Dr. Green has received honoraria from Pfizer (less than $10,000) for educational talks.
A randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis
Article first published online: 31 JAN 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 1, pages 154–160, 15 February 2007
How to Cite
Marzo-Ortega, H., Green, M. J., Keenan, A.-M., Wakefield, R. J., Proudman, S. and Emery, P. (2007), A randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis. Arthritis & Rheumatism, 57: 154–160. doi: 10.1002/art.22467
- Issue published online: 31 JAN 2007
- Article first published online: 31 JAN 2007
- Manuscript Accepted: 19 MAY 2006
- Manuscript Received: 11 JAN 2006
- Arthritis Research Campaign
- Early arthritis;
To determine the outcome after 52 weeks of early intervention with intraarticular corticosteroid injections followed by sulfasalazine versus conservative therapy in patients with recent-onset oligoarthritis in a randomized controlled trial.
Patients with ≤4 joints with clinical synovitis (disease duration ≤12 months) were randomized to early intervention (EI) with intraarticular methylprednisolone into all synovitic joints or to conservative treatment (CT) with nonsteroidal antiinflammatory drugs alone. Sulfasalazine was administered in both groups for persistent disease or disease that evolved into a polyarthritis. Primary outcome was complete response (CR) defined as the absence of synovitis at 52 weeks. Secondary outcomes included CR at weeks 4 and 12, function (Health Assessment Questionnaire), pain (0–100-mm visual analog scale), and work status.
Fifty-nine patients (34 men, 25 women; mean age 32.9 years; median early morning stiffness 30 minutes) were randomized. At baseline, two-thirds reported that they were work impaired. At 52 weeks, 81% of patients in the EI group achieved CR compared with 57% in the CT group (χ2 = 3.833, 1 df, P = 0.05). In addition, 45% of patients in the EI group received sulfasalazine as opposed to 14% in the CT group (χ2 = 5.156, 1 df, P = 0.019). There were no differences in physical disability or work impairment between the treatment groups.
Oligoarthritis has a significant impact on function and work ability. Patients treated with EI using intraarticular corticosteroids followed by sulfasalazine therapy if resistant demonstrated reduced synovitis 12 months after treatment compared with those initially treated with more conservative therapy.