Clinical scenario

A 42 year old woman known to suffer from rheumatoid arthritis presents to the emergency department with an acutely inflammed swollen knee. The patient is given an intra-articular corticosteroid injection. You know this is a standard treatment but wonder how effective it actually is.

Three part question

In [patients with acute rheumatoid monoarthritis] are [intra-articular corticosteroid injections] effective in [reducing pain and swelling and improving mobility]?

Search strategy

Medline 1966-11/03 using the Ovid interface, including Medline in progress and non-indexed citations. (exp arthritis, rheumatoid/OR monoarthritis.mp. OR exp arthritis OR exp rheumatic diseases/OR monoarthropathy.mp.) AND (exp steroids/or steroid$’.mp. OR exp methylprednisolone/OR methylprednisolone.mp OR exp hydrocortisone/OR hydrocortisone.mp OR exp prednisolone/OR prednisolone.mp) AND (exp injections, intra-articular/) LIMIT to human AND English AND abstracts.

Search outcome

Altogether 215 papers found of which 214 were irrelevant or of insufficient quality. The remaining paper is shown in table 5.

Comment(s)

Acute rheumatoid monoarthritides are commonly treated with intra-articular corticosteroid injections. Although this paper indicates a favourable outcome using intra-articular rimexolone injections particularly at 40 mg, the small number used in each group may have introduced bias and the high drop out rate in the placebo group in the later stages of the study prevents efficacious comparisons to be made.

CLINICAL BOTTOM LINE

The available evidence suggests that a single intra-articular injection of 40 mg rimexolone significantly reduces pain, tenderness and stiffness, and increases mobility in patients with acute rheumatoid arthritis.