Despite previously carrying out a first open study of sacroiliac injection of long-acting corticosteroid, it was not possible to evaluate the role of a placebo effect. We therefore performed a double-blind study in 10 patients/13 articulations, suffering painful sacroiliitis. At 1 month, 5/6 sacroiliac joints injected with corticosteroid described a relief of > 70%, in comparison to 0/7 of the placebo group (P < 0.05). Dolometry showed a marked decrease in the corticosteroid group from (mean +/- S.E.M.) 6.8 +/- 0.6 to 1.3 +/- 0.3, and decreases were mild in the placebo group: 7.0 +/- 0.6 to 5.2 +/- 0.5 (P < 0.005). Six of the seven sacroiliac joints of the placebo group and two patients with failure and relapse of the corticosteroid group were reinjected with corticosteroid. At 1 month, 12/14 (85.7%) were assessed as having a good result. Results were still significant at 3 months (62%) and 6 months (58%). Tolerance was good or very good in 86% of the cases, and we did not report any notable complication. This technique is safe and very efficient, and it has to be considered more widely in patients with contraindications or complications with NSAID, or if the medical treatment is unable to control sufficiently the active sacroiliitis.
Objective. To evaluate the efficacy and tolerability of a single intraarticular (IA) injection of hyaluronic acid (HA) for the treatment of hip osteoarthritis (OA).Methods. A multicenter, randomized, parallelgroup, placebo-controlled trial was conducted over 3 months. Patients (older than 30 years) with symptomatic hip OA (pain score of >40 mm on a visual analog scale [VAS]) and a Kellgren/Lawrence grade of 2 or 3 were randomly assigned to receive 1 fluoroscopically guided IA injection of HA (2.5 ml) or placebo (2.5 ml). Patients were followed up for 3 months. The main outcome measure was pain score on a VAS (100 mm) at month 3 compared with baseline. Secondary outcome measures were the proportion of responders defined by Osteoarthritis Research Society International criteria; Western Ontario and McMaster Universities Osteoarthritis Index subscores for pain, stiffness, and disability; and patient and physician global assessment. Randomization was computer generated. HA and placebo preparations were placed in numbered identical containers, and syringes were covered with masking tape. Physicians assessing outcomes were blinded with regard to group assignment.Results. Eighty-five patients were randomized to the HA group (n ؍ 42) or placebo group (n ؍ 43). Baseline characteristics were similar between the 2 groups. At 3 months, the decrease in pain score did not differ between the HA and placebo groups in the intentto-treat analysis (mean ؎ SD decrease 7.8 ؎ 24.9 mm with HA versus 9.1 ؎ 27.4 mm with placebo; P ؍ 0.98). The responder rates were 33.3% and 32.6% in the HA and placebo groups, respectively (P ؍ 0.94). Other secondary end points did not differ between the groups, nor did use of rescue medication or frequency of adverse events.Conclusion. Our findings indicate that a single IA injection of HA is no more effective than placebo in treating the symptoms of hip OA.Osteoarthritis (OA) is the most common type of arthritis and the major cause of disability in elderly populations worldwide. Hip OA is the second most frequent form of OA affecting a large joint, and its prevalence ranges from 3% to 11% in populations older than 35 years (1-3).Current therapies for hip OA include a combination of nonpharmacologic and pharmacologic treatments (4-6). Viscosupplementation is an intraarticular (IA) therapeutic modality that is based on the physiologic importance of hyaluronic acid (HA) in synovial ClinicalTrials.gov identifier: NCT00330135.
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