Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study

Abstract

Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 females and 21 men) rheumatoid arthritis patients with wrist, elbow and shoulder pain by analyzing the number of injections, decrease in pain measured on a visual analog scale (VAS), changes in carpal height ratio (CHR), radio carpal distance ratio (RCDR) and radial rotation angle (RRA) on X-ray imaging, and adverse effects in the subcutaneous tissue and extensor tendons. Results: Over the 8-year study period (average 6 yrs.), the mean numbers of intra-articular triamcinolone acetonide injections per patient were 3.7 for 180 wrists in 118 patients, 2.2 for 45elbows in 36 patients, 2.8 for 60 shoulders in 44 patients. Mean improvements in VAS pain scores from baseline were as follows: wrist, from 75 to 11 mm; elbow, from 79 to 17mm; shoulder, from 54 to 11mm. The group that received the injections showed no significant changes in CHR or RCDR, whereas RRA changed significantly decrease (P < 0.05). In the group that did not receive intra-articular injections, no significant changes were observed in CHR, RCDR and RRA over a mean follow-up period of 8 years. No abnormalities were observed in subcutaneous tissue. Conclusions: Overall, >90% of the patients of all disease grades responded to an average of 1–4 intra-articular triamcinolone acetonide injections, which were effective for pain relief in the wrist, elbow and shoulder joints over both the short and long term. Skin atrophy or extensor tendon rupture due to injection did not occur.