Abstract
Our pilot study aimed to investigate the efficacy and tolerability of intra-articular (i.a.) injections of infliximab as a therapy for erosive osteoarthritis of the hands. Ten women with bilateral involvement of the hands and typical erosive osteoarthritis radiographic findings were enrolled and followed for 12 months. All the patients were refractory to conventional drugs. Treatment consisted in monthly i.a. injections of 0.2 ml of infliximab (0.1 mg/ml) in each affected proximal and distal interphalangeal joint of the most involved hand, identified on the basis of clinical and radiological examinations. The other hand was treated with physiological saline (control). The patients did not know which hand was receiving infliximab. Clinical response was evaluated at enrollment, after 6 and 12 months. Posteroanterior radiographs of both hands were obtained at baseline and 12 months later. At 6 months all the patients experienced relief from spontaneous pain and pain on lateral pressure in the hand treated with infliximab and these findings became statistically significant after 1 year. No important modifications were recognized in the hand treated with physiological saline. The anatomical lesion progression system radiological score indicated a reduction, even if not statistically significant, in the hand treated with infliximab and a tendency to slow worsening in the hand treated with physiological saline at 12-month follow-up. No local or systemic adverse reactions were recorded. Our study shows the symptomatic effect and a possible disease modifying action of i.a. infliximab in erosive osteoarthritis of the hands.
References
Ehlrich GE (2001) Erosive osteoarthritis: presentation, clinical pearls, and therapy. Curr Rheumatol Rep 3:484–488. doi:10.1007/s11926-001-0062-x
Punzi L, Ramonda R, Oliviero F, Sfriso P (2004) Erosive osteoarthritis. Best Pract Res Clin Rheumatol 18:739–758. doi:10.1016/j.berh.2004.05.010
Utsinger PD, Resnick D, Shapiro PF, Wiesner KB (1978) Roentgenologic, immunologic and therapeutic study of erosive (inflammatory) osteoarthritis. Arch Intern Med 138:693–697. doi:10.1001/archinte.138.5.693
Goldring SR, Goldring MB (2004) The role of cytokines in cartilage matrix degeneration in osteoarthritis. Clin Orthop Relat Res Suppl 427:S37–S41. doi:10.1097/01.blo.0000144484.69656.e4
Kammermann JR, Kinkaid SA, Rumph PF, Baird DK, Visco DM (1996) Tumor necrosis factor-alpha (TNF-alpha) in canine osteoarthritis: immunolocalization of TNF-alpha, stromelysin and TNF-receptors in canine osteoarthritic cartilage. Osteoarthritis Cartilage 4:23–34. doi:10.1016/S1063-4584(96)80004-5
Vuolteenaho K, Moilanen T, Hamalainen M, Moilanen E (2002) Effects of TNF-α antagonists on nitric oxide production in human cartilage. Osteoarthritis Cartilage 10:327–332. doi:10.1053/joca.2002.0521
Grunke M, Schulze-Koops H (2006) Successful treatment of inflammatory knee osteoarthritis with tumor necrosis factor blockade. Ann Rheum Dis 65:555–556. doi:10.1136/ard.2006.053272
Goldring MB (2001) Anticytokine therapy for osteoarthritis. Expert Opin Biol Ther 1:817–829. doi:10.1517/14712598.1.5.817
Schatteman L, Gyselbrecht L, De Clerq L, Mielants H (2006) Treatment of refractory inflammatory monoarthritis in ankylosing spondylitis by intraarticular injection of infliximab. J Rheumatol 33:1912–1913
Bliddal H, Terslev L, Qvistgaard E et al (2006) A randomized, controlled study of a single intra-articular injection of etanercept or glucocorticosteroids in patients with rheumatoid arthritis. Scand J Rheumatol 35:341–345. doi:10.1080/03009740600844530
Altman R, Alarcon G, Appelrouth D et al (1990) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 33:1601–1610. doi:10.1002/art.1780331101
Verbruggen G, Veys EM (1996) Numerical scoring systems for the anatomic evolution of osteoarthritis of the finger joints. Arthritis Rheum 2:308–320. doi:10.1002/art.1780390221
Bryant RL, Des Rosier KF, Carpenter MT (1995) Hydroxychloroquine in the treatment of erosive osteoarthritis. J Rheumatol 22:1527–1531
Rovetta G, Monteforte P, Molfetta G, Balestra V (2002) Chondroitin sulfate in erosive osteoarthritis of the hands. Int J Tissue React 24:29–32
Magnano MD, Chakravarty EF, Broudy C et al (2007) A pilot study of tumor necrosis factor inhibition in erosive/inflammatory osteoarthritis of the hands. J Rheumatol 34:1323–1327
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fioravanti, A., Fabbroni, M., Cerase, A. et al. Treatment of erosive osteoarthritis of the hands by intra-articular infliximab injections: a pilot study. Rheumatol Int 29, 961–965 (2009). https://doi.org/10.1007/s00296-009-0872-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-009-0872-0