Predicting pain relief in rheumatoid arthritis

This study evaluated whether there is a predictor of time to relapse in rheumatoid arthritis patients with swelling of the knee.

Rheumatoid arthritis causes painful, swollen joints. Treatment with steroids called glucocorticoids (for example Cortisone, Deltasone) can reduce these symptoms. Injecting steroids directly into the swollen joint allows the doctor to deliver a high dose directly into the problem area.

In 40% of people, the symptoms return in less than 6 months. The presence of certain natural chemicals in the body may predict who will have the fastest return of symptoms. 

This study included 121 rheumatoid arthritis patients with swelling of the knee. To relieve symptoms, they were treated with a single steroid injection of triamcinolone hexacetonide (Aristospan; a long-acting steroid) directly into the knee joint. The time it took for the pain to come back was measured in all patients. If the pain came back in less than 6 months the patients were called “non-responders”.

40% of patients were non-responders. The average time to return was 3 months. The shortest was 5 days. 

Patients who had the least relief from symptoms had more natural chemicals, called VEGF, in their knee joint. 

The authors concluded that the level of VEGF may be a helpful predictor for doctors to identify how long a steroid injection will provide pain relief. In the future, a combined treatment that lowers VEGF in addition to steroid injection may provide the longest pain relief.

Relapse time was based on self-reported complaints of pain. This may not be fully accurate due to differences in pain thresholds among individuals. 

If considering the use of steroids for pain relief in swollen needs, talk to your doctor about the possibility of testing for VEGF to predict treatment outcomes.