Objective: To study the effects of neglecting
intra-articular glucocorticoid injections (IAGCIs) into swollen joints in early
rheumatoid arthritis (RA).

Methods: Ninety-nine patients with early, DMARD
naive RA were treated, aiming at remission, with methotrexate, sulfasalazine, hydroxychloroquine,
low-dose oral prednisolone and, when needed, IAGCIs for 2 years, and randomised
to receive infliximab or placebo from weeks 4 to 26. During each of the 15
study visits, patients were scored retrospectively 0.2–0.4 points (depending on
the number of non-injected joints) if IAGCIs to all swollen joints were not
given. Patients were divided into tertiles by their cumulative scores for
neglected injections (CSNI) over 24 months. 28-joint disease activity score
(DAS28) area under the curve (AUC) between 0–24 months, remission rates,
changes in quality of life, and radiological changes during the follow-up were
assessed. Trends across tertiles of CSNI were tested with generalized linear
models.

Results: Higher CSNI was associated with lower
strict remission rates (p=0.005), and lower quality of life (p=0.004) at 24
months, and higher DAS28 AUC (p<0.001) during the follow-up. At 24 months,
DAS28 remission rates were 90%, 93% and 76% (p=0.081), and strict remission
rates were 74%, 77% and 39% by tertiles of CSNI. No significant differences
were observed in radiological progression (p=0.089). IAGCIs were well
tolerated.

Conclusion: Neglecting IAGCIs into swollen joints is
associated with lower remission rates, higher disease activity, and lower
quality of life. Hence, IAGCIs should be used as an integral part of the
targeted treatment of early RA.