r e v b r a s r e u m a t o l . 2015;55(1):89–90
REVISTA
BRASILEIRA
DE
REUMATOLOGIA
ww w . r e u m a t o l o g i a . c o m . b r
Letter
to
the
editors
Efficacy
and
safety
of
intra-
and
periarticular
corticosteroid
injections
in
treatment
of
lupus
arthritis
Eficácia
e
seguranc¸a
das
injec¸ões
intra-articulares
e
periarticulares
de
corticosteroides
no
tratamento
da
artrite
lúpica
Totheeditor,
Arthritis in systemic lupus erythematosus (SLE) is one of the mostcommon disease manifestation.1 In dailyclinical practice,intra-andperiarticularcorticosteroidinjectionsare frequentlyusedastheyproviderapidreductionofsymptoms inclinicallyinflamedjoints.2,3
Althoughthereare nostudies toprovethe efficacy and safetyofintra-andperiarticularcorticosteroids,theymayalso behelpfulinthemanagementoflupusarthritis.Theaimof thispaperistoassesstheefficacyandsafetyofintra-and peri-articularcorticosteroids’injectionintreatmentofarthritison patientswithSLE.
Retrospectiveanalysis ofmedicalrecordsofall patients withaSLEdiagnosisobservedinourdepartment,withrecord ofdemographicdata,clinicaldataandtherapeutic interven-tionsandtheirresults,wasconducted.Allpatientsincluded fulfilledtheACRcriteria.
Westudied94patients,91female(96.8%)and3male(3.2%), withameanageof30±12yearsatthetimeofthediagnosis and40±12yearsinthefollow-up.
Sixty-three patients(67%) had articularinvolvement. Of these,49%(n=31)underwentintra-and/orperiarticular corti-costeroids’injection.
Sixty-fiveintra-and/or periarticularcorticosteroid injec-tionswerecarriedouton31patients.
Treatments had been unguided before 2009, after that theywereperformedmostlyunderultrasoundguidance.On average, 2.1 procedures were carried out per patient. The most frequent local treatments were intra-articular injec-tions(n=54),usuallywithtriamcinolonehexacetonide(dose dependedonthetreatedjoint).Knees(n=23),wrists(n=15) and proximal interphalangeal joints (n=11) were the most frequently treated joints. The periarticular corticosteroid
injectionswerealwaysperformedwithmethylprednisolone, andthemostcommoninjectionwasintheextensortendon sheathofthewrist.Asingletreatmentinjectionwassufficient tocontrolsymptomsin29patients.Therewereno complica-tionsobserved.
Effectivecontrolofarthritiswiththelocaltreatment pre-cludedtheneedfororalcorticoidsinthemajorityofpatients. Methotrexatewasusedin13of63patients(21%)tofurther controlarthritis.
Inourexperience thelocaltreatmentswithsteroidsare effective and safe for treatment of lupus arthritis as for rheumatoidarthritis,andmaybeusedasfirst-linetherapy.
Effectivecontrolofarthritiswiththislocaltreatmentmay alsoprecludetheneedforsystemiccorticosteroids,withtheir consequentadverseeffects.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
r
e
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e
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n
c
e
s
1.GrossmanJM.Lupusarthritis.BestPractResClinRheumatol. 2009;23:495–506.
2.KonaiMS,VilarFurtadoRN,DosSantosMF,NatourJ. Monoarticularcorticosteroidinjectionversussystemic administrationinthetreatmentofrheumatoidarthritis patients:arandomizeddouble-blindcontrolledstudy.ClinExp Rheumatol.2009;27:214–21.
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rev bras reumatol.2015;55(1):89–90FilipaTeixeira∗,DanielaPeixoto,CarmoAfonso, DomingosAraújo
DepartamentodeReumatologia,UnidadeLocaldeSaúdedoAlto Minho(ULSAM),PontedeLima,Portugal
∗Correspondingauthor.
E-mail:filipadteixeira@gmail.com(F.Teixeira).
