Intra-articular Corticosteroid Injections Research Articles

Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial

ObjectiveThe study’s primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated...

AAOS 2024 Best Paper in the Shoulder and Elbow Classification: Watchful Waiting Provides Higher Value with Similar Functional Outcomes to Physical Therapy for Frozen Shoulder: A Prospective Randomized Controlled Trial

Physical therapy remains a ubiquitous treatment modality for the management of frozen shoulder (adhesive capsulitis) despite limited high-level evidence supporting its use. Leveraging patient-reported outcome measures (PROMs) and healthcare costs, this study compared patient outcomes and value achieved through watchful waiting (WW) versus physical therapy (PT) for conservative management of frozen shoulder. Patients in this prospective, parallel randomized controlled trial who were diagnosed with frozen shoulder were randomized 1:1 to WW or PT. All patients were offered therapeutic, intra-articular corticosteroid injections (CSIs). The primary outcome was the American Shoulder and Elbow Surgeons (ASES) Score. Secondary outcomes included patient value (i.e., 12-month ASES score divided by healthcare costs), the Disabilities of the Arm, Shoulder, and Hand questionnaire, and Visual Analog Scale pain. Due to the confidentiality of internal hospital data, all economic outcomes were divided by an undisclosed constant to set the normalized study mean for direct costs to 1,000; similarly, patient value was normalized to set the study mean to 100. Outcomes were assessed at baseline, 6 weeks, 3 months, 6 months, and 12 months using mixed-effects models, with sensitivity analyses adjusting for nonlinear improvement trajectories and CSIs. Between November 2014 and November 2022, 175 patients were screened, 61 of whom (34.9%) were randomized to WW (31 patients) or PT (30 patients). Forty-seven patients (96%) received at least one CSI, with no significant difference in CSI administration between cohorts (p=0.29). Relative to baseline scores, patients from both cohorts improved significantly at each time point for all PROMs (p<0.05 for all), with no significant differences in PROMs between groups at any time point (p>0.05 for all). However, compared to those assigned WW, patients randomized to PT incurred 10.0x higher costs (normalized mean difference: 1,636; 95% CI: 967, 2,304; p<0.001) and achieved only 16.9% of the patient value (normalized mean difference: -147.0; 95% CI: -207.5, -86.5; p<0.001). These results held across all sensitivity analyses. Relative to WW, patients randomized to PT reported similar PROMs but incurred significantly higher direct costs (10.0x) and imposed a greater economic burden on the healthcare system (3.4-6.0x). Accordingly, WW resulted in significantly higher (5.9x) patient value than PT. Although additional high-level, multicenter studies are needed to corroborate these findings, the present study may support physicians and patients in pursuing the most appropriate treatment plan for each patient based on their individualized needs and preferences.

A comparative study of intraarticular versus subacromial corticosteroid injection in the treatment of frozen shoulder

Background: Frozen shoulder or adhesive capsulitis, is a condition characterized by pain and restricted movement of the shoulder joint. Corticosteroid injections are commonly used to alleviate symptoms, but the optimal injection site remains debated. This comparative study aims to evaluate the efficacy of intraarticular versus subacromial corticosteroid injections in treating frozen shoulder. Methods: This prospective, randomized controlled study was conducted over 12 months, from November 2022 to October 2023, at BMCRI, Bangalore. A total of 60 patients diagnosed with adhesive capsulitis were enrolled and randomized into two groups: 30 patients in the intraarticular (IA) injection group and 30 patients in the subacromial (SA) injection group. Patients were randomly assigned to either the IA group or the SA group. The IA group received a 40 mg injection of Triamcinolone Hexacetonide with 4 ml of 2% lidocaine into the glenohumeral joint. SPSS (Version 25.0) was used for analysis. Results: Patients in the intraarticular group demonstrated significantly lower pain scores compared to those in the subacromial group at the 4th, 8th and 12th weeks (p&lt;0.05). The intraarticular group consistently achieved higher Constant Shoulder Scores at 4, 8 and 12 weeks, suggesting a more effective recovery in shoulder function compared to the subacromial group. Conclusion: This study demonstrates that intraarticular corticosteroid injections are more effective than subacromial injections in treating patients with frozen shoulders, particularly in terms of pain relief and functional improvement.

Intra-articular corticosteroid injections for osteoarthritis: A qualitative study of patients' and clinicians' experiences.

Osteoarthritis is a leading cause of joint pain and disability. Intra-articular corticosteroid injections (IACs) are often used in primary care once other recommended treatments have failed. Evidence shows that IACs provide short-term relief of osteoarthritis symptoms, yet little is known about patients' and primary care clinicians' experiences and beliefs about their use. We explored patients' and primary care clinicians' views about IACs, including the benefits, disadvantages, perceived risks of treatment, when they are used, and factors that affect decision-making. We conducted individual interviews with patients and primary care clinicians and used inductive thematic analysis to investigate their views and experiences of intra-articular corticosteroid injections for osteoarthritis (IACs). We interviewed 38 patients and 19 primary care clinicians. We identified 6 patient themes: variation in access; awareness of IACs; views of risk and trust; effectiveness of IACs; variation in onset and effect duration; and an alternative to undesirable treatments. In the interviews with clinicians, we identified an overarching theme of caution and competence, which included eight subthemes: confidence and (dis)comfort with practical procedures; risk of adverse outcomes; training; uncertainty about evidence and guidelines; technical uncertainties; IACs use on the osteoarthritis pathway; perceived benefits and impacts of IACs; and the possibility of placebo. Patients and clinicians valued IACs' potential to relieve symptoms and improve quality of life. Variability in patients' access to treatment appears related to clinicians' confidence in delivering injections and their concerns about the evidence base. Variation in dose frequency and timing reflect clinicians' uncertainty about current guidance. Despite variation in effectiveness patients preferred IACs to other forms of pain medication and to delay or avoid surgery. IACs were mostly used as an adjunct treatment before surgery was offered. These findings can inform further research into the effectiveness of IACs and improvements in information and guidance.

Intraarticular hip corticosteroid injections offer no meaningful benefit in delaying time to total hip arthroplasty in patients with hip osteoarthritis

IntroductionSymptomatic hip osteoarthritis (OA) causes significant morbidity and functional limitations. While corticosteroid injections (CSI) are commonly offered and administered for OA pain relief, it is unknown if they offer any clinically meaningful long-term benefit or reduce the overall need for surgical intervention.MethodsA cross-sectional retrospective cohort study was performed on primary hip osteoarthritis patients from a single academic tertiary-care center arthroplasty clinic from 2014 to 2019. Patients were divided into three groups. CSI + THA: hip CSI patients who underwent subsequent ipsilateral THA. CSI-noTHA: hip CSI who have not had ipsilateral THA to date. THA-noCSI: a control group of consecutive hip OA patients who underwent primary THA without prior CSI. Demographic variables, injection relief duration, and radiographic arthritis severity were recorded. Time from clinic presentation to injection and/or THA were compared.Results357 patients met inclusion criteria and underwent guided, arthroplasty provider-ordered CSI. Mean duration of relief was 6.7 weeks (SD 8.7). 244 injection patients (67.2%) subsequently underwent THA (CSI + THA). 150 of 390 patients have not undergone THA at mean of 25.5 months follow-up. Mean time from clinic presentation to THA was 8.6 months longer after CSI (16.3, SD 17.8) months in CSI patients compared to 7.7 (SD 10.6) months for patients without CSI (p < 0.001). Of 117 patients in the CSI-noTHA group at mean 25 months follow-up, only 43 (12% of all injection patients) had not had THA because they found injections effective. The remaining 74 (63%) of CSI-noTHA patients have been deemed medically unfit for surgery or are currently scheduled for THA.Discussion/ConclusionThe results of this study suggest the utilization of intra-articular CSI as conservative treatment in an arthroplasty clinic does not prolong time to THA for a clinically important duration. The use of CSI should be reserved for diagnostic purposes and/or short-term pain relief in poor surgical candidates.Level of evidenceIII.

Intraarticular corticosteroid injections in pediatric rheumatology: insights from specialists.

IACIs are widely utilized in pediatric rheumatology for oligoarticular JIA, yet practice variability exists. Standardized protocols through randomized studies can enhance IACI efficacy and patient outcomes. • Intraarticular corticosteroid injections (IACIs) are a widely utilized and effective treatment modality in managing oligoarticular and polyarticular juvenile idiopathic arthritis (JIA), offering rapid symptom relief and the potential to prevent long-term joint deformities. • Despite their widespread use, there is significant variability in the indications, techniques, and anesthetic methods employed for IACI administration among pediatric rheumatologists, and much of the supporting evidence remains anecdotal. • This study highlights the diverse clinical practices and preferences regarding IACI use in pediatric rheumatology across two different countries, revealing considerable variations in the use of ultrasound guidance, anesthetic approaches, and corticosteroid formulations. • The findings underscore the need for standardized treatment protocols and further research to optimize IACI procedures, aiming to reduce variability and improve outcomes in the management of JIA.

Juvenile idiopathic arthritis management: insights into the utilization of intra-articular corticosteroid injections

ABSTRACT Background Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease in children, requiring careful management to reduce both short- and long-term morbidity. In this study, our objective was to assess the clinical features of patients diagnosed with JIA who received intra-articular corticosteroid injections (IACI). Methods In this retrospective study, we evaluated the clinical and laboratory characteristics of 225 JIA patients monitored from January 2012 to October 2023 at a tertiary care center. We focused on patients who underwent intra-articular corticosteroid injections (IACI) as part of their treatment. Triamcinolone hexacetonide (TH) was used due to its demonstrated safety and efficacy. Results Our analysis revealed that IACI, particularly utilizing TH, was a widely employed and effective adjunct therapy, contributing to rapid symptom relief and local disease control. Patients receiving IACI exhibited earlier symptom onset, younger age at diagnosis, longer follow-up durations, and higher cumulative treatment burden (p < 0.001, p < 0.001, p < 0.01, p < 0.001 respectively). Despite inconclusive acute-phase reactants, a higher frequency of ANA positivity and elevated initial lymphocyte counts were associated with increased IACI use (p < 0.001, p < 0.001 respectively). Importantly, on a joint basis, a high percentage of arthritis remission following IACI underscores its efficacy and favorable safety profile. Conclusions Notably, the high percentage of arthritis remission achieved with intra-articular corticosteroid injections (IACI) on a joint-specific basis highlights its efficacy and favorable safety profile. A lymphocyte count exceeding 5000/mm3 at the time of diagnosis may serve as an early indicator for considering intra-articular steroid administration. These findings emphasize the need for nuanced and individualized treatment strategies in JIA management to optimize outcomes for affected children.

Custo-Efetividade de Diferentes Tratamentos Minimamente Invasivos Para Disfunção Temporomandibular de Origem Articular sob a Perspectiva do Sistema Público de Saúde Brasileiro

ObjectiveThis study aimed to evaluate the cost-effectiveness (CE) of minimally invasive interventions for pain associated with articular temporomandibular dysfunction from the Brazilian Public Health System (SUS) perspective. MethodsThis is a CE study with a 1-year time horizon. Effectiveness data were extracted from a network meta-analysis, and 2 treatments with moderate levels of evidence certainty were evaluated: arthrocentesis (ARTRO) plus intra-articular corticosteroid (CO) injection and ARTRO plus intra-articular injection of sodium hyaluronate (SH). For CE analysis, the costs of 2 types of SH (low and high molecular weight) and 4 COs (betamethasone [B], dexamethasone acetate [D], methylprednisolone sodium succinate [M], or triamcinolone hexacetonide [T]) were considered. Modeling was conducted using TreeAge Pro Healthcare software, with the construction of a decision tree representing a hypothetical cohort of adults with articular temporomandibular dysfunction. Deterministic and probabilistic sensitivity analyses were performed. In addition, an acceptability curve was developed. ResultsThe total costs per joint for ARTRO plus low- and high-molecular-weight SH and ARTRO plus COs B, D, M, and T were, respectively, R$583.32, R$763.85, R$164.39, R$133.93, R$138.57, and R$159.86. ARTRO plus dexamethasone acetate was considered cost-effective, with lower cost and higher net monetary benefit than other technologies. In all sensitivity analysis scenarios, it remained cost-effective. It also showed greater acceptability. ConclusionARTRO plus dexamethasone acetate was considered the cost-effective technology, exhibiting higher net monetary benefit and higher acceptability from the SUS perspective.

The Different Effects of 2 Consecutive Glenohumeral Injections of Corticosteroids on Pain Reduction and Range-of-Motion Improvement in Frozen-Phase Frozen Shoulder

PurposeThe purpose of the study is to investigate the improvement of frozen phase frozen shoulder (FS) patients’ pain and shoulder mobility, including passive forward elevation (FE), external rotation (ER), and internal rotation (IR) following two consecutive intra-articular corticosteroids (IACS) injections. MethodsThis retrospective cohort study was performed from July 2020 to November 2023. All patients with frozen phase FS received two ultrasound-guided IACS injections at a six-week intervals. FE, ER, IR, and visual analog scale (VAS) were measured at each follow-up consultation with a 6-week interval. ResultsA total of 134 patients finished the study. There were varying degrees of change in pain relief and ROM improvement between each IACS injection. The FE and IR improved significantly between the first and second injections (both P < 0.001), while ER only improved significantly after the second injection (P < 0.05). The pain level improved both after the first and second injections (both P < 0.001). ConclusionPatients with frozen-phase FS demonstrated improved pain and mobility of FE and IR after a single IACS injection. However, a second IACS injection provides similar therapeutic effects and also significantly improves ER mobility.

Safety and efficacy of intra-articular triamcinolone acetonide injection versus standard of care in patients with rheumatoid arthritis flare

Triamcinolone acetonide is a commonly used corticosteroid for rheumatoid arthritis (RA) flares, providing extended relief. However, there is limited data from controlled trials comparing the efficacy of intra-articular corticosteroid (IACS) injections to standard care, particularly with non-steroidal anti-inflammatory drugs (NSAIDs). This non-randomized, single-center, open-label study evaluated the safety and efficacy of IACS injections in RA patients experiencing knee joint flare-ups. A total of 64 patients were screened and 44 received IACS (triamcinolone acetonide) and 15 were included in the control group. Significant improvements were observed in the IACS group in pain, swelling, and morning stiffness at week 2, which were sustained through weeks 6 and 12. The swollen joint count significantly reduced by week 12, while the tender joint count showed improvement by week 2. Pain reduction was substantial, as indicated by significant decrease in visual analog scale scores for pain, swelling, and mobility. The disease activity score-28 improved significantly across all time points. In addition, the C-reactive protein level decreased significantly at week 2 and its decreasing trend continued until weeks 6 and 12. By week 2, all patients had ceased NSAID use. The study demonstrated the effectiveness of IACS in reducing RA flare severity, particularly in terms of pain, swelling, and functional impairment, with no major safety concerns reported.

Genicular Artery Embolization, Radiofrequency Ablation, and Corticosteroid Therapy for Knee Osteoarthritis: A Cost-Effectiveness Analysis Using Randomized Clinical Trial Data.

Background: Many patients with symptomatic knee osteoarthritis (KOA) are refractory to traditional nonsurgical treatments such as intraarticular corticosteroid (CS) injection but are not yet eligible for or decline surgery. Genicular artery embolization (GAE) and radiofrequency ablation (RFA) are emerging adjunctive or alternative minimally invasive treatments. Objective: To perform a cost-effectiveness analysis (CEA) comparing CS, GAE, and RFA, for treatment of symptomatic KOA using a Markov model based on a de novo network meta-analysis (NMA) of randomized control trials. Methods: CEA was conducted to compare GAE and RFA to CS using a Markov cohort state-transition model from a U.S. Medicare payer's perspective over a 4-year time horizon. The model incorporated each treatment's success and attrition rates, costs, and utility benefit. Utility benefit values were derived at short-term (0.5-3 months) and long-term (6-12 months) posttreatment follow-up from NMA of published RCTs using an outcome of improved knee pain and/or function. Analyses were conducted at a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY). Sensitivity analyses were performed, including when simulating various cost setting scenarios (i.e., office vs hospital outpatient treatment). Results: RFA demonstrated larger treatment effect than GAE, more pronounced at short-term [standardized mean difference (SMD), -1.6688, 95% CI [-2.7806; -0.5571], p=.003] than long-term (SMD -0.3822, 95% CI [-1.9743; 1.2100], p=.64) follow-up. Across cost setting scenarios, incremental cost-effectiveness ratios relative to CS were $561-1563/QALY for GAE versus $76-429/QALY for RFA (not counting scenarios in which RFA was dominated by CS). GAE demonstrated higher cost-effectiveness probability compared to RFA (41.6-54.8% vs. 18.4-29.2%, respectively). GAE was more cost-effective than RFA when the GAE clinical success rate and post-GAE utility value exceeded 32.1-51.0% and 0.562-0.617, respectively, and when the GAE quarterly attrition rate was less than 8.8-17.4%. RFA was more cost-effective when baseline pre-treatment utility values exceeded 0.695-0.713. Neither GAE costs nor RFA costs were sensitive parameters. Conclusion: Across scenarios, GAE was consistently the most likely cost-effective treatment option compared to RFA and CS, although clinical success rates, attrition rates, and utility values impact its cost-effectiveness. Clinical Impact: GAE is likely to be more cost-effective than RFA or CS for treatment of symptomatic KOA.

Similar short-term outcomes of ultrasound guided posterior intra-articular and anterior extra-articular corticosteroid injection in the treatment of primary frozen shoulder. A randomized controlled, single-blind study.

Frozen shoulder, a condition characterized by the limitation of active and passive shoulder movements, is predominantly managed conservatively. Corticosteroid injection stands as a widely utilized and effective method for treatment. Nevertheless, the optimal approach for administering the injection remains a subject of controversy. We hypothesized that the injection of corticosteroid through anterior into the extra-articular area would yield superior results than the posterior intra-articular injection. This prospective, randomized, single-blind, and single-center clinical study aimed to compare the therapeutic effectiveness of ultrasound (USG)-guided injection techniques in patients with primary frozen shoulder. We continued the study with 54 patients who met the inclusion criteria. We evaluated patients pre-injection and at the first, third, and sixth weeks after injection. Two distinct approaches were employed: (1) Injection through the anterior extra-articular area around the coracohumeral ligament (CHL), and (2) injection through the posterior route into the glenohumeral joint. Evaluation parameters, including Visual Analog Scale (VAS) scores, active range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) scores, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, were assessed pre-injection and at the first, third, and sixth weeks post injection. No significant differences in the demographic and clinical characteristics, laboratory, or radiological findings were observed between the groups. It was observed that both groups exhibited similar and significant improvement in all measured parameters within their respective groups. Regarding pain scores, a notable decrease in VAS scores was observed in both groups (P = .000). There was no difference between the groups in terms of pre-injection VAS, QuickDASH, and ASES scores and active ROM measurements. The study concluded that there was no significant difference between ultrasound-guided injection of posterior intra-articular injection and anterior extra-articular injection concerning pain, ROM, and functional scores. Both techniques can be considered as viable options in the early stage of the disease. Level I, Therapeutic study.

The Disease-Modifying Effects of a Single Intra-Articular Corticosteroid Injection during the Freezing Phase of Frozen Shoulder in an Animal Model.

Although frequently prescribed for frozen shoulder, it is not known if corticosteroid injections improve the course of frozen shoulder. This study aimed to assess the disease-modifying effects of an intra-articular corticosteroid administration at the freezing phase of frozen shoulder. Twenty-four Sprague-Dawley rats were divided into four groups. Their unilateral shoulders were immobilized for the first 3 days in all groups, followed by an intra-articular corticosteroid injection in Group A, an injection and the cessation of immobilization in Group B, no further intervention in Group C, and the cessation of immobilization in Group D. All rats were sacrificed in Week 3 of study, at which point the passive shoulder abduction angles were measured and the axillary recess tissues were retrieved for histological and Western blot analyses. The passive shoulder abduction angles at the time of sacrifice were 138° ± 8° (Group A), 146° ± 5° (Group B), 95° ± 11° (Group C), 132° ± 8° (Group D), and 158° ± 2° (Control). The histological assessments and Western blots showed greater fibrosis and inflammation in the groups that did not receive the corticosteroid injection (Groups C and D) compared to the corticosteroid-injected groups (Groups A and B). These findings demonstrate the anti-inflammatory and disease-modifying effects of corticosteroid injections during the freezing phase of frozen shoulder in an animal model.

9. Chronic knee pain.

Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee. The literature on the diagnosis and treatment of chronic knee pain was retrieved and summarized. A modified Delphi approach was used to formulate recommendations on interventional treatments. Patients with knee OA commonly present with insidious, chronic knee pain that gradually worsens. Pain caused by knee OA is predominantly nociceptive pain, with occasional nociplastic and infrequent neuropathic characteristics occurring in a diseased knee. A standard musculoskeletal and neurological examination is required for the diagnosis of knee OA. Although typical clinical OA findings are sufficient for diagnosis, medical imaging may be performed to improve specificity. The differential diagnosis should exclude other causes of knee pain including bone and joint disorders such as rheumatoid arthritis, spondylo- and other arthropathies, and infections. When conservative treatment fails, intra-articular injections of corticosteroids and radiofrequency (conventional and cooled) of the genicular nerves have been shown to be effective. Hyaluronic acid infiltrations are conditionally recommended. Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have, at the moment, not enough evidence and can be considered in a study setting. The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary. When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery.

Corticosteroid injections for knee osteoarthritis offer clinical benefits similar to hyaluronic acid and lower than platelet-rich plasma: a systematic review and meta-analysis.

Intra-articular corticosteroid (CS) injections for knee osteoarthritis (OA) management are endorsed by several scientific societies, while the use of hyaluronic acid (HA) and platelet-rich plasma (PRP) is more controversial. Aim of the study was to quantify and compare the clinical effectiveness of CS injections with respect to HA and PRP in patients with knee OA. The search was conducted on PubMed, Cochrane, and Web of Science following the PRISMA guidelines. Randomized controlled trials (RCTs) on the comparison of CS injections and HA or PRP injections for the treatment of knee OA were included. The minimal clinically important difference (MCID) was used to interpret the clinical relevance of the improvements at different follow-ups up to 12 months. The study quality was assessed using the Cochrane RoB-2 tool and the GRADE guidelines. Thirty-five RCTs were included (3348 patients). The meta-analysis comparing CS and HA revealed no difference in terms of WOMAC improvement, while HA showed superior VAS pain improvement at long-term follow-up (P = 0.011), without reaching the MCID. PRP offered a superior WOMAC improvement compared to CS at short- (P = 0.002), mid- (P < 0.001, exceeding the MCID), and long-term (P < 0.001, exceeding the MCID) follow-ups. PRP offered a superior VAS improvement at mid- (P < 0.001, exceeding the MCID) and long-term (P = 0.023) follow-ups. CS injections for knee OA offer similar results to HA and PRP only at short term, while there is an overall superiority of PRP at longer follow-ups. This difference is not only statistically significant but also clinically relevant in favour of PRP.

Preoperative Hip Injection Response Does Not Reliably Predict 2-Year Postoperative Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

PurposeTo determine whether response to preoperative local anesthetic or corticosteroid intra-articular injections can predict 2-year postoperative outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). MethodsThis was a retrospective analysis of patients undergoing hip arthroscopy for FAIS at a single institution from 2014-2020. Patients who underwent preoperative intra-articular hip injection were classified based on injection type (local anesthetic, corticosteroid) and whether they experienced pain relief following injection (responders, non-responders). Responders were matched 2:1 by age, BMI, and sex with non-responders. Patient reported outcomes (PROs) including Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form Survey mental (SF-12-MCS) and physical component summary (SF-12-PCS) and visual analogue scale (VAS) pain were collected preoperatively and 2-years postoperatively. Mean score change and Minimal Clinically Important Difference (MCID) achievement were calculated and compared between groups. ResultsThe matched cohort included 126 total patients (42 non-responders, 84 responders; 74.6% female; mean ± SD age: 30.9 ± 9.9 years; BMI: 24.7 ± 3.7 kg/m2) with no differences in demographic or radiographic hip variables. Both groups demonstrated significant 2-year postoperative score improvements across all PROs, except SF-12-MCS, which remained unchanged. There was no difference in mean score change or MCID achievement across all PROs between corticosteroid injection responder and non-responder groups. In the local anesthetic group, MCID achievement was similar across all PROs, except VAS pain which showed greater percentage of MCID achievement among local anesthetic non-responders relative responders (Responders: 55.0%, Non-responders: 89.5%; p = 0.03). Significant ceiling effects were most readily apparent among the injection responders group with greater percentages of patients achieving maximal 2-year postoperative survey scores (36.9% HOOS-ADL, 19.0% HOOS-Pain, 15.5% HOOS-QoL, 32.1% HOOS-Sport). ConclusionsResponse to preoperative injection with either corticosteroid or local anesthetic did not predict 2-year outcomes after hip arthroscopy in patients with FAIS. Level of EvidenceLevel III, retrospective matched cohort study.

Intra-articular corticosteroid utilization and characterizations of use in juvenile idiopathic arthritis within the PR-COIN registry.

Intra-articular corticosteroid injections (IACI) have been shown to be effective at improving arthritis across juvenile idiopathic arthritis (JIA) categories. The American College of Rheumatology (ACR) recommends IACI use as primary and adjunctive therapy for JIA patients. However, there remains minimal data describing actual IACI use in North America. The objective of this study was to describe and to evaluate IACI use in JIA, utilizing the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) registry. Study participants from 13 sites were enrolled in the PR-COIN registry from 2011 to 2015. Demographic and clinical variables were summarized and Chi-squared and t-tests were used to evaluate differences between participants who did or did not receive IACI. Multiple logistic regression models were used to evaluate characteristics associated with IACI treatment. Our study included 3,241 participants, the majority of whom were white (85%), female (71%) and had oligoarticular JIA (39%). IACI was administered at least once in 23% of participants, the majority of whom had oligoarticular disease (52.5%), but overall use in oligoarticular participants was low at 30.8%. IACI use varied significantly between treatment centers and use was associated with oligoarticular disease, ANA positivity, and use of other systemic medications. This study demonstrates that participants with JIA enrolled in the PR-COIN registry between 2011 and 2015 with persistent oligoarticular disease, ANA positivity, and use of other systemic medications were more likely to receive IACI. However, IACI use was lower than expected for oligoarticular participants.

SEPTIC COMPLICATIONS AFTER THE USE OF GLUCOCORTICOIDS (RESULTS OF CLINICAL LABORATORY AND PATHOMORPHOLOGICAL STUDIES)

In numerous articles, monographs, and textbooks, the aspects of local application of glucocorticoid injections at the current stage of development of rheumatology are considered from the point of view of expediency, effectiveness, and safety. Factors affecting the effectiveness of this method are analyzed. Periarticular and/or intra-articular injections of corticosteroids are included in various recommendations and protocols for the treatment of arthrosis and rheumatic joint lesions available today. Objective. Determination of pathomorphological, clinical and laboratory manifestations of the infectious process after local administration of glucocorticoid drugs. Methods. Clinical, anamnestic, laboratory, bacteriological and pathomorphologicaldata of 34 patients with infectious complications were analyzed. Results. The administration of long-acting drugs was most often used: DIPROSPAN — 13 (38.2 %) cases; KENALOG — 5 (14.7 %); DEPOS — 3 (8.8 %); FLOSTERON — 2 (5.9 %); a short-acting drug (methylprednisolone acetate (METYPRED), hydrocortisone acetate) was used in 11 (32.4 %) cases. At the time of hospitalization in the clinic, the infectious process was in 8 (23.5 %) patients in the acute stage, 10 (29.4 %) in the subacute stage, and in another 16 (47.1 %) in the chronic stage, 13 (38.2 %) of which are in the active fistula phase. Conclusions. Pathomorphological manifestations and signs of a purulent-necrotic and purulent-inflammatory infectious process (infectious complications) after local administration of glucocorticoid drugs accompany and are closely statistically significantly interrelated with typical clinical and laboratory manifestations (leukocytosis with a «shift of the leukocyte formula to the left», an increase in ESR and level CRP) and etiology («bacteriology») of the infectious process.

Comparative Study between Ultrasound Guided Intraarticular Injection of Corticosteroids and Ultrasound Guided Genicular Nerve Block in Patients with Chronic Knee Pain

Abstract Background Chronic knee pain represents a major cause of disability and a burden on healthcare systems worldwide, being more prevalent in middle-aged and elderly patients. It can take a toll on patients’ daily life, keeps them from their favorite activities, saps of productivity, and diminishes overall quality of life. It can be caused by degenerative conditions, such as osteoarthritis (the most common cause), rheumatoid arthritis, crystalline arthritis and gout. lifestyle modification, pharmacologic management, and injections are the mainstay of therapy for elderly patients having chronic symptomatic knee pain with multiple medical comorbidities who do not wish/fit for surgical options. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate chronic knee pain and was traditionally performed blindly depending only on anatomical land marks. Recently, Genicular nerve block (GNB) has recently emerged as a novel alternative treatment for chronic knee pain. Both Intra-articular corticosteroid injection (IACSI) and Genicular nerve block (GNB) can be carried out under Ultrasound guidance as a safer, cheaper and more feasible imaging modality for guidance as it provides real-time imaging for the knee structures in a dynamic manner giving the ability to do interventional procedures and providing more effective clinical results when compared to blind injections. Aim of the Work Illustrate the technical aspects, the indications and the methodology of local therapies for chronic knee pain performed by interventional radiologists and provide current evidence. Assess the efficacy of Ultrasound (US) guided intraarticular corticosteroids injection and Genicular nerve block to control moderate and advanced chronic knee pain. Compare the immediate and short-term symptomatic and functional improvement obtained after both techniques. Patients and Methods The study was carried out on 30 patients of symptomatic chronic knee pain with radiologically proven knee joint arthritis (26 of them had osteoarthritis, 3 had gout arthritis and one patient had rheumatoid arthritis), all of them were not responding to medical treatment. They were divided into two groups (intraarticular corticosteroids injection group and Genicular nerve block one) both procedures were performed under ultrasound guidance to identify target points for injection. GNB target points for injection where close to the superior lateral, superior medial and inferior medial genicular arteries while target point for the IACSI group was the suprapatellar bursa. All procedures were performed with a spinal needle (22 G) introduced under ultrasound guidance till reaching the desired target points at both groups. Then injection of a mixture of Lidocaine, Bupivacaine hydrochloride and Triamcinolone Acetonide was done. Results In our study, in IACSI group the mean of initial VAS was 80.7±10.3 compared to 81.3±7.7 in GNB group. The mean VAS significantly dropped to be 20.7±5.3 in IACSI group compared to 18.3±5.9 in GNB group. After 2 weeks, it was 34.3±8.4 and 27.7±8.2 respectively. After 4 weeks, it increased to 40±8.7 and 33.7±9.3 respectively. At 8 weeks, it was obviously increased to 75.3±10.3 and 66.7±11.4 respectively and the effect returned gradually till nearly the baseline at 8 weeks. In our study, in IACSI group the mean of initial OKS was 48.6±7.4 compared to 50.1±7.6 in GNB group. After 2 weeks, it was markedly decreased to 25.5±3.9 and 22.7±6.8 respectively. After 4 weeks, it increased to 31.1±3.5 and 27.±6.9 respectively. At 8 weeks, it was obviously increased to 44.1±7.1 and 39.3±6.1 respectively and the effect returned gradually till nearly the baseline at 8 weeks. Conclusion Ultrasound guided genicular nerve block with a mixture of corticosteroid and local anesthetic is an effective, radiation free method to alleviate chronic knee pain and improve knee joint function. US guided intra-articular corticosteroid injection through suprapatellar approach is also an effective method to relive chronic knee pain and inflammation and to improve knee joint functional capacity. Both procedures are effective in alleviation of chronic knee pain for up to 4 weeks with marked decrease in VAS score after 2 weeks and slight increasing trend towards 4 weeks. The favorable effect returned gradually till nearly the baseline at 8 weeks. Genicular nerve block is more effective than intra-articular corticosteroid injection in both pain alleviation and improving knee joint function. The earlier the Kellgren- Lawrence score is, the more reduction in chronic knee pain and the more improvement of joint function is achieved after both procedures.

The Role of Intra-Articular Injection of Autologous Platelet Rich Plasma versus Corticosteroids in Treatment of Synovitis in Lumbar Facet Joint Disease

Abstract Background Low back pain (LBP) is an extremely common health problem and lumbar facet joint (FJ) disease is one of its main causes. Intra-articular injection of FJ is one of the vital therapeutic methods for FJ disease. Corticosteroids (CS) are the most commonly used injected drugs; however, previous studies have indicated that it has limited ability in long-term relief of LBP. Aim of the Work to compare the efficacy of intra-articular injection of platelet rich plasma (PRP) versus CS in improving MRI detected synovitis in correlation to clinical complaints of the patients with lumbar FJ syndrome. Patients and Methods Thirty patients with lumbar FJ syndrome divided into two equal groups: Group ‘I’ injected with PRP and Group ‘II’ with CS. The patients were comparatively assessed pre and post the intervention according to; number of tender lumbar FJs on palpation, maximum active lumbar extension range of motion, LBP visual analogue score (VAS), functional disability questionnaires - Roland Morris disability questionnaire (RMQ) and Oswestry disability index (ODI) - and MRI lumbar FJ detected synovitis and their grading. Results Both study groups showed statistical significant improvement in all mentioned parameters at 3 month follow up, there was no statistically significant difference between the results of both groups, however, PRP injected joints showed better performance regarding MRI synovitis grade in all lumbar FJ levels as compared to those injected with CS. Conclusion Both PRP and CS injections were determined to be effective in improvement of MRI detected FJ synovitis concurrently with improving clinical parameters, pain and functional activities of the patients at 3 months follow-up. However, PRP showed superior effect in improving MRI detected synovitis grade, therefore may be a better treatment option for longer duration efficacy and fewer side effects. TRN NCT04860531- 1/3/2021