Importance of placement of intra-articular steroid injections.

Jones, Adrian; Regan, Marian; Ledingham, Joanna; Pattrick, M; Manhire, A.R.; Doherty, Michael

doi:10.1136/bmj.307.6915.1329

Cited by 359 publications

(254 citation statements)

References 5 publications

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“…Wobig et al (4) did not find differences in the rates of adverse effects in patients who were treated with hyaluronan therapy and those receiving placebo, thus supporting the injection technique etiology. Other studies suggest that even when an experienced rheumatologist performs intraarticular injections, one-third of these are not delivered into the intraarticular space (5 …”

Section: To the Editormentioning

confidence: 99%

Acute adverse reaction to hylan G‐F 20: Comment on the article by Martens

Gil

Matéu

Alegre

2003

Arthritis & Rheumatism

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Section: To the Editormentioning

confidence: 99%

Acute adverse reaction to hylan G‐F 20: Comment on the article by Martens

Gil

Matéu

Alegre

2003

Arthritis & Rheumatism

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“…Therefore the response to CS injections may vary considerably among patients because the physician can perform the injection in an unaffected site or can fail to inject all affected sites (18 -21). Thus, radiographic guidance for injection of certain joints is strongly recommended to ensure accuracy of injection (18). Moreover, the presence of inflammatory signs (synovitis or effusion) seems to correlate with the degree of improvement (22).…”

Section: Introductionmentioning

confidence: 99%

Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind‐, and mid‐foot in chronic inflammatory diseases

D'Agostino¹,

Ayral²,

Baron³

et al. 2005

Arthritis & Rheumatism

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Objective. To assess the impact of ultrasonography (US) on local corticosteroid (CS) injections of painful ankle, hindfoot, and midfoot in chronic inflammatory diseases.Methods. Consecutive patients with chronic rheumatic diseases admitted to the hospital for local CS injections of painful ankle, hindfoot, or midfoot were enrolled in this study. Clinical and radiographic evaluation was performed by the physician in charge of CS injections, and US examination was performed by an independent examiner blinded to the clinical and radiologic findings. According to a randomized weekly-periods design, the physician planned CS injections either aware (G1 group) or unaware (G2 group) of US results. In the latter case, he was nonetheless informed of US results after he had performed the injections. Impact of this information on the treatment planning was assessed in all cases. Prognostic impact of US was also evaluated by comparing the change in global assessment of efficacy of CS injections, in activity of the disease, and in the Western Ontario and McMaster Universities (WOMAC) subscales after 1 and 3 months, between G1 and G2 groups. Results. The knowledge of US findings led the physician to change his decision of local CS injections in 56 (82%) of 68 patients studied. Among 1,131 assessed sites, by clinical, radiographic, and US evaluation, injection was cancelled in 37 (15%) of 242 proposed sites, whereas it was decided in 74 (8%) additional sites. After 1 month, there was an improvement in G1 as compared with G2 groups. The mean ؎ SD change in WOMAC physical function subscale was 15.6 ؎ 17.5 in G1 versus 8 ؎ 13 in G2 (P ‫؍‬ 0.0305). After 3 months, only the global assessment of efficacy of CS injections was statistically greater in G1 than in G2 group (P ‫؍‬ 0.0170). Conclusion. US frequently led the physician to change his diagnosis of inflammatory lesions in painful foot, and consequently his planning of CS injections. Moreover, US could improve the response to local treatment.

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“…Placement of the IA steroid (without imaging guidance) is frequently inaccurate, and this may have a significant effect on clinical response (11). Controversy persists regarding the claim that good results can be achieved without fluoroscopy (12).…”

mentioning

confidence: 99%

Steroid injection for osteoarthritis of the hip: A randomized, double‐blind, placebo‐controlled trial

Lambert

Hutchings

Grace

et al. 2007

Arthritis & Rheumatism

134

110

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Objective. To determine the efficacy of fluoroscopically guided corticosteroid injection for hip osteoarthritis (OA) in a randomized, double-blind, placebocontrolled trial.Methods. Fifty-two patients with symptomatic hip OA were randomly allocated to receive placebo (10 mg bipuvicaine, 2 ml saline) (n ‫؍‬ 21) or corticosteroid treatment (10 mg bipuvicaine, 40 mg triamcinolone hexacetonide) (n ‫؍‬ 31). Patients were followed up for 1, 2, 3, and 6 months. The primary outcome measure was the pain improvement response, defined as a 20% decrease in the Western Ontario and McMaster Universities OA Index (WOMAC) pain score (on 5 100-mm visual analog scales [VAS]) (WOMAC20) from baseline to 2 months postinjection. Secondary outcomes were a 50% decrease in the WOMAC pain score (WOMAC50), changes in other WOMAC subscale scores, patient's global assessment of health (on a 100-mm VAS), and Short Form 36 (SF-36) quality of life indices. Analyses were based on the intent-to-treat principle.Results. The mean WOMAC pain score fell 49.2% (decreasing from 310.1 mm to 157.4 mm) at 2 months postinjection in patients receiving corticosteroid, compared with a decrease of 2.5% (from 314.3 mm to 306.5 mm) in the placebo group (P < 0.0001). The proportion of WOMAC20 responders at 2 months' followup was significantly higher in the corticosteroid group (67.7%) compared with the placebo group (23.8%) (P ‫؍‬ 0.004); similar proportions of WOMAC50 responders were observed between groups (61.3% in the corticosteroid group versus 14.3% in the placebo group; P ‫؍‬ 0.001). Response differences were maintained at 3 months' followup (58.1% responders in the corticosteroid group versus 9.5% responders in the placebo group; P ‫؍‬ 0.004). Significant differences in the WOMAC stiffness and physical function scores (P < 0.0001), patient's global health scores (P ‫؍‬ 0.005), and SF-36 physical component scores (P ‫؍‬ 0.04) were observed, with patients in the corticosteroid group showing greater improvements. There were no differences in the frequency of adverse events between groups.Conclusion. This placebo-controlled trial confirms that corticosteroid injection can be an effective treatment of pain in hip OA, with benefits lasting up to 3 months in many cases. Future studies should address questions related to the benefits of repeated steroid injection and the effects of this treatment on disease modification.Osteoarthritis (OA) affects all vertebrates, and the prevalence of the disease increases exponentially with age. Estimates of the prevalence of hip OA in humans range from 2% at age 35 years to 35% at age 85 years or older (1), and autopsies have shown that cartilage degeneration can be detected in patients as early as the second decade of life (2). A disease prevalence estimate of 3% among North Americans older than age 55 years has been commonly quoted, but this may well be an underestimate of the true burden of hip OA in the general population (3,4). The prevalence of the disease has significant fiscal implications, since it has

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Importance of placement of intra-articular steroid injections.

Cited by 359 publications

References 5 publications

Acute adverse reaction to hylan G‐F 20: Comment on the article by Martens

Acute adverse reaction to hylan G‐F 20: Comment on the article by Martens

Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind‐, and mid‐foot in chronic inflammatory diseases

Steroid injection for osteoarthritis of the hip: A randomized, double‐blind, placebo‐controlled trial

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