HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Durez, P Articles by Houssiau, F A Search for Related Content PubMed PubMed Citation Articles by Durez, P Articles by Houssiau, F A

A randomised comparative study of the short term clinical and biological effects of intravenous pulse methylprednisolone and infliximab in patients with active rheumatoid arthritis despite methotrexate treatment

¹ Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
² Rheumatology Department, UZ Gasthuisberg, Katholieke Universiteit Leuven, Belgium

Correspondence to:
Correspondence to:
Dr F A Houssiau
Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, B-1200 Bruxelles, Belgium; houssiau{at}ruma.ucl.ac.be

Objectives: To compare the short term clinical and biological effects of intravenous (IV) pulse methylprednisolone (MP) and infliximab (IFX) in patients with severe active rheumatoid arthritis (RA) despite methotrexate (MTX) treatment.

Methods: Patients with active RA despite MTX treatment were randomly allocated to receive a single IV infusion of MP (1 g) or three IV infusions of IFX (3 mg/kg) on weeks 0, 2, and 6. Patients were "blindly" evaluated for disease activity measures. Quality of life (QoL) was evaluated through the SF-36 health survey. Serum matrix metalloproteinase-3 (MMP-3) titres were measured at baseline, weeks 2 and 6.

Results: Compared with baseline, significant improvement was noted in all activity measures, including serum C reactive protein (CRP) titres, in the IFX group only. At week 14, 6/9 (67%) and 4/9 (44%) IFX patients met the ACR20 and 50 response criteria, while this was the case in only 1/12 (8%) and 0/12 (0%) MP patients, respectively (p<0.05). None of the QoL scales improved with MP treatment, whereas some did so in the IFX group. Serum MMP-3 titres significantly decreased (41% drop) at week 6 in the IFX group, while no changes were seen in patients given MP.

Conclusion: This short term randomised comparative study demonstrates that TNF blockade is better than MP pulse therapy in a subset of patients with severe refractory RA, with improvement in not only clinical parameters of disease activity but also biological inflammatory indices, such as serum CRP and MMP-3 titres.

Abbreviations: ACR, American College of Rheumatology; CRP, C reactive protein; DMARD, disease modifying antirheumatic drug; IFX, infliximab; IL, interleukin; IV, intravenous; MMP, matrix metalloproteinase; MP, methylprednisolone; MTX, methotrexate; RA, rheumatoid arthritis; SJC, swollen joint count; TJC, tender joint count; TNF, tumour necrosis factor

Keywords: rheumatoid arthritis; glucocorticoids; pulse therapy; infliximab; tumour necrosis factor blockade

This article has been cited by other articles:

				Y. Yazici, N. M. Adler, and H. Yazici Most tumour necrosis factor inhibitor trials in rheumatology are undeservedly called 'efficacy and safety' trials: a survey of power considerations Rheumatology, July 1, 2008; 47(7): 1054 - 1057. [Abstract] [Full Text] [PDF]

				N. Iikuni, E. Inoue, E. Tanaka, M. Hara, T. Tomatsu, N. Kamatani, and H. Yamanaka Low disease activity state with corticosteroid may not represent 'true' low disease activity state in patients with rheumatoid arthritis Rheumatology, April 1, 2008; 47(4): 519 - 521. [Abstract] [Full Text] [PDF]

				Y Yazici and H Yazici A survey of inclusion of the time element when reporting adverse effects in randomised controlled trials of cyclo-oxygenase-2 and tumour necrosis factor {alpha} inhibitors Ann Rheum Dis, January 1, 2007; 66(1): 124 - 127. [Abstract] [Full Text] [PDF]

				E. Morrison and H. A. Capell Corticosteroids in the management of early and established rheumatoid disease Rheumatology, September 1, 2006; 45(9): 1058 - 1061. [Full Text] [PDF]

				D Aletaha and M M Ward Duration of rheumatoid arthritis influences the degree of functional improvement in clinical trials Ann Rheum Dis, February 1, 2006; 65(2): 227 - 233. [Abstract] [Full Text] [PDF]

				M D Smith, P Durez, T A Nzeusseu, B R Lauwerys, D H Manicourt, J-P Devogelaer, F A Houssiau, P Verschueren, and R Westhovens Is IV infliximab better than IV methylprednisolone for the treatment of patients with RA when methotrexate fails? * Authors' reply Ann Rheum Dis, March 1, 2005; 64(3): 512 - 512. [Full Text] [PDF]

				F Buttgereit, G Burmester, J W Bijlsma, P Durez, A Nzeusseu Toukap, B R Lauwerys, D H Manicourt, J-P Devogelaer, F A Houssiau, P Verschueren, et al. Which dose regimen for glucocorticoid pulse therapy in patients with severe refractory RA? * Authors' reply Ann Rheum Dis, January 1, 2005; 64(1): 171 - 172. [Full Text] [PDF]