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Joint Bone Spine
Volume 83, n° 2
pages 161-166 (mars 2016)
Doi : 10.1016/j.jbspin.2015.04.017
accepted : 12 April 2015
Short-term efficacy to conventional blind injection versus ultrasound-guided injection of local corticosteroids in tenosynovitis in patients with inflammatory chronic arthritis: A randomized comparative study
 

Marwin Gutierrez b, , Andrea Di Matteo b, Marcos Rosemffet c, Tomas Cazenave c, Gustavo Rodriguez-Gil d, Cristina Hernandez Diaz a, Lucio Ventura Rios a, Natalia Zamora c, Maria del Carmen Gonzalez Guzman c, Ignacio Carrillo c, Tadashi Okano e, Fausto Salaffi a, Carlos Pineda a
on behalf of the

Pan-American League against Rheumatisms (PANLAR) Ultrasound Study Group1

  PANLAR Ultrasound Study Group: Aliste Marta, Alva Magaly, Aragón-Laínez RA, Areny Roser, Audisio Marcelo, Bertoli Ana, Bouffard José Antonio, Caballero-Uribe Carlo Vinicio, Camacho Walter, Díaz-Coto José Francisco, Filippucci Emilio, Flores Víctor, Hoffman Fritz, Kourilovich Maria, Mendonça José Alexander, Moya Carlos, Mora Claudia, Muñoz-Louis Roberto, Py Guillermo Enrique, Quintero Maritza, Rodríguez Henríquez Pedro, Saavedra Jorge, Santiago Lida, Sedano Oscar, Solano Carla, Urioste Lorena, Villota Orlando, Carmen Ceron, Diego Saaibi, Mario Diaz and Johannes Roth.

a Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico 
b Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy 
c Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina 
d Secion de Reumatologia, Hospital Municipal de Bahìa Blanca, Calle Estomba 968, 8000 Bahia Blanca, Argentina 
e Department of Orthopedic Surgery, Osaka City, University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, 545-8585 Osaka, Japan 

Corresponding author.
Abstract
Objective

To compare the short-term efficacy of conventional blind injection (CBI) versus ultrasound-guided injection (USGI) of corticosteroids (CS) injection in tenosynovitis in patients with chronic arthritis and to investigate if the USGI is a less painful procedure and if there are differences in the changes of US findings during the post injection follow-up.

Methods

Patients presenting tenosynovitis requiring CS injection were involved. After clinical and US evaluation, patients were randomized to receive CBI or USGI. Efficacy of procedure was assessed by the improvement in both Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), including procedure-VAS global-VAS and local-VAS, after 1 and 4 weeks post-procedure. Power Doppler (PD) and greyscale (GS) US findings were also object of the follow-up. CBI or USGI under an aseptic technique were performed according the local guidelines using 20mg of methylprednisolone acetate.

Results

A total of 114 patients were randomized to receive CBI (54 patients) or USGI (60 patients) procedure. No significant difference was observed in terms of gender, age and pain duration among CBI and USGI groups at baseline. USGI proved to be significantly less painful than CBI (P =0.0001). AUC analysis showed that during the follow up visits, the USGI procedure had significantly better response in HAQ, local-VAS and global-VAS (P =0.0001, P =0.012 and P =0.0001 respectively) compared to CBI. During the follow up period, a significant greater reduction in the PD scores was found in the USGI group compared to the CBI group (P =0.0002), whereas no statistical differences were found in the GS findings between the groups (P =0.5627).

Conclusion

Our study demonstrates superiority of USGI over CBI for CS injections in painful tenosynovitis, having better short-term outcomes measured by functional, clinical and US scores. These data support the use of USGI for tenosynovits in typical inpatient and/or outpatient in rheumatological practices.

The full text of this article is available in PDF format.

Keywords : Chronic arthritis, Costicosteroids, Local injections, Ultrasound


1  PANLAR Ultrasound Study Group: Aliste Marta, Alva Magaly, Aragón-Laínez RA, Areny Roser, Audisio Marcelo, Bertoli Ana, Bouffard José Antonio, Caballero-Uribe Carlo Vinicio, Camacho Walter, Díaz-Coto José Francisco, Filippucci Emilio, Flores Víctor, Hoffman Fritz, Kourilovich Maria, Mendonça José Alexander, Moya Carlos, Mora Claudia, Muñoz-Louis Roberto, Py Guillermo Enrique, Quintero Maritza, Rodríguez Henríquez Pedro, Saavedra Jorge, Santiago Lida, Sedano Oscar, Solano Carla, Urioste Lorena, Villota Orlando, Carmen Ceron, Diego Saaibi, Mario Diaz and Johannes Roth.


© 2015  Société française de rhumatologie@@#104156@@