Treatment of resistant rheumatoid arthritis by intra-articular infliximab injections: a pilot study.

R heumatoid arthritis (RA) is a chronic inflammatory disease which is characterised mainly by synovial inflammation and joint destruction, as well as extraarticular manifestations. Cytokines have a central role in the pathogenesis of this synovial inflammation. Tumour necrosis factor a (TNFa) is one of the dominant cytokines. Many studies have shown that TNFa is present in biologically significant amounts in RA synovial tissue and fluids, and the amount seems to parallel the extent of inflammation and bone erosion. 3 Persistent inflamed monarthritis in patients with RA is difficult to treat. Usually it is treated with local patches, intraarticular injections of steroids, or even with chemical, radioactive, or surgical synovectomy. The introduction of anti-TNFa treatments, especially the infusion of infliximab, prompted us to investigate the effectiveness and safety of intra-articular injection of infliximab in patients with RA and resistant monarthritis.