Knee inflammation at first presentation for RA is associated with a severe disease course

  • Published 2007 in Nature Clinical Practice Rheumatology


Treatment with glucocorticoids can resolve most cases of polymyalgia rheumatica within 2 years; however, a minority of patients have a chronic, relapsing form of the disease and require long-term glucocorticoid treatment, which carries a high risk of steroid-related adverse events. After a pilot study suggested that infliximab might have a steroid-sparing effect, Salvarani et al. evaluated the effect of infliximab in patients newly diagnosed with polymyalgia rheumatica in a randomized double-blind placebo-controlled trial. Results showed, however, that infliximab was no better than placebo as treatment for the condition. Of the 51 patients enrolled, 23 received infliximab (3 mg/kg at weeks 0, 2, 6, 14 and 22) and 28 received placebo. All patients also received 15 mg prednisone daily for the first 4 weeks; the dose was then tapered to 2.5 mg daily over the following 12 weeks. Two patients dropped out in the infliximab group because of adverse events—one because of giant cell arteritis and one because of systemic infection. Four patients in the infliximab group had infusion reactions, but treatment did not need to be discontinued. At 52 weeks, 6 patients (30%) in the infliximab group and 10 patients (37%) in the placebo group were free of relapse or recurrence. Limitations of the study included a low dose of infliximab, rapid prednisone tapering (which might have contributed to the high rate of disease flare-ups) and a small sample size (a larger treatment effect was expected). The authors conclude that infliximab is unlikely to benefit patients with polymyalgia rheumatica.

DOI: 10.1038/ncprheum0549

Cite this paper

@article{2007KneeIA, title={Knee inflammation at first presentation for RA is associated with a severe disease course}, author={}, journal={Nature Clinical Practice Rheumatology}, year={2007}, volume={3}, pages={424-425} }