Corticosteroid Infiltration Research Articles

Improvement of rhizarthrosis pain management with the infiltration of hyaluronic acid and corticosteroids versus corticosteroids alone.

The clinical management of rhizarthrosis relies on several pharmacological approaches, demonstrating variable efficacy. The present study aimed at assessing the potential benefit of the combined infiltration of corticosteroids and hyaluronic acid to reduce trapeziometacarpal osteoarthrisis pain at three months, as compared to the administration of corticosteroids alone. We conducted a single-blind trial with two parallel groups and blinded evaluation. Eligible patients (n=150) were randomly assigned to receive hyaluronic acid and corticosteroid (n=74) or saline and corticosteroid infiltrations (n=76 Pain was evaluated one, three, six or twelve months (M1, M3, M6, M12) after infiltration. In total, 149 patients received the injection (mean age 62 years old; 83% females). When looking at the primary end point (M3), reduction of pain during activity was greater in the hyaluronic acid + corticosteroid group, as compared to the corticosteroids + placebo (difference -1.1 on a 0-10 points visual analogue scale, 95% confidence interval [-1.9; -0.2], p=0.012). For the secondary end points (visual analogue scores at rest and during activity at M1, M6 and M12), improvements were observed, although not statistically significant (except at M1). Finally, grip and opposition strength remained unchanged between groups along the follow-up. In patients with painful rhizarthrosis, the infiltrations of hyaluronic acid and corticosteroids demonstrate better efficacy in reducing pain during activity 3 months after intervention, compared to injections with only corticosteroids. The present study brings new arguments in favour of the combination of these two drugs for the clinical management of trapeziometacarpal osteoarthrisis.

Effectiveness of Local Glucocorticoid Infiltration Versus Traditional Gauze Bandaging for the Treatment of Onychocryptosis: A Randomized Controlled Trial.

Local intralesional corticosteroid injections into the periungual fold are used to treat patients with onychocryptosis, but their short- or medium-term effects are unknown. The goal was to compare the efficacy of this treatment in stages IIa, IIb, and III of the condition with a common conservative method such as gauze bandaging. A two-arm randomized trial with 40 patients with stage IIa, IIb, and III onychocryptosis equally assigned into two treatment groups-control (spiculotomy and application of gauze bandaging) and experimental group (spiculotomy and infiltration of corticosteroid)-was performed. Anthropometric data, initial clinical status, pain, and inflammatory measures were collected before and at least one month after the intervention. Pain reduction was higher in the experimental group (5.5 vs. 4.8 points) but with no significant differences (p = 0.306).Corticosteroids significantly reduced inflammation over gauze bandaging (1.9 vs. 1) with significant differences between them (p = 0.029). Corticosteroid infiltration was more effective than gauze bandaging application in reducing inflammation in patients with onychocryptosis, with similar effects on pain. These findings support the clinical importance of corticosteroid treatment for this condition, although a single infiltration may not be sufficient to prevent relapses.

Myotendinous Junction Anesthesia: An Alternative Infiltration Site for Ultrasound-Guided Injections

The myotendinous junction is a highly specialized and complex structure between muscle and tendon. In recent years, various procedures have directly targeted the tendon, with corticosteroid, platelet-rich plasma, or biological therapy infiltrations being prominent. However, these interventions are painful, corticosteroids have demonstrated tendon damage, and anesthesia negatively impacts tenocyte proliferation and viability when used with platelet-rich plasma in the same injection site. There is a need to adapt the injection site to improve therapy effectiveness and pain tolerance. This article presents a proposal for an ultrasound-guided anesthetic block procedure in the myotendinous junction.

The role of Radiotherapy in relieving pain caused by calcaneal spur

The pain caused by the calcaneal spur and the decreased quality of life are the hallmark features of this condition. Radiotherapy has been the subject of increasing evolution in recent decades for pain relief in both benign and malignant pathologies. The aim is to evaluate the efficacy in pain relief and the toxicity associated with the treatment. A retrospective review of a group of patients with painful complaints due to calcaneal spur who underwent Radiotherapy. Between 2012 and 2023, twelve patients, seven men, and five women, with a median age of 61 years (40-82) underwent palliative radiotherapy for calcaneal spur. Five patients had calcaneal spur on the right, five on the left, and two with bilateral spurs. All had complaints of pain in the calcaneus. One patient had undergone previous surgery and one radiofrequency and corticosteroid infiltration without resolution of the painful condition. The treatment regimens varied, with the majority (n=7) receiving 15Gy in 3 fractions of 5Gy on alternate days. 100% of the patients reported complete pain relief after treatment. One patient required re-irradiation after 4 months, with a complete response in pain control. No patient experienced toxicity related to radiotherapy. Radiotherapy plays an important role in pain control for this pathological condition, as demonstrated in this analysis. Classical studies have shown that a minimum total dose of 5Gy would be necessary for better pain control. There is a need to raise awareness among healthcare professionals about the important role of radiotherapy in pain management in this pathology.

Pediatrics severe low back pain by disc herniation: an uncommon entity

BackgroundCommon severe back pain due to disc herniation is rare in the paediatric population which involves children under eighteen years of age. Paediatric lumbar disc herniation (LDH) cannot be considered the same disease as in adults, as it has potentially different natural and clinical backgrounds. The treatment of pediatric LDH is the other particularity of this condition. Indeed, in children, delaying surgery for a conservative treatment is justified. We report 3 cases treated in 8 years.Case presentationThree patients, two of whom were 14 years of age and one 17 years of age, were admitted for L5 or S1 lumbosciatica. A CT scan showed a lumbar disc herniation L5S1 associated with bi-isthmic lysis (and a transitional abnormality in 1 case or spina bifida occulta in 1 other case). The last patient had an magnetic resonance imaging (MRI) that showed a herniated L4L5 disc. The diagnosis of low back pain disc herniation was retained in two patients and that of disabling low back disc in one patient. Percutaneous discolysis in the two hyperalgesic cases and epidural corticosteroid infiltration in the disabling case were effective on lumbosciatica.ConclusionPaediatric common lomw back pain caused by a disc herniation with a hyperalgic or disabling character posed a therapeutic problem which were solved by the invasive approaches that must be given priority nowadays with children.

Corticosteroid Infiltration to Treat Shoulder Stiffness After Rotator Cuff Repair.

To investigate whether the preoperative shoulder range of motion (ROM), would increase the risk of postoperative shoulder stiffness, or whether it would be associated with other preoperative patient characteristics. The authors retrospectively analysed the 372 shoulders that underwent rotator cuff repair by 4 surgeons, between January 2010 and January 2011. All patients were followed up at 3 and 6 months by 2 independent observers to collect the ROM, including active forward elevation (AFE), passive forward elevation (PFE), and external rotation (ER), as well as subjective shoulder value (SSV). Of the initial cohort of 372 patients, 10 were lost to follow-up (2.7%), leaving a final cohort of 362 patients available for outcome assessment at a minimum follow-up of 6 months. Of the 362 patients, 281 did not require corticosteroid infiltration, 68 received corticosteroid infiltrations for shoulder stiffness with no apparent cause, and 13 received corticosteroid infiltrations for other reasons. None of the variables were associated with infiltration for shoulder stiffness. Older patients had greater SSV scores (β = 0.3; 95% CI [0.1, 0.6]; P = .015), while both manual and repetitive workers had lower SSV scores (β = -10.7; 95% CI [-15.8, -5.6]; P < .001, and β = -10.2; 95% CI [-15.1, -5.3]; P < .001). Postoperative SSV was significantly associated with age, as well as manual or repetitive work. Furthermore, postoperative PFE, AFE, and ER were significantly associated with preoperative PFE. Finally, at 3 and 6 months postoperative, patients who required infiltration for shoulder stiffness had significantly lower PFE, AFE, and ER compared to patients who did not require infiltration. IV, Case series.

Comparison of the Effectiveness of Intra-articular Infiltration of Hyaluronic Acid and Corticosteroids in the Management of Knee Osteoarthritis: A Prospective Comparative Study.

Background Knee osteoarthritis (KOA) is a chronic and progressive disease of the knee joint characterized by articular cartilage destruction. It is the most common cause of knee disability and pain globally. Various treatments are used for the management of KOA; however, the role of intra-articular injections in KOA management in Pakistan remains understudied. Therefore, this study aims to evaluate the effectiveness of intra-articular injections of hyaluronic acid (HA) and corticosteroids in the management of KOA. Methodology This randomized, prospective, comparative study was conducted among 88 patients diagnosed with KOA in the outpatient department clinic of orthopedics in Benazir Bhutto Hospital, Rawalpindi, from January 2022 to January 2023. For patient enrolment, structured inclusion and exclusion criteria and a simple random sampling technique were used. Before data collection, ethical approval and informed consent were obtained. Data collection was done via a self-structured and interview-based proforma. Data analysis was performed through descriptive statistics and independent t-tests using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results KOA was more prevalent in women (60, 68.18%) than men (28, 31.82%). The means for study variables such as age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 58.08 ± 7.89 years, 7.66 ± 1.8, and 71.86 ± 8.90, respectively. The incidences of right-sided and left-sided KOA were 57 (64.77%) and 31 (35.23%), respectively. Likewise, the frequency of grade II KOA was 55 (62.50%), while the frequency of grade III KOA was 33 (37.50%). Differences in the mean scores of both VAS and WOMAC between study groups were statistically significant at the second-week, sixth-week, and third-month follow-up visits. However, the mean scores of VAS and WOMAC were lower in group B than in group A at the second-week follow-up visit, whereas the scores were lower in group A compared to group B after the sixth week and third month of intra-articular injections. Conclusions Intra-articular injections of both HA and corticosteroids were adequately effective in the management of KOA-associated pain and functional restrictions; nevertheless, the benefits of corticosteroids were acute and short-term, whereas the outcomes of HA were gradual and long-term.

Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial

BackgroundFrozen shoulder (FS) is a common cause of shoulder pain and stiffness. Conservative treatment is sufficient for the majority of patients with recovery of shoulder function at long term. Manipulation under anesthesia (MUA) is known as a well-established treatment option if conservative treatment fails. It is unknown whether MUA does indeed shorten the duration of symptoms or leads to a superior outcome compared to conservative treatment. The objective of the current trial is to evaluate the effectiveness of MUA followed by a physiotherapy program (PT) compared to a PT program alone in patients with stage two FS. MethodsA prospective, single center randomized controlled trial was performed. Patients between 18 and 70 years old with a stage two FS were deemed eligible if an initial course of conservative treatment, consisting of physiotherapy and an intra-articular corticosteroid infiltration was considered unsatisfactory. Patients were randomized and data was collected with an online data management platform (CASTOR). MUA was performed by a single surgeon under interscalene block and an intensive physiotherapy treatment protocol was started within 4 hours after MUA. In the PT group patients were referred to instructed physiotherapist, and treatment was guided by tissue irritability. The primary outcome was the SPADI score. Secondary outcomes were pain, range of motion, OSS, quality of life and ability to work. ResultsIn total, 82 patients were included, 42 in the PT group and 40 in the MUA group. There was a significant improvement in SPADI, OSS, pain, range of motion and quality of life in both groups at 1 year follow-up. SPADI scores at three months were significantly improved in favor of MUA. MUA showed a significant bigger increase in anteflexion and abduction compared to PT at all points of follow-up. No significant differences between both groups were found for all other parameters. No fractures, dislocations or brachial plexus injuries occurred in this trial. ConclusionMUA in stage 2 FS can be considered safe and results in a faster recovery of range of motion and improved functional outcome, measured with SPADI scores, compared to PT alone at short term. After 1 year, except for slightly better range of motion scores for MUA, the result of MUA is equal to PT.

Assessment of the Effectiveness of Corticosteroid Infiltrations in the Ignace Deen University Hospital Center in Conakry.

Introduction Corticosteroid infiltration is a medical procedure which consists of the injection of a corticosteroid locally, into a painful site. Thus the objective of this study was to evaluate the effectiveness of corticosteroid infiltrations in the rheumatology department of the Ignace Deen University Hospital in Conakry (Guinea). Patients and method This was a prospective descriptive and analytical survey that lasted one year from July 2021 to July 2022 carried out in the rheumatology department of the Ignace Deen University Hospital in Conakry. We included all patients who had received corticosteroid infiltration. The infiltration was carried out by a rheumatologist either by anatomical or ultrasound-guided identification. Results During the study period, we recorded 1452 observations including 508 (35%) cases of corticosteroid infiltration. The average age was 53.7 years +/- 12.7 years with the majority of our patients were young adults (68%). Females predominated (55%), with a sex ratio (M/F) of 0.80. The infiltrations were mainly indicated for osteoarthritis, particularly knee osteoarthritis in 264 (52%) of cases and lumbarthrosis in 204 (40.2%) of cases, followed by rheumatoid arthritis (RA) in 216 (42.5%) of cases, gout in 183 (36%) of cases and lumbosciatica in 118 (23.2%) of cases. Dexamethasone was the corticosteroid predominantly used in 46.2% of cases. The associated medications were lidocaine in 93% of cases. The intensity of pain remained unchanged in 152 (30%) patients despite the infiltration sessions. Conclusion In our study, the majority of patients who benefited from cortisone infiltration were young adults, with females predominating. Osteoarthritis and rheumatoid arthritis were the main indications for infiltration, and dexamethasone was the most commonly used corticosteroid. The study demonstrated the efficacy of cortisone infiltration, with improvement in pain intensity in some patients (70% of cases). For others, however, the pain remained unchanged.

A Rare Case of Carpal Tunnel Syndrome in a Teacher

A case of carpal tunnel syndrome was incidentally discovered during an occupational pathology consultation in a 51-year-old class teacher, with more than 24 years of service, presenting with tingling and tingling in the right hand and pain radiating to fingers and forearm. The use of chalk on the blackboard and the pen on paper constituted the professional causes found. The symptomatology was exacerbated after each working day, calmed down during weekends and holidays, and awoke to rare domestic work such as (washing linen, sifting flour, etc.). The patient, after numerous consultations in traumatology for joint pain in the wrist, was also followed by another doctor for arterial hypertension. The result of the first ultrasound was contradictory to the clinic, concluding with De Quervain's tendonitis. The CT scan of the wrist did not provide any evidence for the diagnosis. The requested electromyogram was not made available. The infiltration of corticosteroids helped to calm the pain and the associated signs.

Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada

BackgroundShoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management.MethodsA survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists’ referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants’ responses were compared between types of providers with Fisher’s exact test.ResultsRespondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%, p = 0.001) and adhesive capsulitis (51% compared to 22%, p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes.ConclusionsMost FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders.

Standardised Tendon Fenestration with ITEC-Technique for Lateral Epicondylosis with Injection of Betamethasone versus Autologous Blood.

Background: Infiltration is one of the treatment options for lateral epicondylosis, a degenerative process in the tendon of the musculus extensor carpi radialis brevis. The aim of this study was to evaluate the clinical outcome of a standardised fenestration technique, the Instant Tennis Elbow Cure (ITEC) technique, with injection of betamethasone versus autologous blood. Methods: A prospective comparative study was performed. Twenty-eight patients received an infiltration with 1 mL betamethasone, in combination with 1 mL 2% lidocaine. Twenty-eight patients received an infiltration with 2 mL autologous blood. Both infiltrations were administered using the ITEC-technique. The patients were evaluated at baseline, 6 weeks, 3 months and 6 months using Visual Analogue Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE) and Nirschl staging. Results: At the 6-week follow-up, the corticosteroid group showed significantly better results for VAS. At the 3-month follow-up, no significant differences were observed for all three scores. At the 6-monthfollow-up, the autologous blood group showed significantly better results for all three scores. Conclusions: Standardised fenestration using the ITEC-technique with corticosteroid infiltration is more effective in reducing pain at the 6-week follow-up. At the 6-month follow-up, the use of autologous blood is more effective in pain reduction and functional recovery. Level of Evidence: Level II.

Quiste gigante acromioclavicular en paciente mayor. Hasta cuando tratar la causa.

Introduction: Acromioclavicular joint cysts are a rare entity, generally present in elderly patients with chronic injuries or arthropathies of the rotator cuff. There are several causes of cyst formation, there are generally two of the most frequent, which we will talk about in this article. Clinical case: We present the case of an 82-year-old male patient with a giant acromioclavicular cyst, more than 20 cm in diameter, with rapid growth in recent months and with associated rotator cuff tendon injury. Discussion: These cysts are not very frequent injuries, mainly caused by degeneration of the acromioclavicular joint, most of the cases associated with rotator cuff injuries. Diagnosis is based on clinical examination, ultrasound and magnetic resonance imaging. Treatment by cyst aspiration and corticosteroid infiltration is not usually very effective and has a high recurrence rate, so surgical removal of the cyst is more indicated. Conclusions: The surgical indication for these cysts is pain, sometimes associated with resection of distal fragments of the clavicle; when a rotator cuff injury is present, reverse shoulder arthroplasty can be an alternative; however, in patients with poor symptoms, simple excision of the cyst can be an effective treatment.

Een leidraad in de conservatieve aanpak van de primaire frozen shoulder

A guideline in the approach of primary frozen shoulder The primary frozen shoulder is a frequent inflammatory condition, characterised by 3 main clinical stages: the painful, stiff and recovery phase. Each of them comes with a certain degree of irritability for the patient. Given the wide range of conservative therapy options, a clear-cut treatment is currently not available. There is sufficient evidence for the use of the following combined approach: the use of intra-articular corticosteroid infiltrations at first, followed by stretching and mobilization according to the Maitland technique in a later phase, along with patient education as well as a physiotherapy home programme. Crucial for this approach is to take into account the specific stage of the condition and the corresponding degree of irritability of the patient at that moment.

THERAPEUTIC MODALITIES FOR BROWN TUMOR OF THE JAWS

<h3>Objectives</h3> The objective was to establish a more appropriate correlation between clinical context and treatment modality for brown tumor of the jaws to determine the best approach. <h3>Study Design</h3> A literature review was made in the PubMed, SciELO, and Google Scholar databases considering mesh terms and Boolean terms "brown tumor AND hyperparathyroidism," "brown tumor AND jaws AND hyperparathyroidism," "central giant cell AND hyperparathyroidism." Inclusion criteria included clinical cases published from 2015 to July 2020 in English, Spanish, French, and German involving patients with brown tumor of the jaws and their therapeutic approaches. Exclusion criteria included case reports with patients without brown tumor of the jaws, without relation to the proposed theme, or with genetic investigation bias. <h3>Results</h3> Eighty-five relevant results were obtained. Among the therapeutic modalities, conservative approaches were found, such as parathyroidectomy and reconditioning of parathyroid hormone levels, with possible total or partial brown tumor regression, or corticosteroid infiltration, as well as curettage, enucleation, and invasive resections. <h3>Conclusions</h3> The best clinical approach results from the correct diagnosis of hyperparathyroidism and treatment of its cause. Given these points, a therapeutical approach for the jaws can be defined.

Management and Outcome of Ozone Therapy in the Lumbar Spine Disc Disease with and without Use of Corticosteroids

Objectives: To determine the Consequences and out-turn of ozone with and without the use of peri-ganglionic infiltration of corticosteroids in lumbar spinal generative disc disease.&#x0D; Material and Methods: Comparative study was conducted in the Neurosurgery Department Pakistan Institute Of Medical Sciences Islamabad from December 2014 to November 2020. We included 338 patients with herniated lumbar disc with backache and radiculopathy. Randomly categorized in groups A and B. Group A was given 4 to 6 ml of intradiscal ozone along with 40 to 80 mg of peri-ganglionic methylprednisolone while group B only received 4 – 6 ml of intra-discal ozone. The visual analog scale was used to assess the degree of pain and modified Macnab criteria were used to assess the post-procedural outcome, periodic follow was carried out up to 6 months after the procedure.&#x0D; Results: 169 patients were enrolled in group A with 70 females and 90 males. Group B had a total of 169 patents with 89 females and 80 males. In group A, a single procedure was required in 89 patients, twice in 27, and thrice in 10 patients to completely obliterate pain. While in group B, 71 patients had the single procedure, twice in 92 and thrice in patients. Data were compared by the Chi-square test, which was further confirmed by a significant P-value of 0.061.&#x0D; Conclusion: The combination of percutaneous ozone chemodiscolysis along with the preganglionic injection of steroids as compared to single ozone therapy is the most effective, rapid, and long-lasting method of relieving backache and radiculopathy associated with lumbar disc herniation.

Determinants of therapeutic success of corticoids injections in trigger finger syndrome

Background and objectiveTrigger finger is a frequent complaint in which corticosteroid infiltrations play a relevant therapeutic role in intermediate degrees of severity when conservative treatment has not worked. However, there are no criteria to select which patients will benefit most from this procedure. The present study aimed to identify the factors leading to the therapeutic success of corticosteroid infiltration in these patients. Materials and methodsWe designed a prospective longitudinal study based on routine clinical practice with adult patients with a clinical diagnosis of trigger finger grade II or III on the Quinnell scale, who underwent an infiltration of 20 mg of triamcinolone acetate. The outcome variables were to achieve a Quinnell grade I or reduce the severity of the symptoms by at least one category two months after the procedure. To identify the determinants of complete or partial therapeutic success, binary logistic regression predictive modelling was performed using those variables that had a satisfactory univariate correlation. Results74 patients were included over three years, 42 of whom (61.8%) were classified as Quinnell grade III. After infiltration, 22 (32.4%) achieved complete resolution and 50 (73.5%) partial resolution. The variables tendon thickening (HR 10.72; 95%CI 2.88-39.93; P < .001) and progression time (HR 1.23; 95%CI 1.02-1.49; P = .027) proved to be predictors of therapeutic success in complete resolution. For the modelling for partial resolution, the same variables proved to be determining predictors (HR 5.57; 95%CI 1.38-22.41; P = .016 and HR 1.18; 95%CI .99-1.41; P = .051, respectively). Pulley thickening did not demonstrate predictive ability in either model. Discussion and conclusionsOur results indicate that the demonstration of finger flexor apparatus thickening is the main determining factor for the success of corticosteroid infiltrations in this pathology. This is in agreement with the histological findings of specimens obtained from both tenosynovial and pulley tissue. In the former, in addition to an infiltrate of inflammatory characteristics, the presence of chondrocytoid cells producing hyaluronic acid is demonstrated. Although the therapeutic success of infiltrations in previous studies reaches 70%, the recurrence rate is similar after 12 months. The selection of patients with tendon thickening ensures therapeutic success in the short term, could reduce recurrence in the long term, and avoid delay in release surgery.

18F]-sodium fluoride PET/MR for painful lumbar facet joint degeneration – a randomized controlled clinical trial

BACKGROUND CONTEXT[18F]-sodium fluoride (NaF) PET/MR is a modern diagnostic modality for imaging increased bone turnover. Its merits in detecting painful facet joint osteoarthritis in patients with lumbar back pain are unknown. PURPOSETo perform a prospective randomized controlled study investigating [18F]-NaF PET/MR for detecting painful facet joints in comparison to the standard of care (SOC), including clinical examination and conventional MRI. STUDY DESIGN/SETTINGRandomized controlled clinical study. PATIENT SAMPLEThirty-nine patients. OUTCOME MEASURESVisual analog pain scale (VAS) before and at several time points after facet joint infiltration. METHODSPatients with low back pain and suspected facet joint osteoarthritis underwent lumbar [18F]-NaF PET/MR, besides conventional MRI and clinical examination. After randomization, they either received local anesthetics/ corticosteroid infiltration of facet joints as defined by clinical examination and conventional MRI (SOC), or according to the hot spots on PET/MR. VAS was documented at 15 minutes, 1 day, 1 week and 1 month after infiltration. Thirty-nine patients underwent PET/MR before the study was stopped due to new Good Manufacturing Practice requirement and new regulations by radiation protection authorities limiting staff radiation exposure during the production of this radiotracer. RESULTSSignificant pain reduction compared to baseline was shown at every timepoint in both groups, except at 1 month after infiltration in the SOC group. Pain levels did not differ between SOC (n=17) and PET/MR patients (n=12) before infiltration and at 15 minutes, 1 day, 1 week and 1 month after infiltration. No significant correlation was detected between the sum of the PET/MR activity and the initial pain scores or relative reduction of pain after 15 minutes.The constructed study groups of patients with infiltration of all facet joints being PET/MR-positive (n=18) had significantly less pain after 1 months than patients with infiltration in PET/MR-negative facet joints (n=11) (VAS: 4 [0, 9] vs. 7 [2, 10], p=.046). CONCLUSIONSThere is no correlation of pain to NaF activity nor a relevant superiority of [18F]-NaF PET/MR for identification of painful facet joints compared to the standard of care.

Periradicular corticosteroid infiltration for radicular pain - comparison of Diprophos and Depomedrone and ozone effects.

To determine the treatment effect of corticosteroids in periradicular therapy (PRT) for radicular pain and to compare different types of corticosteroids and ozone. We also examined the effect in different indication groups for periradicular therapy for each type of treatment agent. Various studies have examined the therapeutic value of periradicular infiltration using treatment agents consisting of local anesthetic and corticosteroids or ozone application for radicular pain. This is the first study to compare different types of corticosteroids and ozone. Eligible patients with radicular pain who failed conservative management were divided into five indication groups and prospectively followed to assess the PRT effect of corticosteroids or ozone application. PRT was performed under computer tomography (CT) monitoring. A set of three PRT applications in three weeks was applied and the outcome was evaluated using a visual analogue score for back and leg pain. The in-group and between-group treatment effect was tested using the Wilcoxon signed-rank test and the Kruskal-Wallis H-test with Dunn's post-hoc tests, respectively. The dependency between treatment effectiveness and indication for each group was tested using the Kruskal-Wallis H-test and Dunn's post-hoc tests. We prospectively followed 150 patients, randomized into three groups of 50 patients each. The follow-up rate was 100%. All three treatment agents showed a statistically significant treatment effect (P<0.001). The statistically significant effect was higher in betamethasone (Diprophos) versus methylprednisolone (Depomedrone) (P=0.019) and Diprophos versus ozone (P<0.001). Diprophos also showed the highest decrease of VAS after therapy versus VAS prior to therapy (median decrease = 4) compared to Depomedrone and ozone (median decrease = 3 and 2, respectively). The statistically significant outcome was better with the indication of spondylolisthesis and disc herniation (P=0.019) indication for the Diprophos group and between spinal stenosis and spondylolisthesis (P=0.022) and spondylolisthesis and disc herniation (P=0.016) for the ozone group. Clinical improvement occurred in all three groups but Diprophos showed the statistically best treatment effect compared to Depomedrone and ozone. Disc herniation resulting in radicular pain had a statistically significant better effect in comparison with spondylolisthesis in the Diprophos and ozone groups, but the ozone group showed heterogeneity depending on treatment effect and indication.

P039 Evolutionary course of Juvenile Idiopathic Arthritis

Abstract Background Juvenile idiopathic arthritis (JIA) is a heterogeneous group of rare conditions that begin before the age of 16. Seven categories have been defined by the International League of Associations for Rheumatology (ILAR) classification. The aim of our work is to describe the demographic, clinical, and radiological characteristics and therapeutic of patients with JIA. Materials and methods A retrospective, descriptive study of patients followed for AIJ in the rheumatology department of Mohamed LamineDebaghine during a period of 15 years (2005–2020). Patients were included if satisfied ILAR criteria. Results Ten patients with JIA were included, 5 of whom were females. The mean age of onset was 9.20 ± 3.15 (range: 5–14 years). The subtypes were as follows: 4 patients had RF-negative polyarthritis, one case had RF-positive polyarthritis, one with systemic arthritis form, 2 cases of oligoarthritis, 1 case of psoriatic arthritis, and enthesitis-related arthritis. Three children have coxitis. ACPA was positive in one case and antinuclear antibodies were negative. Eight patients have developed osteoarticular destruction. Pulmonary involvement was noted in a patient who had RF-positive polyarthritis. Corticosteroid therapy was prescribed in 9 patients, 5 of whom developed complications related to steroids, including growth retardation, which was observed in 3 cases. Nine JIA patients received methotrexate. The use of etanercept and IL-1 inhibitors were required in 7 and 1 cases, respectively. Corticosteroid infiltrations were performed in 9 patients. Total hip replacement was indicated in 3 patients. Conclusion Through our study, we note a predominance of the polyarticular form. Osteoarticular destruction seems to be frequent, particularly in the hip. The use of biotherapy and the total hip prosthesis proved the severity of juvenile idiopathic arthritis in our patients.