The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee

Abstract

Although intraarticular injections are important to the management of rheumatoid arthritis, there are few studies regarding the cost-effectiveness of alternative injection techniques. This randomized controlled study addressed the cost-effectiveness of two different low-cost, anatomic landmark palpation-directed intraarticular injection techniques. Ninety-six symptomatic rheumatoid knees were randomized to two different low-cost, palpation-guided intraarticular injection techniques utilizing (1) a conventional syringe or (2) a mechanical syringe, the RPD (the reciprocating procedure device). Three milliliters of 1% lidocaine were used to anesthetize the synovial membrane, followed by arthrocentesis and hydrodissection, and injection of 80 mg of triamcinolone acetonide utilizing the one-needle two-syringe technique. Baseline pain, procedural pain, aspirated fluid volume, pain at outcome (2 weeks and 6 months), responders, reinjection rates, cost/patient/year, and cost/responder/year were determined. Pain was measured with the 10 cm Visual Analogue Pain Scale (VAS). Both techniques significantly reduced pain scores at outcome from baseline (P < 0.001). The mechanical syringe technique resulted in a greater volume of aspirated fluid (P < 0.01), a 38% reduction in procedural pain (P < 0.001), a 24% reduction in pain scores at outcome (P < 0.03), an increase in the responder rate (P < 0.025), 33% increase in the time to next injection (P < 0.001), 23% ($35 US) reduction in cost/patient/year for a patient treated in a physician office (P < 0.001), 24% reduction ($26 US) in cost/patient/year for a hospital outpatient (P < 0.001), and 51% ($151 US) reduction in cost/responder/year (P < 0.001). The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee can be improved significantly with low-cost alternations in technique.

Local controlled release of corticosteroids extends surgically induced joint instability by inhibiting tissue healing

“…Based on joint space volume, the 0.7‐mg dose (the lowest dosage used here) corresponds to 56‐mg TAA in a human knee joint, which is only 1.4 times higher the 40‐mg TAA bolus generally administered in patients. Even the 80 mg of bolus TAA administered in arthritic knees in several clinical studies did not result in adverse effects (C. E. Chavez‐Chiang et al, ; N. R. Chavez‐Chiang et al, ; Kumar, Dhir, Sharma, Sharma, & Singh, ; Popma et al, ). Moreover, the IA release of a dose of 60‐mg TAA from a PLGA MS platform, equivalent to the lowest dosage used in the current study, was shown to be safe in knee OA patients (Bodick et al, ).…”

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine

“…Most studies evaluated injections into a single structure (42/49 (86%)),17 51 54 69 80 84–87 90–95 97–101 103–113 115–125 but seven studies (14%) investigated injections into more than one structure 52 71 88 89 96 102 114. In decreasing frequency, studies evaluated injections into bursae (19/49 (39%)),17 51 52 54 69 87 91–93 95 97 100 101 103 105 110 115 121 123 tendon sheaths (9/49 (18%)),71 89 102 106 108 111–113 116 tendons or fascia (8/49 {(16%)),96 102 107 112 119 120 124 125 perineural regions (6/49 (12%)),85 88 94 104 109 122 muscles (5/49 (10%)),86 97 114 117 118 cysts (2/49 (4%)),84 90 peritendinous regions (2/49 (4%)),71 102 wounds (1/49 (2%))52 and periarticular spaces (1/49 (2%)) 80…”

“…Three level 2 studies compared the efficacy of USG carpal tunnel injections to LMGIs 85 109 122. All three studies reported that USG carpal tunnel injections were less painful and more efficacious than LMGIs.…”

“…Furthermore, one of the studies performed a cost analysis and concluded that USG carpal tunnel injections were also more cost-effective than LMGIs (see table 10). 85 However, the cost analysis only included those who responded to the injection. When all patients were included in the cost analysis (responders and non-responders), the cost was higher for USGIs than for LMGIs when the procedure was performed in a physician's office, and was equivalent when performed in a hospital-based setting.…”

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

“…Although the literature is limited, there is some evidence suggesting that guided procedures are a more cost effective treatment strategy. Researchers evaluated ultrasound versus blind injections in patients with inflammatory and non-inflammatory arthritis and found a reduction of $7-17 per patient per year with the use of ultrasound and even bigger reduction in costs of $64-224 per patient per year in a subgroup identified as ''responders'' [17][18][19].…”