Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients

Akihiro Fukui; Yamada Hideki

doi:doi:10.11648/j.ajim.20221004.13

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Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients

Akihiro Fukui, Yamada Hideki

Published in American Journal of Internal Medicine (Volume 10, Issue 4)

Received: 29 July 2022 Accepted: 12 August 2022 Published: 24 August 2022

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Abstract

Objectives: In Grade III and IV of advanced wrist joint destruction in RA patients, the combination of triamcinolone acetonide injection, biologics and anti-rheumatic drug use was investigated by X-ray examination to check if joint destruction progressed in an average of 5.9 years. Methods: We unilaterally injected 20 mg of triamcinolone acetonide and 5 mL of 1% lidocaine hydrochloride of RA patients. Changes in the X-ray image were compared between the time of the first visit and at the end of the investigation. Only triamcinolone acetonide injection patients were Group (A), and the number of patients was 35 patients and 53 wrists. Triamcinolone acetonide injection and biologics patients were Group (B), and the number of patients was 21 cases and 33 wrists. Group (C) was only taking anti-rheumatic drug cases in 23 patients and 33 wrists, and Group (D) was only biologics in 21 patients and 33 wrists. The total number of grade III and IV of Larsen classification were 100 patients and 152 wrists. Results: In Group (A), RRA changed only a one-side test, and showed a significant difference (p < 0.05) indicating progression, but no significant differences were observed a two-side test. There was no significant difference in Group (B), (C) and (D). Conclusions: It is thought that the slow progress of wrist joint destruction on X-rays is due to the fact that it is not a load joint. If wrist joint destruction did not progress, there was an opportunity to increase the number of injections, the degree of swelling and pain could be reduced.

Published in	American Journal of Internal Medicine (Volume 10, Issue 4)
DOI	10.11648/j.ajim.20221004.13
Page(s)	86-91
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Rheumatoid Arthritis, Synovitis, Triamcinolone Acetonide, Wrist Joint

References

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[2]	Fukui A, Hideki Yamada, Takashi Yoshii. Effect of intra-articular injection of triamcinolone acetonide for wrist, elbow and shoulder pain in patients with rheumatoid arthritis: Retrospective study. J of Surg 2019, 7 (6) 168-179.
[3]	Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radio Diagn. 1977; 18: 481-91.
[4]	Youm Y, McMurthy RY, Flatt AE, et al. Kinematics of the wrist. I. An experimental study of radial-ulnar deviation and flexion-extension. J Bone Joint Surg. 1978; 60A: 423-31.
[5]	Yoshii I. Influence of intraarticular injection with triamcinolone for rheumatoid arthritis patient. Clin Rheumatoid Rel Res. 2020; 32: 210-19.
[6]	Fizgerald BT, Hofmeister EP, Fan RA, et al. Delayed flexor digitorum superficialis and profundus rupture in a trigger finger after a steroid injection: a case report. J Hand Surg. 2005; 30A: 479-82.
[7]	Chandler GN, Wright V. Deleterious effect of intra-articular hydrocortisone. Lancet. 958; 2: 661-63.
[8]	Salter RB, Gross A. Hall JH. Hydrocortisone arthroplasty. An experimental investigation. C M A J. 1967; 97: 374-77.
[9]	Ishikawa K. A study of deleterious effects of intra-articular corticosteroid on knee joints: A clinical investigation on primary gonoarthrosis. J Jpn Orthop Assoc 1978; 62 (3): 359-74.
[10]	Koski JM, Hermunen H. Intra-articular glucocorticoid treatment of the rheumatoid wrist. Scand J Rheumatol. 2001; 30 (5): 268-70.
[11]	Hetland ML, Stengaard-Pedersen K, Junker P, et al. Aggressive combination therapy with intra-articular glucocorticoid injections and conventional disease-modifying anti-rheumatic drugs in early rheumatoid arthritis second year clinical and radiographic results from the CIMESTRA study. Ann Rheuma Dis. 2008; 67: 815-22.
[12]	Haugeberg G, Morton S, Emery P, et al. Effect of intra-articular corticosteroid injections and inflammation on periarticular and generalized bone loss in early rheumatoid arthritis. Ann Rheuma Dis. 2011; 70: 154-57.
[13]	Hetland ML, Østergaard M, Ejbjerg B, et al. Short and long-term efficacy of intra-articular injections with betamethasone as part of a treat- to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, and CCP, IgM-RF and CRP. Ann Rheum Dis. 2012; 71: 851-56.
[14]	Nagano R, Fukui A. Recurrence of synovia proliferation after the wrist operation in RA. Cent Jap Associ Orthop Surg Trau. 2006; 49: 891-92.
[15]	Fukui A, Yoshii T, Ueda Y, Nakanishi Y. Plaster cast fixation is not necessary after performing modified version of the Sauvè-Kapandji procedure in rheumatoid arthritis patients. J Jpn Soc Surg Hand 2008; 24 (6): 1030-34.
[16]	Uson J, Sebastián C, Raul C, et al. EULAR recommendations for intra-articular therapies. Am Rheuma Dis. 2021: 80: 1299-305.
[17]	Paul S, Helga R, Josef S, et al. Discrepancies between patients and physicians in their perceptions of rheumatoid arthritis disease activity. Arthritis Rheum. 2012; 64: 2814-223.

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APA Style

Akihiro Fukui, Yamada Hideki. (2022). Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients. American Journal of Internal Medicine, 10(4), 86-91. https://doi.org/10.11648/j.ajim.20221004.13

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ACS Style

Akihiro Fukui; Yamada Hideki. Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients. Am. J. Intern. Med. 2022, 10(4), 86-91. doi: 10.11648/j.ajim.20221004.13

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AMA Style

Akihiro Fukui, Yamada Hideki. Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients. Am J Intern Med. 2022;10(4):86-91. doi: 10.11648/j.ajim.20221004.13

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@article{10.11648/j.ajim.20221004.13,
  author = {Akihiro Fukui and Yamada Hideki},
  title = {Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients},
  journal = {American Journal of Internal Medicine},
  volume = {10},
  number = {4},
  pages = {86-91},
  doi = {10.11648/j.ajim.20221004.13},
  url = {https://doi.org/10.11648/j.ajim.20221004.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20221004.13},
  abstract = {Objectives: In Grade III and IV of advanced wrist joint destruction in RA patients, the combination of triamcinolone acetonide injection, biologics and anti-rheumatic drug use was investigated by X-ray examination to check if joint destruction progressed in an average of 5.9 years. Methods: We unilaterally injected 20 mg of triamcinolone acetonide and 5 mL of 1% lidocaine hydrochloride of RA patients. Changes in the X-ray image were compared between the time of the first visit and at the end of the investigation. Only triamcinolone acetonide injection patients were Group (A), and the number of patients was 35 patients and 53 wrists. Triamcinolone acetonide injection and biologics patients were Group (B), and the number of patients was 21 cases and 33 wrists. Group (C) was only taking anti-rheumatic drug cases in 23 patients and 33 wrists, and Group (D) was only biologics in 21 patients and 33 wrists. The total number of grade III and IV of Larsen classification were 100 patients and 152 wrists. Results: In Group (A), RRA changed only a one-side test, and showed a significant difference (p Conclusions: It is thought that the slow progress of wrist joint destruction on X-rays is due to the fact that it is not a load joint. If wrist joint destruction did not progress, there was an opportunity to increase the number of injections, the degree of swelling and pain could be reduced.},
 year = {2022}
}

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TY  - JOUR
T1  - Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients
AU  - Akihiro Fukui
AU  - Yamada Hideki
Y1  - 2022/08/24
PY  - 2022
N1  - https://doi.org/10.11648/j.ajim.20221004.13
DO  - 10.11648/j.ajim.20221004.13
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 86
EP  - 91
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20221004.13
AB  - Objectives: In Grade III and IV of advanced wrist joint destruction in RA patients, the combination of triamcinolone acetonide injection, biologics and anti-rheumatic drug use was investigated by X-ray examination to check if joint destruction progressed in an average of 5.9 years. Methods: We unilaterally injected 20 mg of triamcinolone acetonide and 5 mL of 1% lidocaine hydrochloride of RA patients. Changes in the X-ray image were compared between the time of the first visit and at the end of the investigation. Only triamcinolone acetonide injection patients were Group (A), and the number of patients was 35 patients and 53 wrists. Triamcinolone acetonide injection and biologics patients were Group (B), and the number of patients was 21 cases and 33 wrists. Group (C) was only taking anti-rheumatic drug cases in 23 patients and 33 wrists, and Group (D) was only biologics in 21 patients and 33 wrists. The total number of grade III and IV of Larsen classification were 100 patients and 152 wrists. Results: In Group (A), RRA changed only a one-side test, and showed a significant difference (p Conclusions: It is thought that the slow progress of wrist joint destruction on X-rays is due to the fact that it is not a load joint. If wrist joint destruction did not progress, there was an opportunity to increase the number of injections, the degree of swelling and pain could be reduced.
VL  - 10
IS  - 4
ER  -

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Author Information

Akihiro Fukui

Department of Orthopedic Surgery, Nishinokyo Hospital, Nara, Japan
Yamada Hideki

Department of Internal Medicine, Nijo-Ekimae Clinic, Nara, Japan

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APA Style

Akihiro Fukui, Yamada Hideki. (2022). Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients. American Journal of Internal Medicine, 10(4), 86-91. https://doi.org/10.11648/j.ajim.20221004.13

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ACS Style

Akihiro Fukui; Yamada Hideki. Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients. Am. J. Intern. Med. 2022, 10(4), 86-91. doi: 10.11648/j.ajim.20221004.13

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AMA Style

Akihiro Fukui, Yamada Hideki. Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients. Am J Intern Med. 2022;10(4):86-91. doi: 10.11648/j.ajim.20221004.13

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@article{10.11648/j.ajim.20221004.13,
  author = {Akihiro Fukui and Yamada Hideki},
  title = {Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients},
  journal = {American Journal of Internal Medicine},
  volume = {10},
  number = {4},
  pages = {86-91},
  doi = {10.11648/j.ajim.20221004.13},
  url = {https://doi.org/10.11648/j.ajim.20221004.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20221004.13},
  abstract = {Objectives: In Grade III and IV of advanced wrist joint destruction in RA patients, the combination of triamcinolone acetonide injection, biologics and anti-rheumatic drug use was investigated by X-ray examination to check if joint destruction progressed in an average of 5.9 years. Methods: We unilaterally injected 20 mg of triamcinolone acetonide and 5 mL of 1% lidocaine hydrochloride of RA patients. Changes in the X-ray image were compared between the time of the first visit and at the end of the investigation. Only triamcinolone acetonide injection patients were Group (A), and the number of patients was 35 patients and 53 wrists. Triamcinolone acetonide injection and biologics patients were Group (B), and the number of patients was 21 cases and 33 wrists. Group (C) was only taking anti-rheumatic drug cases in 23 patients and 33 wrists, and Group (D) was only biologics in 21 patients and 33 wrists. The total number of grade III and IV of Larsen classification were 100 patients and 152 wrists. Results: In Group (A), RRA changed only a one-side test, and showed a significant difference (p Conclusions: It is thought that the slow progress of wrist joint destruction on X-rays is due to the fact that it is not a load joint. If wrist joint destruction did not progress, there was an opportunity to increase the number of injections, the degree of swelling and pain could be reduced.},
 year = {2022}
}

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TY  - JOUR
T1  - Triamcinolone Acetonide, Biologics and Anti-rheumatic Drug Prevent Destruction of Larsen Grade III and IV Wrist Joint in Rheumatoid Arthritis Patients
AU  - Akihiro Fukui
AU  - Yamada Hideki
Y1  - 2022/08/24
PY  - 2022
N1  - https://doi.org/10.11648/j.ajim.20221004.13
DO  - 10.11648/j.ajim.20221004.13
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 86
EP  - 91
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20221004.13
AB  - Objectives: In Grade III and IV of advanced wrist joint destruction in RA patients, the combination of triamcinolone acetonide injection, biologics and anti-rheumatic drug use was investigated by X-ray examination to check if joint destruction progressed in an average of 5.9 years. Methods: We unilaterally injected 20 mg of triamcinolone acetonide and 5 mL of 1% lidocaine hydrochloride of RA patients. Changes in the X-ray image were compared between the time of the first visit and at the end of the investigation. Only triamcinolone acetonide injection patients were Group (A), and the number of patients was 35 patients and 53 wrists. Triamcinolone acetonide injection and biologics patients were Group (B), and the number of patients was 21 cases and 33 wrists. Group (C) was only taking anti-rheumatic drug cases in 23 patients and 33 wrists, and Group (D) was only biologics in 21 patients and 33 wrists. The total number of grade III and IV of Larsen classification were 100 patients and 152 wrists. Results: In Group (A), RRA changed only a one-side test, and showed a significant difference (p Conclusions: It is thought that the slow progress of wrist joint destruction on X-rays is due to the fact that it is not a load joint. If wrist joint destruction did not progress, there was an opportunity to increase the number of injections, the degree of swelling and pain could be reduced.
VL  - 10
IS  - 4
ER  -

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