Abstract | BACKGROUND: Hand pain with stiffness is a common clinical presentation to early arthritis clinics, with outcome varying from resolution to the development of rheumatoid arthritis. OBJECTIVE: METHODS: Patients with inflammatory hand pain (IHP), defined as predominantly hand pain and morning stiffness of at least 30 min duration, received a standardised assessment prior to receiving intramuscular MP. Response (primary outcome) at 4 weeks was a 50% improvement in symptoms as perceived by the patient; responders who relapsed received repeat intramuscular MP and HCQ. RESULTS: 102 patients were recruited, of which 21% were rheumatoid factor (RF) positive, 23% had clinical synovitis, 25% had raised C-reactive protein level and 55% had ultrasound-detected synovitis. 73% responded, with associated significant reductions in morning stiffness, Health Assessment Questionnaire, painful and tender joint counts, and visual analogue scores (p < or = 0.006 for all). Ultrasound-detected synovitis (p<0.001) and RF (p = 0.04), but not clinical synovitis (p = 0.74), were significantly associated with response to intramuscular MP. 86% who remained on HCQ long term reported a benefit. CONCLUSIONS: Patients with IHP have significant improvement in symptoms and function following intramuscular MP. Further placebo-controlled trials are required to assess the role of intramuscular MP and ultrasonography in managing this patient group.
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Authors | Zunaid Karim, Mark A Quinn, Richard J Wakefield, Andrew K Brown, Michael J Green, Elizabeth M A Hensor, Philip G Conaghan, Paul Emery |
Journal | Annals of the rheumatic diseases
(Ann Rheum Dis)
Vol. 66
Issue 5
Pg. 690-2
(May 2007)
ISSN: 0003-4967 [Print] England |
PMID | 17127687
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Hydroxychloroquine
- Methylprednisolone
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Topics |
- Adult
- Anti-Inflammatory Agents
(administration & dosage)
- Antirheumatic Agents
(administration & dosage)
- Female
- Hand
(physiopathology)
- Humans
- Hydroxychloroquine
(administration & dosage)
- Injections, Intramuscular
- Male
- Methylprednisolone
(administration & dosage)
- Middle Aged
- Pain
(drug therapy)
- Treatment Outcome
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