Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2005 Apr 20;64(12):1750–1753. doi: 10.1136/ard.2004.035022

Changes of cartilage and bone markers after intra-articular glucocorticoid treatment with and without postinjection rest in patients with rheumatoid arthritis

T Weitoft 1, A Larsson 1, T Saxne 1, L Ronnblom 1
PMCID: PMC1755303  PMID: 15843449

Abstract

Background: Joint immobilisation improves the therapeutic effect of intra-articular glucocorticoid injection for knee synovitis. This may be due to retarded steroid resorption by immobilisation, a procedure that also could influence cartilage and bone metabolism.

Objective: To evaluate changes in cartilage and bone turnover after intra-articular glucocorticoid treatment for knee synovitis with and without postinjection rest.

Methods: 20 patients with rheumatoid arthritis and knee synovitis were randomised to 24 hour bed rest or to normal activity after intra-articular glucocorticoid treatment. Serum and urine markers of cartilage and bone turnover were studied for two weeks. Cartilage oligomeric matrix protein (COMP) was used as a marker of cartilage turnover, osteocalcin as marker of bone formation, and deoxipyridinoline (DPD) as marker of bone resorption.

Results: After the glucocorticoid injection COMP levels decreased in both groups (p<0.001), but significantly more in resting patients. Serum osteocalcin levels decreased significantly (p<0.001) without any difference between the groups. DPD was unchanged in both groups.

Conclusions: Intra-articular glucocorticoid treatment for knee synovitis reduced serum COMP, which suggests that such treatment may have a cartilage protective effect. The slightly larger decrease of serum COMP in the resting group may reflect a lower clearance of COMP from the joint cavity. Serum osteocalcin was temporarily reduced, indicating a reversible suppression of bone formation.

Full Text

The Full Text of this article is available as a PDF (77.8 KB).

Figure 1.

Figure 1

Open in a new tab

 Mean serum cartilage oligomeric matrix protein (S-COMP) levels for mobile patients (empty circles) and patients with 24 hour postinjection rest (filled circles) during a two week period after intra-articular glucocorticoid treatment for knee synovitis. The results are means, error bars = SEM, for 10 samples in the resting group and nine in the mobile group.

Figure 2.

Figure 2

Open in a new tab

 The change of serum cartilage oligomeric matrix protein (S-COMP) levels for each patient during the first 24 hours.

Figure 3.

Figure 3

Open in a new tab

 Mean serum osteocalcin (S-osteocalcin) levels for mobile patients (empty circles) and patients with 24-hour postinjection rest (filled circles) during a two week period after intra-articular glucocorticoid treatment for knee synovitis. The results are means, error bars = SEM, for 10 samples in each group.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  2. Behrens F., Shepard N., Mitchell N. Alterations of rabbit articular cartilage by intra-articular injections of glucocorticoids. J Bone Joint Surg Am. 1975 Jan;57(1):70–76. [PubMed] [Google Scholar]
  3. Chakravarty K., Pharoah P. D., Scott D. G. A randomized controlled study of post-injection rest following intra-articular steroid therapy for knee synovitis. Br J Rheumatol. 1994 May;33(5):464–468. doi: 10.1093/rheumatology/33.5.464. [DOI] [PubMed] [Google Scholar]
  4. Ekdahl C., Eberhardt K., Andersson S. I., Svensson B. Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. Scand J Rheumatol. 1988;17(4):263–271. doi: 10.3109/03009748809098795. [DOI] [PubMed] [Google Scholar]
  5. Emkey R. D., Lindsay R., Lyssy J., Weisberg J. S., Dempster D. W., Shen V. The systemic effect of intraarticular administration of corticosteroid on markers of bone formation and bone resorption in patients with rheumatoid arthritis. Arthritis Rheum. 1996 Feb;39(2):277–282. doi: 10.1002/art.1780390215. [DOI] [PubMed] [Google Scholar]
  6. Frediani Bruno, Falsetti Paolo, Bisogno Stefania, Baldi Fabio, Acciai Caterina, Filippou Georgios, Bacarelli Maria Romana, Filipponi Paolo, Galeazzi Mauro, Marcolongo Roberto. Effects of high dose methylprednisolone pulse therapy on bone mass and biochemical markers of bone metabolism in patients with active rheumatoid arthritis: a 12-month randomized prospective controlled study. J Rheumatol. 2004 Jun;31(6):1083–1087. [PubMed] [Google Scholar]
  7. Garnero P., Rousseau J. C., Delmas P. D. Molecular basis and clinical use of biochemical markers of bone, cartilage, and synovium in joint diseases. Arthritis Rheum. 2000 May;43(5):953–968. doi: 10.1002/1529-0131(200005)43:5<953::AID-ANR1>3.0.CO;2-Q. [DOI] [PubMed] [Google Scholar]
  8. Gibson T., Burry H. C., Poswillo D., Glass J. Effect of intra-articular corticosteroid injections on primate cartilage. Ann Rheum Dis. 1977 Feb;36(1):74–79. doi: 10.1136/ard.36.1.74. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gogia P. P., Brown M., al-Obaidi S. Hydrocortisone and exercise effects on articular cartilage in rats. Arch Phys Med Rehabil. 1993 May;74(5):463–467. doi: 10.1016/0003-9993(93)90105-j. [DOI] [PubMed] [Google Scholar]
  10. Hart S. M., Eastell R. Biochemical markers of bone turnover. Curr Opin Nephrol Hypertens. 1999 Jul;8(4):421–427. doi: 10.1097/00041552-199907000-00005. [DOI] [PubMed] [Google Scholar]
  11. Joosten L. A., Helsen M. M., Saxne T., van De Loo F. A., Heinegard D., van Den Berg W. B. IL-1 alpha beta blockade prevents cartilage and bone destruction in murine type II collagen-induced arthritis, whereas TNF-alpha blockade only ameliorates joint inflammation. J Immunol. 1999 Nov 1;163(9):5049–5055. [PubMed] [Google Scholar]
  12. Kirwan J. R. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. The Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. N Engl J Med. 1995 Jul 20;333(3):142–146. doi: 10.1056/NEJM199507203330302. [DOI] [PubMed] [Google Scholar]
  13. Lems W. F., Gerrits M. I., Jacobs J. W., van Vugt R. M., van Rijn H. J., Bijlsma J. W. Changes in (markers of) bone metabolism during high dose corticosteroid pulse treatment in patients with rheumatoid arthritis. Ann Rheum Dis. 1996 May;55(5):288–293. doi: 10.1136/ard.55.5.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Oka M. Radiation synovectomy of the rheumatoid knee with yttrium 90. Ann Clin Res. 1975 Jun;7(3):205–210. [PubMed] [Google Scholar]
  15. Pelletier J. P., Martel-Pelletier J. Protective effects of corticosteroids on cartilage lesions and osteophyte formation in the Pond-Nuki dog model of osteoarthritis. Arthritis Rheum. 1989 Feb;32(2):181–193. doi: 10.1002/anr.1780320211. [DOI] [PubMed] [Google Scholar]
  16. Saxne T., Heinegård D. Cartilage oligomeric matrix protein: a novel marker of cartilage turnover detectable in synovial fluid and blood. Br J Rheumatol. 1992 Sep;31(9):583–591. doi: 10.1093/rheumatology/31.9.583. [DOI] [PubMed] [Google Scholar]
  17. Saxne T., Heinegård D., Wollheim F. A. Therapeutic effects on cartilage metabolism in arthritis as measured by release of proteoglycan structures into the synovial fluid. Ann Rheum Dis. 1986 Jun;45(6):491–497. doi: 10.1136/ard.45.6.491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Sharif M., Salisbury C., Taylor D. J., Kirwan J. R. Changes in biochemical markers of joint tissue metabolism in a randomized controlled trial of glucocorticoid in early rheumatoid arthritis. Arthritis Rheum. 1998 Jul;41(7):1203–1209. doi: 10.1002/1529-0131(199807)41:7<1203::AID-ART9>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
  19. Topp J. R., Cross E. G., Fam A. G. Treatment of persistent knee effusions with intra-articular radioactive gold. Can Med Assoc J. 1975 May 3;112(9):1085–1089. [PMC free article] [PubMed] [Google Scholar]
  20. Vingsbo-Lundberg C., Saxne T., Olsson H., Holmdahl R. Increased serum levels of cartilage oligomeric matrix protein in chronic erosive arthritis in rats. Arthritis Rheum. 1998 Mar;41(3):544–550. doi: 10.1002/1529-0131(199803)41:3&#x0003c;544::AID-ART21&#x0003e;3.0.CO;2-#. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES