Background:Low doses of glucocorticoids (GCs) can be useful in the management of osteoarthritis when it is related to hypoestrogenic states (estrogen-dependent primary polyarticular osteoarthritis [EDPOA]), that usually can appear after the menopause. Deflazacort is a GC that has similar anti-inflammatory effects than other steroids, but with fewer side effects.Objectives:To describe the average dose of GCs that best controlled articular pain, based on tender joint count in patients with EDPOA.Methods:The diagnosis of EDPOA was made in postmenopausal patients with polyarticular compromised (six or more joints affected), morning stiffness less than 30 minutes, erythrocyte sedimentation rate less than 45mm/hour and imaging studies with changes related to osteoarthritis (radiography, magnetic resonance imaging or bone scintigraphy). Patients with autoimmune diseases such as rheumatoid arthritis, lupus or Sjögren syndrome were excluded.The clinical records of patients diagnosed with EDPOA and treated between January 2015 and June 2019 at the Valle del Lili foundation Hospital were reviewed. The patients treated with deflazacort GC were included. Pain was assessed by the treating rheumatologist using the visual analog scale (VAS, possible score 0-10). Tender joints were those with VAS> 5. The count of compromised joints was compared with inflammatory findings on bone scintigraphy (Figure 1).Figure 1.Comparison between number of joints with inflammatory findings on bone scintigraphy and number of swollen joints in physical evaluationThe number of tender joints was recorded at the start of treatment, which was a dose of 6 mg/day of deflazacort for two months. Subsequently, the dose was reduced depending on the improvement of pain (items: intensity of pain and number of tender joints) until achieving a stabilization along the time with an improvement of 75% of the items evaluated. The number of painful joints was recorded again two months after the stabilization on pain control was achieved.Quantitative variables were described with medians and interquartile ranges because the absence of normal distribution of the sample size. To assess the presence of a significant decrease on the number of tender joints the Wilcoxon range test was used, a value of p<0.001 was considered statistically significant. The data were analyzed with Stata v.15.Results:Twenty-eight patients with EDPOA were included, with a median of age of 50 years (IQR 44-51), 56 years (IQR 52-66) and 61 years (IQR 54-69) at the time of menopause, onset of symptoms and the diagnosis of EDPOA respectively. A median of 18 tender joints (IQR 10-27) was obtained from the physical examination of the records reviewed. The dose of deflazacort that achieved stabilization on the improvement of the pain along the time was 21mg/week (IQR 12-21); after 8 weeks of treatment the number of tender joints was 2 (IQR 1-4), which implies a reduction of 14 (IQR 8-20; p<0.0001) on the tender joint count (Figure 2).Figure 2.Number of tender joints before and after eight weeks of treatment achieving with a stable pain control in patients with EDPOA treated with deflazacort with a media dose of 3mgr/day.Conclusion:In this case series a media dose of deflazacort of 21mg per week (3mg/day) was useful to significantly reduce the number of tender joints in patients with EDPOA.References:[1]Roman-Blas JA, Castañeda S, Largo R,et al. Osteoarthritis associated with estrogen deficiency. Arthritis Research & Therapy 2009;11:241.[2]Cvoro A, Yuan C, Paruthiyil S,et al. Crosstalk between glucocorticoid and estrogen receptors occurs at a subset of proinflammatory genes. The Journal of Immunology 2011;186:4354-4360.[3]Féline K, Marion K, Annelies B,et al. Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): a double-blind, randomised, placebo-controlled trial. Lancet 2019;394:1993-2001.Disclosure of Interests:None declared
Double blinded, a randomized, double-blinded, control trial shows that onabotulinum toxin A (Botox®) nerve blocks do not provide improved long term pain control compared to control treatments for men with chronic scrotal pain