Neue Studien

Intraarticular infliximab in gonarthritis

Efficacy o Intrarticular Infliximab in Patients With Chronic or Recurrent Gonarthritis:
A Clinical Randomized Trial
Van der Bijl AE et al. Arthritis and Rheum, 61, 7: 974-978, 2009
DOI 10.1002/art.24513

Objective
Comparison of the efficacy and safety of intraarticular Infliximab compared to intraarticular methylprednisolone in patients with gon-arthritis.

Methods
In 23 patients with gonarthritis despite previous intraarticular corticosteroid therapy a total of 41 intraarticular injections (20 infliximab and 21 methylprednisolone) were performed. Initial ther-apy was randomly assigned; crossover therapy was eligible within 3 months. The clinical effect was assessed during 6 months of follow-up. Primary outcome was event-free survival, defined as the time after treatment until local retreatment was performed and/or non-improvement of the knee joint score.

Results
All patients treated with intraarticular infliximab had insufficient response. In contrast, 8 of the 21 intraarticular methylprednisolone injections were effective (p=0.004). Both patient groups were compa-rable at baseline. Reported adverse effects were not related to treatment.

Conclusion
Treatment with intraarticular infliximab injection was not effective in patients with a chronically inflamed knee joint. Intraarticular injections with methylprednisolone was superior despite previous intraarticular corticosteroid therapy.

Comment
In chronic monoarticular inflammation of the knee intraarticular in-jections of corticosteroids are the choice of treatment. However, the efficacy of this therapy is varying with relapses up to 50% within 6 months. In this study, all patients previously had intraar-ticular corticosteroid treatment. Therefore the treatment with intraarticular infliximab was only tested in resistant arthritis of the knee. Dosage of infliximab was 100 mg, the dosage of methylpred-nisolone 80 mg per injection. Several reports of intraarticular in-fliximab showed mostly good clinical outcomes. However, such reports were not double-blinded and did not directly compare infliximab with corticosteroids. The only reported double-blinded study comparing intraarticular methylprednisolone with intraarticular etanercept showed similar results to this study using infliximab.

In gonarthritis resistant or recurrent despite injections with corticosteroids, intraarticular infliximab (or injection of other TNF-blockers) does not appear to offer advantages to retreatment with corticosteroids.


Beat A. Michel

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