AB0286 EFFICACY AND SAFETY OF INTRA-ARTICULAR INJECTION OF ETANERCEPT IN RHEUMATOID ARTHRITIS PATIENTS

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-week p <0.002 and 1-month p <0.003 follow-up periods, but there was insignificant change after 3 months p =0.116, by MSUS, there was an insignificant change in synovitis p =0.112, but a significant change was found in power Doppler after 1-week p = 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