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#172381 10/14/04 05:08 PM
Joined: Mar 2004
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Kotte Offline OP
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Hi all!

Has any of you ever heard about Remicade injections directly into an inflammed joint?

When I had my Remicade infusion today, I overheard the nurse talking to one of the other patients in the room (think she was a RA). If I understand correctly she took Remicade injections directly in her TMJ (jaw joint), because the steroid shots she was taking earlier was eroding away all the bone. She was also taking regular Remicade infusions. She said it had worked well and her ability to open her mouth increased from 25 to 40 mm (1-1.6 inches). I've also big problems with my TMJ, can only open my mouth some 13 mm (0.5 inches), but my rheummy never mentioned this.

/Mattias



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Yes, I've heard about it. Here's a study on it in psoriatic arthritis:

From European League Against Rheumatism http://www.eular.org


FRI0143 INTRAARTICULAR INJECTION OF INFLIXIMAB IN RELAPSING KNEE EFFUSION IN PSORIATIC ARTHRITIS: A PILOT STUDY
L. Niccoli1, F. Cantini1, G. Porciello1, L. Storri1, C. Nannini1, A. Padula2, I. Olivieri2, L. Boiardi3, C. Salvarani3
1II Division of Medicine-Rheumatology Unit, Hospital of Prato, Prato, 2Department of Rheumatology of Basilicata, Ospedale S.Carlo, Potenza, 3Division of Rheumatology, Arcispedale S.maria Nuova, Reggio Emilia, Italy

Background: Some patients with psoriatic arthritis (PsA) continue to experience recurrent knee effusion despite repeated local corticosteroid injections and a good clinical response to immunosuppressive therapy of other articular manifestations.

Objectives: To evaluate the efficacy and safety of intraarticular knee injections of infliximab in a clinical series of patients with PsA who had refractory knee effusion.

Methods: We treated 3 females (median age 46 ys.) with PsA who experienced monthly recurrent, abundant knee effusion with local injection of infliximab at the dose of 50 mg diluted in 5 ml of saline solution at 6-week intervals. This dose was arbitrarily chosen. The median duration of the disease was 88 months. All 3 patients were receiving methotrexate (10 to 15 mg/week/im) and infliximab 5 mg/Kg/iv every 8 weeks. The 3 patients respectively received this therapy for 16, 14 and 12 months with remission of other articular symptoms at month 2, 3 and 3, respectively. Knee effusions relapsed every 6-8 weeks despite repeated fluid aspiration followed by local injection of 40 mg of methylprednisolone acetate. All aseptic procedure precautions were carried out before the injections. The first injection was done through the same needle used for arthrocentesis after a complete fluid aspiration. Fluid analysis for bacterial infections was performed. The following injections were done with the needle of the drug-filled syringe if joint effusion was absent. At the time of injection, patients were clinically and sonographically assessed for the presence of fluid in the knee joint. Moreover, patients were clinically evaluated for the presence of symptoms and signs of local infection every 2 weeks.

Results: Before the first injection, patient 1 had bilateral knee effusion and 160 ml and 150 ml of synovial fluid were aspirated from the right and left knee, respectively. 120 ml of fluid was aspirated from the right knee of the second patient and 100 ml fluid from the left knee of the third patient. Patient 1 did not experience any further knee fluid effusion over a 4-month follow up period. Patient 2 had a recurrence after 5 weeks but did not relapse anymore over the next 4 months. The third patient experienced a good response with no recurrence of fluid effusion during the next 3 months of follow up. None of the patients developed neither symptoms and signs of local infection nor local or systemic signs of adverse events due to infliximab.

Conclusion: Local knee injections of infliximab at the dose of 50 mg may represent an effective and safe therapy in patients with PsA and refractory knee effusions.



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Kotte Offline OP
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Thanks for the info Nina, this was new to me.

Still doing ok on the Humira I hope?

/Mattias


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Hi Mattias,

Yep Humira is working very well, although I managed to catch "svinkoppor" (which is pretty weird, since it's a kindergarten disease) a while ago and had to temporarily go off it until they were gone. This caused a rebound effect, so now I have to go for a cortisone shot on Thursday for my shoulder.

I was wondering - have you had any cortisone injections into your jaw? If so, did they work? My jaw is really painful, so I'm gonna ask my rheumy for one when I have the shoulder injected.

Nina


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Kotte Offline OP
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Ouch

You do everything to feel young again (though not in any way implying that you are old)

I've never gotten any cortisone injections. The problem with my jaw involvement, is that there has never been any pain, only a very gradual decrease in movement, even though the joint now seems to be more or less completely ruined. Because of the lack of pain, I failed to tell my rheumy before it was (I suspect) too late. And when he finally become aware of it, he sent me to a oral/maxillofacial surgeon. (my rheumy isn't the most committed one). I was on the track of having a total TMJ-replacement, but after getting a second opinon on the matter, I think I'll wait and see. At least it's not getting worse, since I started on Remicade.

/Mattias




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