Injection of the rheumatoid knee: does intra-articular methotrexate or rifampicin add to the benefits of triamcinolone hexacetonide?

British Journal of Rheumatology
T BlythJ A Hunter


Does the addition of 600 mg rifampicin or 50 mg methotrexate improve pain relief after injection of the rheumatoid knee with 20 mg triamcinolone hexacetonide (TH)? Eighty-two patients on stable therapy were allocated at random to receive intra-articular TH alone, TH and methotrexate (TH+M) or TH and rifampicin (TH+R). Pain was recorded by a weekly chart and analysed using the area under the curve (AUC), periods of total pain relief and duration of effect. Examinations and microwave thermography were performed by an independent meteorologist at baseline, 3 and 6 months. Using the AUC, pain was significantly better in the TH+R group compared with TH alone (P=0.039, Mann Whitney U). The median duration of improved pain scores was 13.5 weeks with TH alone, 10 with TH+M and 19 with TH+R. Examination and microwave thermography revealed improvements compared with baseline, but there were no significant differences between the groups. Eleven of 28 patients treated with TH + R developed a flare of post-injection pain. Whilst the addition of rifampicin improved pain relief, the occurrence of pain after injection remains a problem. Measures to minimize this are needed when TH+R is used.


Apr 1, 2004·Rheumatology·N HassoA Breslin
Apr 15, 2004·Annals of the Rheumatic Diseases·L Gossec, M Dougados
May 16, 2014·Inflammopharmacology·Justin SchererWalter F Kean
May 25, 2012·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Olivia T ChengJianguo Cheng
Apr 14, 2018·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·George PentazosElias Siores
Jan 31, 2014·Revista brasileira de reumatologia·Rita Nely Vilar FurtadoJamil Natour
May 18, 1999·Current Opinion in Rheumatology·L Ryan, P Brooks
Nov 9, 2019·Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders·Masahiro TadaHiroaki Nakamura

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