Predictors of outcome in patients with oligoarthritis - Results of a protocol of intraarticular corticosteroids to all clinically active joints

Objective. To determine the outcome and the factors that predict the persis tence of synovitis following intraarticular corticosteroid injections in pa tients with recent-onset oligoarthritis. Methods. Fifty-one patients with less than or equal to5 joints with synovit is (disease duration less than or equal to 12 months) were treated with int raarticular injections of methylprednisolone into all joints with clinical synovitis. Predictors of outcome were sought, with the primary end point a complete response (no synovitis on clinical examination) at 12 weeks. Results. Patient's and physician's assessments of disease activity, the swo llen joint count, and function (by Health Assessment Questionnaire) were al l significantly improved at 12 weeks (P < 0.001). Twenty-nine patients (57% ) were judged to have had a complete response at 2 weeks. The best predicto r of response at 12 and 26 weeks was the presence or absence of synovitis a t 2 weeks (P = 0.002 and P = 0.004, respectively). At 52 weeks of followup, nearly 50% of the patients still had evidence of synovitis. Conclusion. Intraarticular corticosteroids are an effective treatment for e arly oligoarthritis, but there is still a high level of long-term morbidity . Failure to respond by 2 weeks indicates a high likelihood of persistent d isease, and this is relevant when producing management guidelines and selec ting patients for studies focusing on early intervention.