Corticosteroid injections reduce size of rheumatoid nodules

Background: Symptomatic rheumatoid nodules are frequently surgically treated. Injection with steroids might be an alternative treatment. Patients and methods: To determine whether injection with triamcinolon acetonide reduces the size of rheumatoid nodules, we randomized twenty patients with symptomatic nodules to either triamcinolon acetonide 40 mg/ml plus lidocaine 2% or lidocaine 1% (placebo). We measured the nodules before injection and 2, 4, 8, and 12 weeks after injection. Possible side effects were recorded. Results: We found that the volume of the nodules injected with triamcinolon acetonide reduced significantly (p=0.011), from 130 to 8 mm3 (median calculated size) at 12 weeks, compared with baseline. Furthermore, at 12 weeks, the difference between the groups was significant (p=0.03). The median size of the placebo nodules diminished as well, from 358 to 237 mm3, but this was not significant. Pain at injection was the only side effect, equally distributed in both treatment groups. Conclusion: Injection with triamcinolon acetonide seems to be an alternative for surgery of rheumatoid nodules. No adverse events occurred but the limited sample does not allow definitive conclusions.