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The association between synovial fluid serine proteinase activity and response to intra-articular corticosteroid injection in psoriatic arthritis

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Abstract

Introduction/objectives

Intra-articular corticosteroid (IAS) injections are often used for the immediate relief of pain and inflammation in the joint of psoriatic arthritis (PsA) patients. However, studies identifying factors that predict response to the IAS injections are lacking. We aimed to assess the usefulness of serine proteinase activity measurements in PsA synovial fluid (SF) samples obtained at the time of injection in predicting clinical response.

Methods

The PsA patients with available SF samples from the knee joint were identified from the University of Toronto PsA cohort. Clinical response was defined as an absence of tenderness or swelling in the injected joint at the first post-injection visit, at either 3 or 6 months. SF proteinase activity was determined by measuring cleavage of fluorogenic tri-peptide substrates for trypsin-like (VPR-AMC and VLK-AMC) and chymotrypsin-like (AAPF-AMC) serine proteinases. Generalized estimating equation (GEE) models were used to investigate factors associated with response.

Results

A total of 32 patients with 60 injected joints and data available for follow-up at 3 or 6 months were included in the analysis, with 25 (41.7%) injected joints resulting in clinical response. Age, sex, active joint count, systemic medications and SF serine proteinase activity at the time of injection were included as covariates. Only treatment with biologics was significantly associated with response at 3 or 6 months in the multivariate reduced model (OR 3.02, p = 0.027).

Conclusions

We could not demonstrate an association between SF serine proteinase activity and response to IAS injection. Biologic agents significantly improve the likelihood of achieving clinical response.

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Data availability

The datasets generated during and/or analysed during the current study are available in the Mendeley repository (https://doi.org/10.17632/w5fxh4bv85.1).

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Funding

This work was supported by an Edward Dunlop 2017 challenge research grant and a Krembil Foundation 2016 research grant. The Psoriatic Arthritis Program is supported by a grant from the Krembil Foundation.

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Author notes

  1. Katerina Oikonomopoulou and Vinod Chandran contributed equally to this work.

Authors and Affiliations

  1. Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, University of Toronto, 399 Bathurst Street 1E-416, Toronto, Ontario, M5T 2S8, Canada

    Fatima Abji, Justine Yang Ye, Katerina Oikonomopoulou & Vinod Chandran

  2. Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada

    Richard J Cook

  3. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada

    Vinod Chandran

  4. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

    Vinod Chandran

  5. Institute of Medical Science, University of Toronto, Toronto, Canada

    Vinod Chandran

  6. Department of Medicine, Memorial University, St. John’s, Canada

    Vinod Chandran

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  1. Fatima Abji
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  2. Justine Yang Ye
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Correspondence to Vinod Chandran.

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Abji, F., Ye, J.Y., Cook, R.J. et al. The association between synovial fluid serine proteinase activity and response to intra-articular corticosteroid injection in psoriatic arthritis. Clin Rheumatol 39, 2355–2361 (2020). https://doi.org/10.1007/s10067-020-05003-9

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