 29 while a comparison of IA etanercept and IA methylprednisolone showed equivalence.…”