Intra-articular Steroid Injection Research Articles

Is there a short-term benefit from an intra-articular steroid injection in female patients with adhesive capsulitis of the shoulder treated with physiotherapy?

The purpose of this retrospective study was to investigate the possible short-term benefit of a single intra-articular corticosteroid injection in those patients treated with physiotherapy when compared to a group of patients undergoing physiotherapy only (PT only). A retrospective chart review was conducted to identify eligible patients treated over a 4-year period. All female patients between 40 years and 60 years with a confirmed clinical diagnosis of idiopathic adhesive capsulitis who completed a prescribed physiotherapy program were considered eligible. Sixty-three patients fulfilled the inclusion criteria, but 22 were excluded because of missing data in the medical record. The remaining 41 patients comprise the study cohort; an experienced musculoskeletal physiotherapist assessed these patients both at initial presentation and at 12 weeks. Twenty patients with a mean age of 55.1 years underwent PT only and 21 patients with a mean age of 52.4 years received a single intra-articular dose of 40 mg methylprednisolone followed by physiotherapy. Outcome measures included the visual analogue scale (VAS) and measurement of range of motion. At final assessment (12 weeks), significant between-group differences were identified for the 'PT only' group for flexion ( p = 0.01) and abduction ( p = 0.008). When comparing the mean change from the initial assessment, a significant between-group difference was observed for abduction ( p = 0.03). The results of this study suggest that the intra-articular injection of a single dose of cortisone has no significant short-term benefit in female patients with idiopathic adhesive capsulitis managed with physiotherapy.

Brief Report: Synovial Fluid White Blood Cell Count in Knee Osteoarthritis: Association With Structural Findings and Treatment Response.

ObjectivesOsteoarthritis (OA) is a disease with a significant inflammatory component. The aim of this analysis was to determine the relationship between synovial fluid white cell count (SF WCC) and two parameters: disease severity and the reduction in knee pain after intra-articular steroid injection.MethodsSubjects with painful knee OA were recruited for participation in an open label study of intra-articular steroid therapy. Information was obtained about knee pain using the KOOS questionnaire and a proportion of subjects had magnetic resonance imaging (MRI) performed. Prior to injection with methylprednisolone acetate (80mg), the index knee joint was aspirated and the fluid obtained forwarded for assessment of SF WCC.ResultsInformation on SF WCC was available in 55 subjects. An increase in white cell count category (< 100, 101–250 and > 250–1,000 cells/mm3) was associated with an increase in synovial tissue volume (p = 0.028) and with other MRI-based measures of disease severity. Also, with each category increase in SF WCC there was a greater mean reduction in KOOS pain score after steroid injection; ≤100 cells/mm3 12.5 (SD 19.9) [referent], 101–250 cells/mm3 21.3 (SD 20.6) [β coefficient 0.279 p=0.049 ] and 251–1000 cells/mm3 29.3 (SD 15.2) [β coefficient 0.320 p=0.024].ConclusionAlthough within the ‘normal’ range, total synovial fluid white cell count appears to be a biomarker for MRI synovitis and may also predict response to anti-inflammatory treatment.

Comparative study of ultrasound guided supra-scapular nerve block versus intra-articular steroid injection in frozen shoulder

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Frozen shoulder is one of the most common musculoskeletal problems seen in orthopaedics. Many treatment modes are available however, it is difficult to treat and data on the comparative efficacy of various interventions are limited. Intra-articular corticosteroid injection (IASI) is a commonly used to treat frozen shoulder pain. Supra-scapular nerve block (SSNB) is also effective method to treat pain in chronic diseases that affect the shoulder. The present study was done to compare efficacy of ultrasound guided SSNB and IASI in management of painful frozen shoulder.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 patients with painful frozen shoulder were divided in two groups, Group A received ultra-sound guided SSNB with 6 ml 0.5% Bupivacaine; Group B received IASI using 40 mg Triamcinolone. Outcome measures were shoulder ranges mainly lateral rotation and abduction, shoulder pain and disability index and visual analogue scale (VAS). Patients were followed-up on 2&lt;sup&gt;nd&lt;/sup&gt; day, at 1&lt;sup&gt;st&lt;/sup&gt;, 3&lt;sup&gt;rd&lt;/sup&gt; and 6&lt;sup&gt;th&lt;/sup&gt; week.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All baseline parameters improved significantly in both groups; however, on comparison Group A showed significant improvement in passive lateral rotation on 2&lt;sup&gt;nd&lt;/sup&gt; day and 1&lt;sup&gt;st&lt;/sup&gt; week follow up (P =0.038 and 0.040 respectively). VAS score showed significance at all follow-up in Group A, whereas, in Group B significance was seen after 1 week. On inter group comparison Group A shows significance on 2&lt;sup&gt;nd&lt;/sup&gt; day (P =0.050), 1&lt;sup&gt;st&lt;/sup&gt; week (P =0.042) and 3&lt;sup&gt;rd&lt;/sup&gt; week (P =0.036).&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt;Both SSNB and IASI have efficacy in management of frozen shoulder. But supra-scapular nerve block is better than intra-articular injection and should be considered prior to steroid as it has early onset pain relief, early improvement in ranges, potentially lesser contraindications and side effects.&lt;p&gt; &lt;/p&gt;

Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis

Background: Intra-articular steroid injection is a common intervention for frozen shoulder (FS). Purpose: This review aimed to illustrate the effects of intra-articular steroid injection for FS. Study Design: Systematic review and meta-analysis. Methods: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing intra-articular steroid injection with no injection or sham injections for FS. Visual analog scale (VAS) pain scores were the primary outcome measure. Secondary outcome measures included passive external rotation, abduction, flexion, internal rotation, and functional scores. Complication rates were the safety outcome measure. Comparisons were performed with mean differences (MDs) and 95% confidence intervals (95% CIs). Three time intervals were analyzed: 4 to 6 weeks, 12 to 16 weeks, and 24 to 26 weeks postintervention. Trial sequential analysis was used to verify the pooled results. Line charts were drawn to view the recovery trend in both the intervention and control groups. Results: Eight RCTs with 416 patients were included. Compared with controls, patients who received intra-articular steroid injection had significantly reduced VAS pain scores at 4 to 6 weeks (MD, 1.28 cm [95% CI, 0.75 to 1.82]), 12 to 16 weeks (MD, 1.00 cm [95% CI, 0.47 to 1.52]), and 24 to 26 weeks (MD, 0.65 cm [95% CI, 0.19 to 1.10]) postinjection. Trial sequential analysis confirmed the pooled results at 4 to 6 weeks and 12 to 16 weeks but not at 24 to 26 weeks. Patients who received intra-articular steroid injection had improved passive external rotation, abduction, and flexion and Shoulder Pain and Disability Index (SPADI) scores at all 3 time intervals, as well as improved American Shoulder and Elbow Surgeons (ASES) scores at 12 to 16 weeks (MD, 12.20 [95% CI, 2.55 to 21.85]). No difference was noticed in Constant scores (MD, 5.70 [95% CI, –0.59 to 11.99]) or internal rotation except at 12 to 16 weeks (MD, 0.81° [95% CI, 0.18° to 1.44°]) and 24 to 26 weeks (MD, 3.88° [95% CI, 0.51° to 7.25°]) between steroid injection and placebo. Complication rates were 1.78% for facial flushing, 0.71% for dizziness owing to vasovagal reactions during injection, 1.07% for chest or shoulder pain, and 0.36% for nausea. Line charts improved in both groups. Conclusion: Intra-articular steroid injection is effective and safe for FS and relieves pain, improves functional performance, and increases range of motion. The effects are significant at 4 to 6 and 12 to 16 weeks postintervention and may last as long as 24 to 26 weeks.

Is Intra-Articular Steroid Injection to the Temporomandibular Joint for Juvenile Idiopathic Arthritis More Effective and Efficient When Performed With Image Guidance?

To compare short-term outcomes and procedure times for intra-articular steroid injection (IASI) to the temporomandibular joint (TMJ) with and without the use of intraoperative image guidance for patients with juvenile idiopathic arthritis (JIA). This is a retrospective study of children with JIA who underwent TMJ IASI atBoston Children's Hospital (Boston, MA). Patients were divided into groups according to IASI technique: 1) "landmark" group if performed by an oral and maxillofacial surgeon using an anatomic landmark technique with no intraoperative image guidance or 2) "image-guided" group if performed by an interventional radiologist using intraoperative ultrasound and computed tomography. Predictor variables included IASI technique (landmark vs image guided), age, gender, JIA subtype, category of medications for arthritis, and presence of family history of autoimmune disease. Outcome variables were changes in patient-reported pain, maximal incisal opening (MIO), synovial enhancement ratio (ER), and total procedure time. Forty-five patients with 71 injected TMJs were included. Twenty-two patients with 36 injected TMJs were in the landmark group and 23 patients with 35 injected joints were in the image-guided group. There were no relevant differences in age, gender, family history of rheumatologic disease, or disease subtype between groups. There were no differences in resolution of pain (P= 1.00), increase in MIO (P= .975), or decrease in ER (P= .492) between groups, but procedure times averaged 49minutes longer for the image-guided group (P < .008). There were no statistical differences in short-term outcomes, but procedure times were longer for the image-guided group. Although specific indications for the use of image guidance might exist, routine use of this procedure cannot be justified.

A Young Man with Joints Effusion without Trauma: It is a Rheumatic Disease

The problem of swollen joints in athletes represents a typical risk following a sports injury, but this is not the only cause, although it is the most frequent one. Indeed inflammatory arthritis may also be a source of joint effusion. We report the case of a 21-year-old professional football player who suffered from pain and swelling in his joints after a mild sprain. He first underwent arthroscopy, followed by intra-articular steroid injections at a later stage. Despite that, his joints swelled again over the next few weeks. The patient was diagnosed as suffering from reactive arthritis (ReA) and treated with a conventional treatment. As the synovitis still persisted, he was finally treated with Etanercept (50 mg s.c. weekly) which resulted in a complete and quick resolution of arthritis, allowing the patient to return to his previous level of performance.

Arthroscopic 360° Capsular Release for Adhesive Capsulitis in the Lateral Decubitus Position

Idiopathic adhesive capsulitis of the shoulder is a relatively common condition that results in pain and loss of motion due to capsular thickening and fibrosis. Most cases are successfully treated with conservative management including physical therapy and intra-articular steroid injections. If conservative management fails, arthroscopic capsular release allows precise release of thickened capsular tissue with a lower risk of complications and less soft-tissue trauma than manipulation under anesthesia alone. Arthroscopic capsular release in the beach-chair position typically requires some degree of manipulation to release the inferior capsule, which is often not visualized intraoperatively. In this technique article and video, we describe and demonstrate a technique of arthroscopic capsular release in the lateral decubitus position, providing a clear view of the inferior capsule, which facilitates a complete, 360° capsular release and mitigates the need for any manipulation under anesthesia.

Does Ultrasound Guidance Improve Effectiveness for Intra-Articular TMJ Steroid Injections in Juvenile Idiopathic Arthritis?

Juvenile Idiopathic Arthritis (JIA) is the most common childhood rheumatic disease. JIA frequently affects the temporomandibular joints (TMJs) and, when this occurs, intra-articular steroid injection (IASI) is one option for treatment. IASI is typically performed by an oral and maxillofacial surgeon (OMS) using facial landmarks and joint palpation, but some authors have suggested that superior results can be achieved when the procedure is performed by an Interventional Radiologist (IR) using image guidance.1 The purpose of this study is to compare outcomes of TMJ IASI performed by an OMS without intraoperative imaging versus by an IR using ultrasound guidance in a series of patients with JIA and TMJ synovitis. We hypothesized that there would be no measurable difference in treatment outcomes based on injection technique.

Arthropathie temporomandibulaire après infiltration cortisonique in situ

Temporomandibular disorders (TMDs) affect the masticatory muscles and the temporomandibular joints (TMJs). TMDs most often result from occlusal and/or muscular disorders and are then called primary or idiopathic TMDs. Less frequently, TMDs are related to local (trauma, infection) or general (rheumatoid arthritis) causes and are then called secondary TMDs. A little known iatrogenic cause of secondary TDM is the osteoarthritis that may be induced by intra-articular cortisone injections. We report one case of condylar lysis that occurred after one single intra-articular cortisone injection. A 62-years-old woman consulted for a long-lasting TMD on the left side manifesting itself through pain and noise. She benefited one year before from an intra-articular injection of cortisone by her rheumatologist for repeated closed lock of her left TMJ. Physical examination showed limited mouth opening with deviation on the left side. Lateral movements on the right side were impossible. The panoramic X-ray showed a condylar lysis on the left side that was on the CT scan. MRI additionally showed an anteriorly displaced and severely reshaped disc and an articular inflammation without intra-articular effusion. TMJ osteoarthritis secondary to unique or repeated intra-articular steroid injections are little-known. They are clinically expressed as typical TMDs and characterized on X-rays by condylar lysis and inflammation. Intra-articular injections of steroids are not totally harmless and other treatments must be preferred.

Neutrophil-to-lymphocyte ratio is a reliable marker of treatment response in rheumatoid arthritis patients during tocilizumab therapy

Objective: To investigate the reliable markers reflecting treatment response better than the traditional inflammatory indices in patients with rheumatoid arthritis (RA) receiving tocilizumab therapy.Methods: A total of 58 RA patients treated with tocilizumab for more than six months from January 2013 to December 2014 were initially included. Flares were defined as events that required steroid dose escalation, intra-articular steroid injections, or switching tocilizumab to other biologic agents. The clinical and laboratory data were retrospectively collected from electronic medical records.Results: Of the 52 patients except for six patients who were excluded, 16 experienced flares, and 36 were stable during tocilizumab therapy. The C-reactive protein (CRP) level did not significantly differ between a stable state before flares and at flares. Compared with those at the preflare time point, erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR) were significantly higher at flares; however, ESR levels (n = 9) were within the normal limit or decreased (n = 4) at flares. Interestingly, NLR increased at flares in all but one patient in the flare group.Conclusion: NLR is a more reliable marker than ESR or CRP for evaluating the disease activity in patients with RA during tocilizumab therapy.

Intra-articular steroid injection for osteoarthritis of the hip prior to total hip arthroplasty : is it safe? a systematic review.

Using a systematic review, we investigated whether there is an increased risk of post-operative infection in patients who have received an intra-articular corticosteroid injection to the hip for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection to the hip and infection following subsequent THA were identified from databases for the period between 1990 to 2013. Retrieved articles were independently assessed for their methodological quality. A total of nine studies met the inclusion criteria. Two recommended against a steroid injection prior to THA and seven found no risk with an injection. No prospective controlled trials were identified. Most studies were retrospective. Lack of information about the methodology was a consistent flaw. The literature in this area is scarce and the evidence is weak. Most studies were retrospective, and confounding factors were poorly defined or not addressed. There is thus currently insufficient evidence to conclude that an intra-articular corticosteroid injection administered prior to THA increases the rate of infection. High quality, multicentre randomised trials are needed to address this issue. Cite this article: Bone Joint J 2016;98-B:1027-35.

Predictors of response to intra-articular steroid injections in patients with osteoarthritis of the knee joint.

This study aimed to determine the factors associated with response to intra-articular steroid injection (IASI) in patients with knee joint osteoarthritis. One hundred seventy-four female patients, age ranging from 30 to 80years, diagnosed to have osteoarthritis of the knee joint, were given IASI. Response to IASI was assessed by using WOMAC and VAS at 2weeks, 4weeks and 3months. At 3months, the subjects were categorized as responders, partial responders and non-responders to treatment by IASI. Various factors were narrowed down to see their effect on response, namely age, BMI, smoking habits, comorbidities, presence of clinical effusion, radiographic score, local knee tenderness, range of movement and socioeconomic status. One hundred twenty-four patients completed the study. 16.1% showed 50% or more improvement in WOMAC score at 3months post IASI therapy, whereas 38.7% of OA patients had more than 50% improvement in VAS score. Out of all factors, range of movement, local knee tenderness and radiographic score of the affected joint are the three parameters which can predict the improvement in WOMAC score after 3months of IASI therapy (P=0.013, P=0.045 and P=0.000, respectively). Age of the patient can predict improvement in VAS at 3months post IASI (P=0.027). We conclude that age, range of movement, local knee tenderness and radiographic score of the affected joint can predict response to IASI after 3months of IASI therapy.

Evaluating the Effect of Valsalva Maneuver on Pain Occurring During Knee Injection

Background: Intra-articular injection of steroid is a common treatment for osteoarthritis of the knee and injection is a simple and reliable method However many people refuse it because of fear of needle and injection pain. Baroreceptor activation induces antinociception and the use of Valsalva maneuver for its activation may help to decrease local injection pain. Aim: This study was the first to evaluate the efficacy of Valsalva maneuver on needle insertion pain during local knee injection. Design: prospective randomized trial. Setting: study carried out on patients attending the outpatient clinic of rheumatology and rehabilitation department of Al-Azhar university hospital. Population: patients with osteoarthritis and indicated for local knee injection. Methods: Patients were randomized into 2 groups of 50 each. i. Group I: 50 patients with Knee Osteoarthritis were asked to do Valsalva maneuver during injection. The Valsalva maneuver is performed by having the subject conduct a maximal, forced expiration against a closed glottis and holding this for at least 16 seconds. ii. Group II: 50 patients with Knee Osteoarthritis were given a rubber ball in the palm of the hand and were asked to press it as hard as they could before local injection. All patients were subjected to: Complete history and clinical examination. Patient Pain scoring: pain during injection was evaluated using visual analogue scale (VAS) Physician pain scoring: Pain was graded using a 4-point scale: 0 _ no pain, 1 _ mild pain 2 _ moderate pain 3_ severe pain. Local corticosteroid injection: of 40 mg of triamcinolone acetonide. Results: The results of Pain score in group I was : 33 (66%) patients shows mild pain, 15 (30%) patients shows moderate pain and only 2 (4%) patients shows sever pain. In group II: 0% patient’s shows mild pain, 23 (46%) patient’s shows moderate pain and 27 (54%) patients’ shows sever pain. Figure (1) VAS for pain was 3.7+2.1 in group I and 6.5+1.8 in group II. VAS for pain was significantly lower in group I than group II as p was >0.001. Conclusion: In conclusion we suggest that Valsalva maneuver can decrease the skin puncture pain associated with local knee injection.

Quantifying the Effect of Temporomandibular Joint Intra-Articular Steroid Injection on Synovial Enhancement in Juvenile Idiopathic Arthritis

To quantify the effect of intra-articular steroid injections (IASIs) on temporomandibular joint (TMJ) synovitis in children with juvenile idiopathic arthritis (JIA) using gadolinium-enhanced magnetic resonance imaging (MRI). The present study was a retrospective study of children with JIA who had undergone TMJ IASIs at Boston Children's Hospital. The patients were included if they had undergone contrast-enhanced MRI both before and after IASI and if the pre-IASI MRI had demonstrated synovitis (enhancement ratio [ER] >1.55). Patients with TMJ pathology or pain unrelated to JIA or a history of facial trauma were excluded. The predictor variables were age, gender, JIA subtype, exposure to medications for arthritis, and a family history of autoimmune disease. The primary outcome variable was the ER. Additional outcome variables included patient-reported pain and the maximal incisal opening (MIO). Twenty-nine subjects (83% female) with a total of 50 injected TMJs were included. The average age at JIA diagnosis and at IASI was 6.8 ± 1.7years and 12.1 ± 1.9years, respectively. The mean follow-up period was 22.9 ± 4.3months (range 5 to 48). The ER decreased in all injected joints, with a mean reduction of 1.05 ± 1.01 (P < .001). The post-IASI ER was less than the normal threshold (1.55) in 18% of the injected TMJs. IASI was associated with an elimination of pain in 89% of the subjects (P < .001) and in augmentation of the MIO by 5.8 ± 2.6mm(P < .001). In children with JIA and TMJ synovitis, TMJ IASI was associated with a reduction in synovial enhancement, decreased pain, and an increased MIO. Only 18% of injected joints, however, experienced complete resolution of synovitis. These results support the use of IASI in the management of the pain and dysfunction associated with TMJ synovitis. Further study is required to determine the efficacy of IASI in limiting inflammation and future joint destruction.

Intraarticular slow-release triamcinolone acetate reduces allodynia in an experimental mouse knee osteoarthritis model

Intraarticular steroid injection has been the mainstay of short-term treatment of knee osteoarthritis (OA) pain. However, the duration of therapeutic effect from a single injection is not as long as desired. In this study we use a viscous formulation of triamcinolone acetate (TCA) in hyaluronic acid to prolong the anti-allodynia effect of that steroid. OA was induced in mice by a partial medial meniscectomy. Over time the animals' developed a mechanical allodynia in the injected leg. Mice were then given a single intraarticular injection of TCA in a short-acting DMSO formulation, or a standard commercial suspension, or the drug formulated in 5% hyaluronic acid for slow-release. Control injections in OA mice were PBS or 5% hyaluronic acid vehicle. Mechanical allodynia was then monitored over the therapeutic period. Organotypic spinal cord slices and DRG culture were performed to assess whether TCA attenuates expressions of pain mediators induced by interleukin 1β. TCA 40μg in a fast-releasing DMSO formulation produced relief from mechanical allodynia for a few days compared to PBS control injections (P=0.007). Similarly, the commercial suspension of TCA 40μg also produced relief from mechanical allodynia for a few days compared to PBS control injections (P=0.001). However, TCA 100μg in 5% hyaluronic acid produced relief from mechanical allodynia for at least 28days compared to PBS control or 5% hyaluronic acid vehicle injections (P=0.0005). Furthermore, TCA significantly suppressed expression of pain mediators induced by interleukin 1β in spinal cord and DRG organotypic culture. Intraarticular TCA in a sustained release formulation of viscous 5% hyaluronic acid will produce a long-term attenuation of mechanical allodynia in the OA knees of mice.

Randomized, controlled blind study comparing sacroiliac intra-articular steroid injection to radiofrequency denervation for sacroiliac joint pain

Background and objectiveSacroiliac joint pain is a common cause for chronic axial low back pain, with up to 20% prevalence rate. To date, no effective long-term treatment intervention has been embarked on yet. The aim of our study was to compare steroid block to radiofrequency ablation for SIJ pain conditions.MethodsA randomized, blind, study was conducted in 30 patients with sacroiliac joint pain. Fifteen patients received radiofrequency denervation of L4–5 primary dorsal rami and S1–3 lateral sacral branch, and 15 patients received steroid under fluoroscopy. Those in the steroid group who did not respond to steroid injections were offered to cross over to get radiofrequency ablation.ResultsAt 1-, 3- and 6-months post-intervention, 73%, 60% and 53% of patients, respectively, gained ⩾50% pain relief in the radiofrequency (RF) ablation group. In the steroid group, at one month postintervention follow-up, only 20% gained ⩾50% pain relief, but failed to show any improvement at 3 month and 6 month follow-up.ConclusionsRadiofrequency ablation at L4 and L5 primary dorsal rami and S1–3 lateral sacral branch may provide effective and longer pain relief compared to the classic intra-articular steroid injection, in properly selected patients with suspected sacroiliac joint pain. Larger studies are called for to confirm our results, and lay out the optimal patient selection and treatment parameters for this poorly comprehended disorder.

Synovial volume vs synovial measurements from dynamic contrast enhanced MRI as measures of response in osteoarthritis

SummaryObjectiveSynovium is increasingly a target of osteoarthritis (OA) treatment, yet its optimal measurement is unclear. Using dynamic contrast enhanced (DCE) MRI in knee OA patients before and after intraarticular steroid injection, we compared the responsiveness of static synovial volume measures to measures of dynamic changes in synovial enhancement, changes that are strongly related to synovial vascularity.MethodsNinety three patients underwent DCE-MRI before and 1–2 weeks after intra-articular injection of 80 mg methylprednisolone. Synovium was segmented and volume, relative enhancement rate (RER), maximum relative enhancement (REmax), late relative enhancement (RElate) and pharmacokinetic parameters (Ktrans, ve) were calculated. KOOS (​knee injury and osteoarthritis outcome score) pain score was recorded before and after injection. Standardized change scores were calculated for each parameter. Linear regression and Pearson's correlations were used to investigate the relationship between change in MRI parameters and change in pain.ResultsThe change in standardized score for the measures of synovial enhancement, RElate and REmax were −0.58 (95% CI −0.79 to −0.37) and −0.62 (95% CI −0.83 to −0.41) respectively, whereas the score for synovial volume was −0.30 (−0.52 to −0.09). Further, change in knee pain correlated more strongly with changes in enhancement (for both REmax and RElate, r = −0.27 (95% CI −0.45 to −0.07)) than with changes in synovial volume −0.15 (−0.35 to 0.05).ConclusionThis study suggests DCE-MRI derived measures of synovial enhancement may be more sensitive to the response to treatment and more strongly associated with changes in pain than synovial volume and may be better outcomes for assessment of structural effects of treatment in OA.

Blood Glucose Levels Following Intra-Articular Steroid Injections in Patients with Diabetes

Background: Parenterally administered steroids have been shown to affect the metabolism of glucose and to cause abnormal blood glucose levels in diabetic patients. These abnormal blood glucose levels in diabetic patients raise concerns that intra-articular steroid injections also may affect blood glucose levels. We performed a systematic review of studies examining the effect of intra-articular steroid injections on blood glucose levels in patients with diabetes mellitus. Methods: A literature search of the PubMed, EMBASE, AMED, and CINAHL databases using all relevant keywords and phrases revealed 532 manuscripts. After the application of inclusion criteria, seven studies with a total of seventy-two patients were analyzed. Results: All studies showed a rise in blood glucose levels following intra-articular steroid injection. Four of the seven studies showed a substantial increase in blood glucose. Peak values reached as high as 500 mg/dL. The peak increase in blood glucose did not occur immediately following intra-articular steroid injection, and in some cases it took several days to occur. In many patients, post-injection hyperglycemia occurred within twenty-four to seventy-two hours. Conclusion: Intra-articular steroid injections may cause hyperglycemia in patients with diabetes mellitus, and patients should be warned of this complication. Diabetic patients should be advised to regularly monitor their blood glucose levels for up to a week after injection and should seek medical advice if safe thresholds are breached. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Percutaneous resolution of lumbar facet joint cysts as an alternative treatment to surgery: a meta-analysis.

Lumbar facet joint cysts (LFJC), associated with lower back and radicular pain, have been clinically treated with an array of strategies. The prevalence of LFJCs is greatest in the latter decades of life, and LFJCs are associated with neurogenic claudication and spinal stenosis (1). As LFJCs rarely resolve without intervention, management may involve non-steroidal anti-inflammatory drugs, analgesics, intra-articular steroid injections and fluoroscopy-guided needle aspiration. LFJCs are also frequently treated through surgical interventions such as laminectomy, facetectomy, flavectomy and cyst excision (2). These surgical procedures currently provide the most successful long-term symptomatic relief (3). However, percutaneous resolution can be an effective alternative treatment strategy in a large sub-group of patients (4). Furthermore, percutaneous treatment may be advantageous to elderly and high-risk patients. Shuang et al . (5) recently published a systematic review and meta-analysis to assess the use of percutaneous resolution to treat LFJCs. Here we describe their study and comment on/discuss the limitations and clinical implications of their findings.

Bone and Joint Infections due to Haemophilus parainfluenzae: Case Report and Review of the Literature.

Haemophilus parainfluenzae is a normal inhabitant of the human respiratory tract. However it is an increasingly recognized pathogen in invasive infections, particularly in the immunocompromised host and where there is disruption of the normal skin or mucosal barriers. We present a case of a 56-year-old female with a history of asplenia who developed H. parainfluenzae septic arthritis of the hip following an intra-articular steroid injection. We also summarize previously reported cases of bone and joint infections caused by H. parainfluenzae.