Intra-articular infliximab for refractory Ankylosing Spondylitis

A single intra-articular injection of influximab can provide several months of remission for refractory inflammatory monoarthritis in patients with ankylosing spondylitis (AS).In order to evaluate the effect of intra-articular infliximab in patients with AS with treatment-resistant arthritis as a means to avoiding long-term treatment with intravenous infliximab Dr Lieve Schatteman (St. Augustinus Hospital, Belgium) and colleagues describe a series of case studies.The three subjects included a 24-year-old man, a 27-year-old woman and a 48-year-old man. Participants had swelling, pain and immobility in one knee that did not respond to treatment with non-steroidal anti-inflammatory drugs or intra-articular injections of corticosteroids. Two patients also were on methotrexate.Following a single 100mg dose of infliximab into the affected joint the investigators describe a remission of peripheral arthritis for up to three months in two of the patients and for up to four months in the third. No important side effects were noted.The authors report that mobility was restored and pain and swelling had completely resolved. A decrease in synovial thickening and the amount of fluid within the joint was seen on MRI, and scores on the Bath Ankylosing Spondylitis Disease Activity Index were reduced.Schattermans group comment, "This procedure could be considered an effective and safe treatment for therapy of refractory monoarthritis in patients with ankylosing spondylitis and an alternative to TNF-blocking therapy."Reference...