Changes of cartilage and bone markers after intra-articular glucocorticoid treatment with and without postinjection rest in patients with rheumatoid arthritis

T Weitoft, A Larsson, T Saxne, L Rönnblom, T Weitoft, A Larsson, T Saxne, L Rönnblom

Abstract

Background: Joint immobilisation improves the therapeutic effect of intra-articular glucocorticoid injection for knee synovitis. This may be due to retarded steroid resorption by immobilisation, a procedure that also could influence cartilage and bone metabolism.

Objective: To evaluate changes in cartilage and bone turnover after intra-articular glucocorticoid treatment for knee synovitis with and without postinjection rest.

Methods: 20 patients with rheumatoid arthritis and knee synovitis were randomised to 24 hour bed rest or to normal activity after intra-articular glucocorticoid treatment. Serum and urine markers of cartilage and bone turnover were studied for two weeks. Cartilage oligomeric matrix protein (COMP) was used as a marker of cartilage turnover, osteocalcin as marker of bone formation, and deoxipyridinoline (DPD) as marker of bone resorption.

Results: After the glucocorticoid injection COMP levels decreased in both groups (p<0.001), but significantly more in resting patients. Serum osteocalcin levels decreased significantly (p<0.001) without any difference between the groups. DPD was unchanged in both groups.

Conclusions: Intra-articular glucocorticoid treatment for knee synovitis reduced serum COMP, which suggests that such treatment may have a cartilage protective effect. The slightly larger decrease of serum COMP in the resting group may reflect a lower clearance of COMP from the joint cavity. Serum osteocalcin was temporarily reduced, indicating a reversible suppression of bone formation.

Figures

Figure 1
Figure 1
Mean serum cartilage oligomeric matrix protein (S-COMP) levels for mobile patients (empty circles) and patients with 24 hour postinjection rest (filled circles) during a two week period after intra-articular glucocorticoid treatment for knee synovitis. The results are means, error bars = SEM, for 10 samples in the resting group and nine in the mobile group.
Figure 2
Figure 2
The change of serum cartilage oligomeric matrix protein (S-COMP) levels for each patient during the first 24 hours.
Figure 3
Figure 3
Mean serum osteocalcin (S-osteocalcin) levels for mobile patients (empty circles) and patients with 24-hour postinjection rest (filled circles) during a two week period after intra-articular glucocorticoid treatment for knee synovitis. The results are means, error bars = SEM, for 10 samples in each group.

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