Effect of intra-articular corticosteroid injections and inflammation on periarticular and generalised bone loss in early rheumatoid arthritis

Objectives To explore the effect of intra-articular corticosteroid (IAST) injections on bone mineral density (BMD) in the hand and at the metacarpophalangeal (MCP) joints in early rheumatoid arthritis (RA). Methods In the first 3 months of the study, 19 patients with RA received methotrexate (MTX) alone and 21 received MTX and IAST injections into clinically inflamed joints. In the following 9 months, all patients received MTX+IAST. BMD was assessed at the hand and periarticular regions at MCP joints 2-5 at baseline, 3 and 12 months. Results In the first 3 months a numerically lower percentage rate of bone loss was seen in MTX+IAST-treated patients compared with MTX-treated patients. This observation was more pronounced at the MCP periarticular regions (eg, partial proximal phalanges: digit 2, -0.45% vs -2.69%, p = 0.045; digit 3, -0.34% vs -3.32%, p = 0.003; digit 4, -0.39% vs -2.57%, p = 0.14; digit 5, -0.59% vs -2.70%, p = 0.24) than for the whole hand (-1.53% vs -2.42%, p = 0.32). In the 3-12-month period, only minor non-statistically significant differences were seen between the two groups. Conclusion IAST given over 3 months protects against periarticular bone loss in inflamed finger joints in RA. These data emphasise the importance of suppressing inflammation in patients with active RA to maintain bone health.