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Intra-articular steroids: Confounder of clinical trials

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Summary

The effect of intra-articular (i-a) steroid injection on ESR and C-reactive protein (CRP) in rheumatoid arthritis (RA) was investigated. One week following injection of 1 or 2 knees there was a significant fall in ESR (p<0.0001) and CRP (p<0.01) in a cohort of 20 RA patients. The mean drop for both ESR and CRP was 46%. This effect lasted over a variable period up to 6 months. A survey of 50 published drug efficacy studies in RA revealed that, while 44 used ESR and 20 CRP as efficacy measures, 37 neither excluded nor recorded i-a steroid injections during the study. Steroid injections were excluded in 8 studies and recorded in 5, being used as an outcome measure in 2 of these. It is recommended that the frequency with which i-a injections are used in drug efficacy studies is reported and that they are avoided in the 3 months preceding an outcome measurement if ESR or CRP are being used as outcome measures.

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Authors and Affiliations

  1. The Staffordshire Rheumatology Centre, Haywood Hospital, High Lane, ST6 7AG, Burslem, Stoke-on-Trent, UK

    H. G. Taylor, P. D. Fowler, M. J. David & P. T. Dawes

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  2. P. D. Fowler
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  3. M. J. David
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  4. P. T. Dawes
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Taylor, H.G., Fowler, P.D., David, M.J. et al. Intra-articular steroids: Confounder of clinical trials. Clin Rheumatol 10, 38–42 (1991). https://doi.org/10.1007/BF02208031

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