Patients will be assigned to receive either Depo Medrol or Acthar treatment. A synovial biopsy, blood draws, synovial fluid aspiration, and physician assessments will be performed before and after initiating treatment.
Patients will be assigned to receive either Depo Medrol or Acthar treatment. A synovial biopsy, blood draws, synovial fluid aspiration, and physician assessments will be performed before and after initiating treatment. At screening visit, inclusion and exclusion criteria will be assessed. If assessments have not been completed to verify these criteria, they will be performed at this visit. After patients are confirmed to meet criteria, patient disease activity will be assessed and blood draw, synovial aspiration, and biopsy will be performed before first treatment injection. About 5 days after this first treatment injection, these assessment and samples will be performed again. About 5-6 weeks after first treatment injection, a final physician assessment will be performed. Patients will have the option of consenting to allow storage of samples for future research.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
6
Acthar is a non-specific melanocortin receptor agonist
Depo medrol is an anti-inflammatory glucocorticoid
Attune Health
Beverly Hills, California, United States
Degree of inflammation after short term treatment, as measured by a pathologist during histological assessment
Samples will be sectioned and stained with Haemotoxylin and Eosin and a pathologist blind to treatment will examine the sections under a microscope to determine whether or not inflammation is present compared to how healthy samples would be expected to appear.
Time frame: Samples collected about 30 minutes before first treatment injection and about five days after this first injection
Initial degree of inflammation, as measured by a pathologist during histological assessment
Samples will be sectioned and stained with Haemotoxylin and Eosin and a pathologist blind to treatment will examine the sections under a microscope to determine whether or not inflammation is present compared to how healthy samples would be expected to appear.
Time frame: Samples collected about five days after first injection of treatment
Initial disease activity as measured by blinded clinician using DAS28 (Disease Activity Score)
In DAS28, a clinician assesses 28 specified joints for tenderness and swelling. A blood draw is performed at time of assessment to measure Erythrocyte Sedimentation Rate (in mm/h). The patient global health assessment (from 0=best to 100=worst) is also used. A specific algorithm is used to calculate the DAS28 score, using the measurements obtained as variables that plug into the algorithm.
Time frame: Assessments are performed about 1 hour before first treatment injection
Disease activity after short-term treatment as measured by blinded clinician using DAS28 (Disease Activity Score)
In DAS28, a clinician assesses 28 specified joints for tenderness and swelling. A blood draw is performed at time of assessment to measure Erythrocyte Sedimentation Rate (in mm/h). The patient global health assessment (from 0=best to 100=worst) is also used. A specific algorithm is used to calculate the DAS28 score, using the measurements obtained as variables that plug into the algorithm.
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Time frame: Assessments are performed about 5 days after first treatment injection
Disease activity after long-term treatment as measured by blinded clinician using DAS28 (Disease Activity Score)
In DAS28, a clinician assesses 28 specified joints for tenderness and swelling. A blood draw is performed at time of assessment to measure Erythrocyte Sedimentation Rate (in mm/h). The patient global health assessment (from 0=best to 100=worst) is also used. A specific algorithm is used to calculate the DAS28 score, using the measurements obtained as variables that plug into the algorithm.
Time frame: Assessments are performed about 5-6 weeks after first treatment injection.
Initial number of tender and swollen joints as measured by clinician while palpating 28 specified joints
A clinician assesses 28 specified joints for tenderness and swelling.
Time frame: Assessments are performed about 1 hour before first treatment injection
Number of tender and swollen joints after short-term treatment as measured by clinician while palpating 28 specified joints
A clinician assesses 28 specified joints for tenderness and swelling.
Time frame: Assessments are performed about 5 days after first treatment injection
Number of tender and swollen joints after long-term treatment as measured by clinician while palpating 28 specified joints
A clinician assesses 28 specified joints for tenderness and swelling.
Time frame: Assessments are performed about 5-6 weeks after first treatment injection.
Initial Erythrocyte Sedimentation Rate (ESR) present in blood (in mm/h)
The Westergren method requires collecting 2 ml of venous blood into a tube containing 0 .5 ml of sodium citrate. It should be stored no longer than 2 hours at room temperature or 6 hours at 4 °C. The blood is drawn into a Westergren-Katz tube to the 200 mm mark. The tube is placed in a rack in a strictly vertical position for 1 hour at room temperature, at which time the distance from the lowest point of the surface meniscus to the upper limit of the red cell sediment is measured. The distance of fall of erythrocytes, expressed as millimeters in 1 hour, is the Erythrocyte Sedimentation Rate.
Time frame: Assessments are performed about 1 hour before first treatment injection
Erythrocyte Sedimentation Rate (ESR) present in blood (in mm/h) after short-term treatment
The Westergren method requires collecting 2 ml of venous blood into a tube containing 0 .5 ml of sodium citrate. It should be stored no longer than 2 hours at room temperature or 6 hours at 4 °C. The blood is drawn into a Westergren-Katz tube to the 200 mm mark. The tube is placed in a rack in a strictly vertical position for 1 hour at room temperature, at which time the distance from the lowest point of the surface meniscus to the upper limit of the red cell sediment is measured. The distance of fall of erythrocytes, expressed as millimeters in 1 hour, is the Erythrocyte Sedimentation Rate.
Time frame: Assessments are performed about 5 days after first treatment injection
Erythrocyte Sedimentation Rate (ESR) present in blood (in mm/h) after long-term treatment
The Westergren method requires collecting 2 ml of venous blood into a tube containing 0 .5 ml of sodium citrate. It should be stored no longer than 2 hours at room temperature or 6 hours at 4 °C. The blood is drawn into a Westergren-Katz tube to the 200 mm mark. The tube is placed in a rack in a strictly vertical position for 1 hour at room temperature, at which time the distance from the lowest point of the surface meniscus to the upper limit of the red cell sediment is measured. The distance of fall of erythrocytes, expressed as millimeters in 1 hour, is the Erythrocyte Sedimentation Rate.
Time frame: Assessments are performed about 5-6 weeks after first treatment injection.
Initial patient global health assessment measured by the patient (from 0=best to 100=worst)
A patient is asked to rate their general global health on a scale from 0 to 100
Time frame: Assessments are performed about 1 hour before first treatment injection
Patient global health assessment measured by the patient (from 0=best to 100=worst) after short-term treatment
A patient is asked to rate their general global health on a scale from 0 to 100
Time frame: Assessments are performed about 5 days after first treatment injection
Patient global health assessment measured by the patient (from 0=best to 100=worst) after long-term treatment
A patient is asked to rate their general global health on a scale from 0 to 100
Time frame: Assessments are performed about 5-6 weeks after first treatment injection.