摘要：目的： 为了解关节内注射激素对早期类风湿关节炎手和掌指关节骨密度的影响。方法：最初的3个月，19例类风湿关节炎患者仅用甲氨蝶呤，另21例患者则除用甲氨蝶呤外，同时对炎性关节内注射激素；随后9个月，所有患者均用甲氨蝶呤联合关节内激素注射治疗。治疗前、治疗3个月和12个月分别检测患者的手及第2-5掌指关节周围的骨密度。结果：最初3个月，与单用甲氨蝶呤组相比，甲氨蝶呤联合关节内注射激素组的骨丢失发生率较低，尤其是与整个手(-1.53% 对-2.42%， p=0.32)相比，掌指关节周围区域的骨密度更明显(如, 近端指骨：第二指，-0.45% 对 -2.69%, p=0.045；第三指，-0.34%对-3.32%, p=0.003；第四指，-0.39% 对-2.57%， p=0.14；第五指，-0.59%对-2.70%，p=0.24) 。而在3~12个月间，两组间仅有轻度差别，无统计学意义。结论：类风湿关节炎患者3个月内关节内注射激素有助于防止炎性手指关节的关节周围骨丧失。对活动性类风湿关节炎抑制炎症有助于保持骨健康。

附原文 Abstract OBJECTIVES: To explore the effect of intra-articular corticosteroid (IAST) injections on bone mineral density (BMD) in the hand and at the metacarpophalangeal (MCP) joints in early rheumatoid arthritis (RA). METHODS: /st> In the first 3 months of the study, 19 patients with RA received methotrexate (MTX) alone and 21 received MTX and IAST injections into clinically inflamed joints. In the following 9 months, all patients received MTX+IAST. BMD was assessed at the hand and periarticular regions at MCP joints 2-5 at baseline, 3 and 12 months. RESULTS: /st> In the first 3 months a numerically lower percentage rate of bone loss was seen in MTX+IAST-treated patients compared with MTX-treated patients. This observation was more pronounced at the MCP periarticular regions (eg, partial proximal phalanges: digit 2, -0.45% vs -2.69%, p=0.045; digit 3, -0.34% vs -3.32%, p=0.003; digit 4, -0.39% vs -2.57%, p=0.14; digit 5, -0.59% vs -2.70%, p=0.24) than for the whole hand (-1.53% vs -2.42%, p=0.32). In the 3-12-month period, only minor non-statistically significant differences were seen between the two groups. CONCLUSION: /st> IAST given over 3 months protects against periarticular bone loss in inflamed finger joints in RA. These data emphasise the importance of suppressing inflammation in patients with active RA to maintain bone health.

引自：Haugeberg G, Morton S, Emery P, et al.Effect of intra-articular corticosteroid injections and inflammation on periarticular and generalised bone loss in early rheumatoid arthritis.Ann Rheum Dis, 2010 Aug 30. [Epub ahead of print]