Since the 1990s bDMARDs have revolutionized the treatment of chronic dysimmune inflammatory arthropathies such as Rheumatoid Arthritis, Psoriatic Arthritis and Axial Spondylarthritis. Nevertheless, despite a full treatment regimen, mono- and oligoarticular persistence of the synovitis is sometimes observed. The IA use of bDMARD drugs could resolve the persistent joint inflammation and result in a reduction in the degree of immunosuppression of individuals; moreover, the use of these drugs intra-articularly could be associated with a reduction in treatment related costs.
We extensively searched via PubMed and Google Scholar articles regarding IA injections using as key words “etanercept‿, “infliximab‿, “adalimumab‿, “certolizumab‿,‿ golimumab‿,‿ tocilizumab‿, “ixekizumab‿, “secukinumab‿, “rituximab‿ each combined with “intra-articular injection‿.
We found and evaluated 161 papers, then we selected 24 that were highly related to the topic of the present work. The articles examined a total of 349 patients, 85 males (M), 168 females (M), mean age 44,75 ± 12,09 years old and considered 556 treated joints. Three hundred and forty-one patients were affected by Rheumatoid Arthritis, 198 by Psoriatic Arthritis, 56 by Axial Spondylarthritis, 26 by Juvenile Idiopathic Arthritis, 19 by Undifferentiated Arthritis, 1 by arthritis associated with inflammatory bowel disease and 9 patients by an unspecified inflammatory articular disorder. All patients were treated intra-articularly (IA) with a TNFα inhibitor among Adalimumab, Etanercept or Infliximab. Side effects were documented in 9 out of 349 (2,57%) treated patients and all were mild or moderate. In some cases the effectiveness of IA bDMARDs treatment is maintained for several months, however in the few published RCTs the GCs appeared to act better when administered IA compared to bDMARDs.
The use of bDMARDs seems to be weakly effective in the management of resistant synovitis and not superior to corticosteroids injections. The treatment’s main limit appear to be the poor persistence of the compound in the joint.
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