Intra-articular Corticosteroid Injections In Patients Research Articles

The effect of intra-articular steroid injection on the cartilage and tendon thicknesses in juvenile idiopathic arthritis.

Intra-articular corticosteroid injection (IACI) is a safe first-line or adjunct therapy that can be used in any subtype of juvenile idiopathic arthritis (JIA). However, limited studies evaluated the effect of IACI on cartilage. As a result, our study aimed to examine the distal femoral cartilage thickness of patients with JIA who received IACI to the knee joint using ultrasound imaging. We randomly selected JIA patients who performed IACI in the knee joint. Baseline bilateral joint cartilage and tendons thickness were measured. Then, the articulary fluid was aspirated, and intra articulary steroid was injected during the same period. Six months after injection, the exact measurements were repeated. Exclusion criterias were that patients had IACI past six months of the baseline measurement and more than one IACI during the study period.. Distal femoral cartilage thickness, quadriceps tendon thickness, and distal and proximal patellar tendon thicknesses were compared at baseline (before IACI) and six months after IACI. Thirty patients with JIA were included in the study, and 23 (76.7%) were female. The median age was 11 years (interquartile range (IQR), 6 to 14), and the median disease duration was 3.3 years (IQR, 5 months to 5 years). Subtypes of JIA were oligoarticular in 25 (83.3%), polyarticular in 2 (6.7%), enthesitis-related arthritis in 2 (6.7%), and juvenile psoriatic arthritis in 1 (3.3%). Distal femoral cartilage thickness was 2.96±0.79 mm at baseline and 2.85±0.70 mm at six months after IACI (p=0.35). Also, the tendon thicknesses were the similar at six months after baseline measurements. Our findings reveal that knee IACI in patients with JIA did not significantly change cartilage and tendons thicknesses. This observation could indicate that IACIs have no detrimental effects on the cartilage and the tendons.

Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5years.

Intra-articular corticosteroid injections (CSI) are used commonly for the non-operative management of patients with knee pain. Recent literature has raised concern for chondrotoxicity of CSI. The purpose of the present study is to evaluate for any dose-dependent association between CSI in non-osteoarthritic knees and subsequent total knee arthroplasty (TKA). The Pearl Diver database identified patients with a diagnosis of knee pain without concomitant osteoarthritis who were administered CSI over a 2-year period. Patients were compared to matched and unmatched cohorts. The primary endpoint was the incidence of TKA at 5years. Multivariable regression analysis was used to assess CSI quantity as an independent risk factor. 49,443 of 986,162 (5.0%) Patients diagnosed with knee pain without concomitant knee osteoarthritis who received at least one CSI were identified. At 5years, there was a higher incidence of TKA in the matched injection cohort relative to the non-injection matched cohort (0.26 vs 0.13%; p < 0.001) and unmatched cohort (0.26 vs. 0.10%, p < 0.001). The quantity of CSI corresponded with an increased probability of TKA at 5years; one injection: 0.22% (OR 1.23, 95% CI [0.87-1.74], p = 0.236); two injections: 0.39% (OR 1.98 CI [1.06-3.67], p = 0.03, three or more injections: 0.49% (OR 3.22 CI [1.60-6.48], p = 0.001). The average time to TKA after one CSI was 3.03 ± 2.29years. This time was nearly halved with three CSI (1.78 ± 0.80years, p < 0.001). Intra-articular corticosteroid injections in patients without knee osteoarthritis at the time of injection are associated with a dose-dependent risk of TKA at 5years. CSI may not be as benign of a treatment modality as previously thought.

Evaluation of intra-articular corticosteroid injections in patients with sacroiliac pain

Background:Sacroiliac pain is one of the causes of low back pain, representing with discomfort and tenderness in the sacroiliac joint. Interventional procedures might be beneficial in cases unresponsive to medical treatments. Here, we aimed to investigate the effects of intra-articular corticosteroid injections in patients with sacroiliac pain.Materials and Methods:This is a clinical trial performed in 2017–2018 in Kashani Hospital, Isfahan, on patients with low back pain and formerly diagnosed with sacroiliac pain. Patients were recruited based on inclusion and exclusion criteria. Corticosteroid injections were performed for patients. Patients were visited within 2 weeks, 4 weeks, and 6 months after interventions, and pain and disabilities of patients were assessed using the numerical rating scale (NRS) and Oswestry Disability Questionnaire.Results:A total number of 27 patients entered our clinical trial. We showed that the mean NRS score among patients before interventions was 8.01 ± 0.96. Assessments of disability score also indicated that the mean disability scores was 41.48 ± 7.48. Our data also indicated that there was a significant reducing trend in both NRS and disability score after interventions (P < 0.001 for both items).Conclusion:Intra-articular steroid injection is associated with significantly reduced pain and disability in patients with sacroiliac pain. Previous studies evaluated variable methods and reported that this method has high values and significant advantages compared with other techniques which were in line with our results.

Comparison of Functional Outcome Between Intra-Articular Injection of Corticosteroid Versus Platelet-Rich Plasma in Frozen Shoulder: A Randomized Controlled Trial.

BackgroundIn this study, we compared the functional outcome of intra-articular injection of corticosteroid versus platelet-rich plasma (PRP) in patients with frozen shoulder (FS).MethodologyThis randomized controlled trial was conducted in the Department of Orthopedics, Mayo Hospital, Lahore, from January 2018 to December 2018.A total of 202 patients with FS aged 40 to 70 years were included. Patients with medical comorbidities such as chronic liver disease (assessed on history and serum bilirubin >2.0 mg/dl), chronic renal failure (assessed on history and serum creatinine >1.5 mg/dL), and chronic steroid use were excluded. Employing an anterior approach, subjects in groups A and B received one intra-articular injection of 2 mL PRP and 2 mL (80 mg) methylprednisolone acetate, respectively. Age, gender, duration of disease, and pre-injection and post-injection range of motion (ROM) (flexion, extension, abduction, external rotation, and internal rotation) were assessed. The University of California at Los Angeles Shoulder Score (UCLA) and visual analog scale (VAS) scores were measured and compared before and after the injection. All patients were followed at regular intervals post-therapy and the final functional outcome was measured after 12 weeks of therapy.ResultsData were analyzed using SPSS version 20 (IBM Corp., Armonk, NY, USA). A p-value of 0.05 was considered significant when comparing flexion, abduction, external rotation, and internal rotation in both groups using the independent t-test. The ROM in group A (intra-articular PRP) improved significantly (p < 0.05) after injection compared to group B (intra-articular corticosteroid). The ROM after PRP for abduction was 147.09 ± 7.78, forward flexion 154.52 ± 6.48, external rotation 71.59 ± 7.43, and internal rotation 59.20 ± 3.96. The ROM in the steroid injection group for abduction was 129.07 ± 4.72, forward flexion 127.14 ± 7.87, external rotation 56.27 ± 5.93, and internal rotation 48.86 ± 4.90.ConclusionsIntra-articular injection of PRP resulted in a substantial improvement in the VAS score, UCLA, and ROM when compared to intra-articular corticosteroid injection in patients with FS.

Functional improvement of bilateral frozen shoulder by unilateral intra-articular corticosteroid injection: a retrospective study.

ObjectiveBilateral frozen shoulder (FS) is often treated with intra-articular corticosteroid injection (IACI). No studies have been performed to establish whether IACI must be administered in both shoulders or in only one shoulder to improve function. This study was therefore performed to determine whether unilateral IACI improves shoulder pain and passive range of motion (pROM) in bilateral FS.MethodsThe medical records of 165 patients with bilateral primary FS who underwent ultrasonography-guided IACI (2 mL of 10-mg/mL triamcinolone acetonide mixed with 5 mL of 1% lidocaine) in one shoulder were retrospectively reviewed. The outcome measures, namely the numeric rating scale (NRS) scores and pROM values (abduction, external rotation, flexion, hyperextension, and internal rotation), were evaluated pre- and post-injection.ResultsThe patients’ mean age was 54.0 ± 8.0 years. The mean symptom duration was 6.5 ± 2.8 months. The mean follow-up period after injection was 6.7 ± 0.8 weeks. The NRS scores and pROM values significantly improved in both the injected and non-injected shoulders.ConclusionsThis study showed that unilateral IACI in patients with bilateral FS improves the clinical outcome of the non-injected shoulder. We suggest that physicians observe the non-injected shoulder after unilateral injection rather than performing bilateral injections.

Evaluation of Hylan G-F 20 Treatment with Opioid Prescriptions and Intraarticular Corticosteroid Injections in Patients with Osteoarthritis of the Knee Using a Claims Database.

ObjectiveAssess how treatment with the viscosupplement hylan G-F 20 relates to opioid prescriptions and intraarticular corticosteroid injections (IACS) in patients with osteoarthritis of the knee (OAK).DesignCase-crossover; adult patients with OAK identified in a claims database were treated with hylan G-F 20 from July 1, 2007, to June 29, 2017. Opioid or IACS prescriptions in the 6 months before treatment were compared to the 6 months after. Patients with comorbid conditions requiring pain medications were excluded, resulting in a 29,395-patient cohort. Four subgroups were investigated: patients with (1) opioids before hylan G-F 20 (OB; n = 6,609); (2) opioids before and after hylan G-F 20 (OBF; n = 3,320); (3) IACS before hylan G-F 20 (CB; n = 11,162); and (4) IACS before and after hylan G-F 20 (CBF; n = 2,810). All opioids were converted to morphine milligram equivalents (MME).ResultsOB subgroup patients had a significant decrease (P < 0.01) in total MME (−14.0%), MME per day (−14.2%) and opioid prescription days (−12.6%) after treatment versus before. Only 50.2% of patients prescribed opioids before hylan G-F 20 were prescribed an opioid after treatment. OBF subgroup patients had a significant increase (P < 0.01) in opioid prescription days (7.8%) before versus after treatment. There was a significant decrease (P < 0.01) in the number of IACS after versus before treatment for the Total Cohort (−56.1%), and subgroups CB (−72.6%) and CBF (−4.1%). A total of 74.8% of patients receiving an IACS before treatment did not receive an IACS after treatment.ConclusionsHylan G-F 20 is associated with a reduction in opioid prescriptions and IACS in OAK patients.

Comparison of Clinical Outcomes between Idiopathic Frozen Shoulder and Diabetic Frozen Shoulder After a Single Ultrasound-Guided Intra-Articular Corticosteroid Injection.

There is no consensus on the use of intra-articular corticosteroid injections in diabetic frozen shoulder (FS). Thus, we aimed to compare clinical outcomes after intra-articular corticosteroid injections in patients with diabetic FS and idiopathic FS. Data collected from 142 FS patients who received glenohumeral joint intra-articular corticosteroid injections were retrospectively reviewed. Thirty-two patients were diagnosed with diabetic FS and 110 patients with idiopathic FS. Data including visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and passive range of motion (ROM) were compared before the injection and at 3, 6, and 12 weeks after the injection. There were significant improvements in all outcomes (p < 0.001 for all parameters) through 12 weeks in both groups. There were no significant differences in all outcomes, except for ASES scores, between both groups at 3 weeks. However, there were significant differences in VAS score, SSVs, ASES scores, and passive ROMs, except for angle of abduction, between the two groups at 6 weeks and 12 weeks after injection. A single intra-articular steroid injection can be used as a conservative treatment for diabetic FS, but less effective than for idiopathic FS.

Risk of Periprosthetic Infection Following Intra-Articular Corticosteroid Injections After Total Knee Arthroplasty

BackgroundRecent literature has advocated for the effectiveness of postoperative steroid injections following total knee arthroplasty (TKA) for improving pain and range of motion when other correctible causes of these symptoms have been eliminated. The safety of such injections has not been thoroughly evaluated. The aim of this study was to determine the risk of acute infection following intra-articular corticosteroid injection into a preexisting TKA. MethodsThe Humana dataset was used to identify patients who underwent TKA from 2007 to 2017. Patients with ipsilateral knee corticosteroid injections in the postoperative period were then identified and compared to a 2:1 matched control cohort. A diagnosis of infection within 6 months and 1 year following the injection and an ipsilateral procedure for infection at any time postoperatively were then assessed and compared to controls using a multivariate binomial logistic regression analysis. ResultsOf the 166,946 TKA performed during the study period, 5628 patients had a postoperative corticosteroid injection (3.4%). Patients with injections had a significantly higher rate of periprosthetic infection compared to noninjection matched controls at all studied time points. ConclusionIn a large national database, about 3% of patients who undergo TKA have a postoperative steroid injection into their postoperative knee. While there is some existing literature demonstrating improvement in pain and stiffness symptoms after TKA with postoperative injections, the present study demonstrates a significant correlation between postoperative intra-articular corticosteroid injections in patients with preexisting TKA and periprosthetic joint infection compared to matched controls who did not receive an injection.

Adhesive Capsulitis: Demographics and Predictive Factors for Success Following Steroid Injections and Surgical Intervention

PurposeExamine demographic factors of all patients treated for adhesive capsulitis by a single surgeon, report the treatments and outcomes of these patients, and determine the effectiveness of various treatments, including corticosteroid injections and operative intervention in relation to risk factors for adhesive capsulitis.MethodsAll patients treated for adhesive capsulitis by a single surgeon between 2008 to 2014 with minimum 2 years' follow-up were identified via charts and operative reports and were eligible for inclusion. Demographic information including sex and medical comorbidities was documented. Preintervention and postintervention shoulder range of motion was recorded. Specific treatment information (number of corticosteroid injections, etc) was collected. Treatment outcomes were then compared as an aggregate and among varying comorbidities.ResultsOverall, 1377 patients were treated for adhesive capsulitis (946 women vs 431 men [P = .001]). For patients with adhesive capsulitis: a higher percentage of men than women had diabetes (24.8% vs 17.3% [P = .001]); nondiabetic patients had better forward flexion at initial presentation than patients with diabetes (114° vs 108° [P = .015]); more patients with diabetes required capsular release than nondiabetic patients (13% vs 7.3% [P = .003]); more nondiabetic patients resolved adhesive capsulitis without corticosteroid or surgical intervention than patients with diabetes (83.6% vs 61.7% [P = .001]); more nondiabetic patients resolved adhesive capsulitis after single corticosteroid injection than did patients with diabetes (95.9% vs 86.7% [P = .001]). Multiple intraarticular corticosteroid injections provided no added benefit over a single injection in resolving adhesive capsulitis in patients with diabetes and nondiabetic patients.ConclusionIn shoulder adhesive capsulitis, women and patients with diabetes are more commonly affected, patients with diabetes respond less favorably to physical therapy in isolation and physical therapy plus corticosteroid injections than nondiabetic patients. No benefit from multiple intraarticular corticosteroid injections was seen compared with a single intraarticular corticosteroid injection in patients with diabetes and nondiabetic patients. Patients with diabetes and nondiabetic patients have functional improvement after capsular release and manipulation if conservative treatment for adhesive capsulitis fails.Level of EvidenceIII, case control.

Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis.

Intra-articular corticosteroid injections are often used for short-term pain relief in patients with knee osteoarthritis (OA). This study investigates the efficacy of intra-articular corticosteroid injections in patients with symptomatic knee OA and factors that affect treatment response. This prospective, multicentered cohort study had 100 participants with radiographic evidence of knee OA enrolled. Participants received one corticosteroid injection into the affected knee and were evaluated before the injection (baseline) and at 3 weeks, 6 weeks, 3 months, and 6 months after the injection. Participants' Visual Numeric Scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores improved at all time points except for the Visual Numeric Scale score at 6 months, compared with baseline scores (P < 0.001). Participants with Kellgren-Lawrence grade 1 or 2 OA saw clinical improvement in the WOMAC scores at all time points, compared with the baseline score (P < 0.01). Compared with all other subgroups, obese patients with Kellgren-Lawrence grade 3 or 4 OA had significantly worse WOMAC scores at baseline, 6 weeks, and 3 months (P < 0.01 and P < 0.01, respectively). Our findings validate previously established guidelines for nonsurgical management of knee OA and suggest that intra-articular corticosteroid injections may be an acceptable short-term management option in patients unwilling or unable to undergo surgical treatment. Obesity and OA severity affect the efficacy of intra-articular corticosteroid injections. Patients receiving intra-articular corticosteroid injections had improved pain and function. Clinicians should expect less improvement in patients with obesity and/or advanced arthritis. Clinical benefits of intra-articular injections in these patients are less predictable.

Clinical efficacy of hydrodistention with joint manipulation under interscalene block compared with intra-articular corticosteroid injection for frozen shoulder: a prospective randomized controlled study

Hydrodistention is known to be an effective method of treatment for frozen shoulder. However, hydrodistention is accompanied by severe pain during the procedure. An interscalene block may relieve the severe pain associated with the procedure of hydrodistention. This study compared the clinical efficacy of hydrodistention with joint manipulation under an interscalene block with that of intra-articular corticosteroid injection. This prospective randomized controlled study included 121 patients presenting with frozen shoulder. Patients were randomized into 2 groups; those in group A (60 patients) were treated by hydrodistention with joint manipulation under an interscalene block, and those in group B (61 patients) were managed with intra-articular corticosteroid injection. Pain intensity and patient satisfaction were assessed by the visual analog scale. Functional outcomes were assessed by the Constant score and the range of shoulder motion. Group A demonstrated better patient satisfaction and earlier restoration of range of motion than group B at 6 weeks (P ≤ .001). At 12 weeks, the pain score was lower and the Constant score was better in group A than in group B. However, at 12 months after treatment, pain score (P = .717), patient satisfaction (P = .832), range of motion (P > .05), and Constant score (P = .480) were similar in the 2 groups. Hydrodistention combined with joint manipulation under an interscalene block provided earlier pain relief and restoration of shoulder range of motion and function compared with single intra-articular corticosteroid injection in patients with primary frozen shoulder.

AB0599 The oa trial bank: individual patient data meta-analysis of trials investigating the effectiveness of intra-articular corticosteroid injections in patients with knee or hip oa

BackgroundBased on small to moderate effect size of the wide range of symptomatic treatments in osteoarthritis (OA), and the heterogeneity of OA patients, treatment guidelines for OA have stressed the...

The OA trial bank: individual patient data meta-analysis of trials investigating the effectiveness of intra-articular corticosteroid injections in patients with knee or hip OA

s / Osteoarthritis and Cartilage 21 (2013) S63–S312 S259 activities as putting on their clothes. In addition, individuals with multiple co-morbidities had even more complex and challenging selfmanagement experiences, which resulted in family and friends taking on additional “work” to compensate. The multi-joint nature of OA and other co-morbidities further complicated self-management. Many participants described experiencing pain or stiffness in multiple joints at the same time as a result of OA. Additionally, several participants had other health conditions that affected their ability to participate in selfmanagement activities. Conclusions: These findings suggest that previous research on OA selfmanagement overlooks the everyday modifications patients already make to manage their disease prior to surgery, and additionally focuses solely on the individual patient, ignoring the social context of their lives. We found that self-management is not an individual activity but rather can involve the individual's spouse, children, friends and/or co-workers. Further, self-management is complicated by the multi-joint nature of OA and by comorbidities. Future approaches to self-management in OA need to consider these additional issues/aspects as well as the various psychosocial factors that may influence patients’ experiences. 498 THE OA TRIAL BANK: INDIVIDUAL PATIENT DATA META-ANALYSIS OF TRIALS INVESTIGATING THE EFFECTIVENESS OF INTRA-ARTICULAR CORTICOSTEROID INJECTIONS IN PATIENTS WITH KNEE OR HIP OA M. van Middelkoop y, K. Dziedzic z, M. Doherty x, W. Zhang x, J. Bijlsma k, T. McAlindon {, S. Lohmander , S.M. BiermaZeinstra y. y Erasmus MC Med. Univ., Rotterdam, The Netherlands; z Primary Care Sci. Keele Univ., Keele, United Kingdom; xUniv. of Nottingham, Nottingham, United Kingdom; kUniv. Med. Ctr. Utrecht, Utrecht, The Netherlands; { Tufts Univ., Boston, MA; # Lund Univ., Lund,

Intra-articular Corticosteroid Injection in Osteoarthritis of the Knee and Hip: Factors Predicting Pain Relief—A Systematic Review

Variations in the degree of pain relief reported by patients with osteoarthritis following intra-articular corticosteroid injections are well recognized but the reasons for this are not widely understood and factors which might predict variations in response have not been subjected to systematic review. We set out to review systematically the literature relating to predictors of pain reduction following intra-articular corticosteroid injections in patients with knee and hip osteoarthritis. Searches were performed using Medline, EMBASE, Web of Knowledge and MeSH search of Pubmed, the last search being performed in August 2012. Search terms included knee osteoarthritis, hip osteoarthritis, corticosteroid and related terms, and intra-articular injection. Papers were selected and reviewed by 2 reviewers. For inclusion, papers were required to describe studies in which patients with osteoarthritis of the knee or hip received intra-articular corticosteroid injection as an intervention, contain clearly defined outcome measures relating to pain and contain analysis relating to predictors of clinical response to treatment. Twenty-one studies met criteria for inclusion from a total of 54 papers reviewed in full. Eight of these related to hip OA and 13 related to knee OA. No factors that were investigated as potential predictors of response, including radiographic grade and clinical or sonographic evidence of inflammation or synovial hypertrophy were supported by strong evidence. The review also identified that several plausible potential predictors had not been studied to date. Previous research has not identified reliable predictors of response to IA corticosteroid injections, a widely practised intervention in knee and hip OA. Further studies are required if this question is to be answered.

Intra-articular steroid injection for temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic review on efficacy and safety

ObjectiveTo determine the current level of evidence for the use of intra-articular corticosteroid injections (IACI) against temporomandibular joint (TMJ) arthritis in patients with juvenile idiopathic arthritis (JIA) with a particular focus on clinical and radiological improvements and safety profile. MethodsA comprehensive electronic search strategy was performed in all major medical databases in February 2012. Studies were selected independently by two reviewers in accordance with a pre-specified protocol and a risk of bias assessment for all included studies. ResultsNinety-four unique citations were identified of which seven remained after the inclusion criteria were applied and all of these were assessed to have a high risk of bias. The current limited level of evidence suggests potential beneficial properties of IACI in patients with TMJ arthritis-related symptoms and/or MRI-verified signs of TMJ inflammation. Currently, no scientific evidence substantiates the effect of IACI in terms of (I) improving maximal mouth opening capacity significantly, (II) reducing radiological disease progression, (III) normalising/improving mandibular growth, and (IV) increasing efficacy upon repeated injections. ConclusionThe current level of evidence allows only very limited conclusions on the effect of IACI therapy in patients with TMJ arthritis. Knowledge on the long-term impact of IACI on mandibular growth is not available. Future studies designed in accordance with evidence-based standards are needed to allow a more general conclusion on efficacy and safety of this treatment modality in patients with TMJ arthritis.

Predictive value of synovial fluid analysis in estimating the efficacy of intra-articular corticosteroid injections in patients with rheumatoid arthritis.

The predictive relevance of synovial fluid analysis and some other variables for the efficacy of intra-articular corticosteroid injections in 30 patients with rheumatoid arthritis and hydropsy in a knee joint was evaluated in a prospective study. At the onset of the study, the knee joints were aspirated and 30 mg triamcinolone hexacetonide injected intra-articularly. The circumferences and the tenderness scores of the knee joints were measured at onset, after two months, and at the end of the six months' follow up. Of the variables studied, synovial fluid C4, percentage of synovial fluid polymorphonuclear leucocytes, blood haemoglobin, and serum C3 correlated significantly with the decrease in knee joint circumference after two months, whereas only the percentage of synovial fluid polymorphonuclear leucocytes correlated significantly after six months. Between the patients with and without improvement in the tenderness scores of the knee joints, only serum IgM differed at the examination after two months; this was higher in patients whose scores showed no improvement.