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Effectiveness of Intra-Articular Injection in Wrist Joints According to Triamcinolone Hexacetonide Dose in Rheumatoid Arthritis: A Randomized Controlled Double-Blind Study

Pereira, Daniele Freitas MD; Natour, Jamil MD, PhD; Machado, Natália Pereira MD; Furtado, Rita Nely Vilar MD, PhD

American Journal of Physical Medicine & Rehabilitation: February 2015 - Volume 94 - Issue 2 - p 131–138
doi: 10.1097/PHM.0000000000000174
Original Research Articles

Objective The aim of this study was to compare the effectiveness in the medium term between low and high doses of triamcinolone hexacetonide used in intra-articular injection in medium-sized joints of rheumatoid arthritis (RA) patients.

Methods A randomized double-blind study was carried out in rheumatoid arthritis patients with wrist painful refractory synovitis. Sixty wrists were included and randomized to receive low dose (20 mg) or high dose (40 mg). The outcomes assessed in T0, T1, T4, T8, and T12 weeks were visual analog scale for pain and for swelling, chronic disease activity index, goniometry, simplified Stanford Health Assessment Questionnaire, and side effects.

Results Baseline mean (standard deviation) values were pain visual analog scale of 6.1 (1.6) and 6.3 (1.7), P = 0.562; swelling visual analog scale of 5.9 and 6.4, P = 0.466; chronic disease activity index of 17.8 and 16.8, P = 0.366; and Health Assessment Questionnaire of 0.8 and 0.7, P = 0.238, in the high- and low-dose groups, respectively. Both groups improved pain and swelling assessed by the visual analog scale, P < 0.001, in the intragroup analysis. Chronic disease activity index, goniometry, and Health Assessment Questionnaire also improved equally over time in both groups in the intragroup analysis (P < 0.001, 0.001, and 0.002, respectively). No serious side effects were detected.

Conclusions High and low triamcinolone hexacetonide doses had good effectiveness in wrist-blinded intra-articular injection of rheumatoid arthritis patients, without statistical difference between them.

From the Rheumatology Division, Universidade Federal de São Paulo, São Paulo, Brazil.

All correspondence and requests for reprints should be addressed to: Rita Nely Vilar Furtado MD, PhD, Rheumatology Division, Universidade Federal de Sao Paulo, Rua Botucatu, 740, 04023900 São Paulo/SP, Brazil.

Supported by grants provided by Fundação de Amparo à Pesquisa do Estado de São Paulo 2010/51092-4.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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