Intra-articular Steroid Injection Research Articles

High- versus Low-dose Steroid Injection for Adhesive Capsulitis (Frozen Shoulder): A Systematic Review and Meta-analysis

BACKGROUND: Intraarticular steroid injections are a commonly used and proven treatment for frozen shoulder; however, there is no scientific basis for a certified dose. OBJECTIVES: This study aimed to identify the difference between high- and low-dose steroid injections treatments and suggest an appropriate dose. STUDY DESIGN: Systematic review and meta-analysis. METHODS: The MEDLINE, EMBASE, and Cochrane electronic databases were searched through February 15, 2023 for eligible randomized controlled trials. The effects of high- and low-dose steroid injections were calculated as standardized mean differences (SMD) in pain, shoulder range of motion (ROM), and functional improvement. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate evidence quality. RESULTS: Four studies with 274 patients were included in the final analysis. The meta-analysis showed that improvement in pain (SMD, 0.10; 95% CI, -0.12 to 0.32), ROM (SMD, 0.07; 95% CI, -0.05 to 0.19), and functional improvement (SMD, 0.08; 95% CI, -0.10 to 0.26) did not differ significantly between the high- and low-dose steroid injections. Subgroup follow-up analyses also showed no clinically significant differences in SMD for pain, ROM, and functional scale measurement in any subgroups (after 3 weeks, 6 weeks, and one year). One article described that, although there was no significant difference in adverse events frequency between the high- and low-dose groups, flushing tended to occur more frequently in the high-dose group. LIMITATIONS: Limitations are the small number of studies included in the meta-analysis, no disease stage considered, and a short follow-up period. CONCLUSIONS: This meta-analysis suggests there are no significant differences between the high- and low-dose steroid groups in pain, ROM, or functional improvement. Therefore, considering the side effects of high-dose steroids, starting with low-dose steroids is recommended. However, further studies are needed to establish exact protocols according to disease severity. KEY WORDS: Frozen shoulder, adhesive capsulitis, steroids, triamcinolone acetonide, injections, intraarticular, optimal dose, meta-analysis, randomized controlled trial

OA19 A complex case of bilateral pneumothoraces due to probable certolizumab driven rheumatoid lung nodules

OA19 A complex case of bilateral pneumothoraces due to probable certolizumab driven rheumatoid lung nodules

Arthroscopic capsular release for frozen shoulder: when etiology matters.

No therapeutic intervention is universally accepted for frozen shoulder, and the most effective management to restore motion and diminish pain has yet to be defined. The aim of this study was to investigate functional and psychological outcomes in patients who underwent arthroscopic capsular release for a frozen shoulder. A retrospective study with prospective data collection was conducted with 78 patients suffering from frozen shoulder resistance to conservative treatment. Considering the etiology, there were 36 (46.2%) idiopathic, 31 (39.7%) postoperative, and 11 (14.1%) posttraumatic cases. Preoperatively, each patient was evaluated with the range of motion (ROM) assessment and the Constant-Murley score (CMS). At follow-up, the 4-point subjective satisfaction scale (SSS), the ROM assessment, the SF-12 questionnaire, the numerical rating scale (NRS) for the subjective assessment of pain, the CMS and the Hospital Anxiety and Depression Scale (HADS) were assessed. After a mean follow-up of 54.2 ± 22.3months, ROM and CMS showed a statistically significant improvement between pre- and postoperative values (all p < 0.001). Before surgery, the mean CMS was 36.9% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 99.9% that of sex- and age-matched healthy individuals, and 49 (62.8%) patients showed a CMS equal to or higher than the normative data. The mean increase in the CMS was 56.1 ± 8.3 points. The mean SSS, HADS-A, HADS-D, and NRS were 3.7 ± 0.5, 2.5 ± 1.6, 2.2 ± 1.3, and 2.2 ± 1.0, respectively. All patients returned to their previous level of work and sports activity after 2 and 2.5months, respectively. The multivariate analysis showed the association between a higher postoperative CMS and the idiopathic etiology of a frozen shoulder (p = 0.004, β = 3.971). No intraoperative complications occurred. Postoperatively, four patients (5.1%) were treated with intra-articular steroid injections to manage residual symptoms. One patient (1.3%) with a postoperative frozen shoulder showed persistent symptoms and underwent a new successful arthroscopic capsular release. High patient satisfaction and statistically significant ROM and CMS recovery can be achieved after arthroscopic capsular release to manage frozen shoulder. Better functional outcomes are expected when the etiology is idiopathic. Results can help surgeons identify the patients who will most benefit from surgery and should be discussed with the patient. III.

Manipulation Under Anesthesia with Intra-Articular Steroid Injection versus Manipulation under Anesthesia in Idiopathic Adhesive Capsulitis of the Shoulder in terms of Functional Outcome

Objective: To compare the outcome between manipulation under anaesthesia with intra-articular steroid injection in patients with shoulder adhesive capsulitis.&#x0D; Study Design: Retrospective longitudinal study&#x0D; Place and Duration of Study: Ziauddin Hospital, Karachi Pakistan, from Sep 2019 to Feb 2020.&#x0D; Methodology: A total of 70 patients diagnosed with primary ACS were distributed into two groups, i.e., Group-M (35 in manipulation under anaesthesia only) and Group-MI (35 in manipulation under anaesthesia with an intra-articular steroid injection). All patients were assessed for shoulder pain and disability index along with the pain severity on the visual analogue scale at each subsequent visit on the first week, 1st, third and sixth months after the intervention.&#x0D; Results: The results indicated a significant time effect (p=0.001) in both groups. The mean shoulder pain, disability index and pain on the visual analogue scale were lesser in the MI-Group than in the M-Group. Further, we found a statistically significant difference in mean shoulder pain (p=0.001) and disability index (p=0.016) between groups at six months.&#x0D; Conclusion: In the initial post-procedure period and over six months of follow-up, MI showed improved outcomes than M. These patients require additional counselling and motivation for long-term physical therapy programs even after intervention for optimal results.Keywords: Adhesive capsulitis of the shoulder, Intra-articular steroid injection, Manipulation under anaesthesia

Efficacy of Intraarticular Knee Injection of PRP (Platelet Rich Plasma) vs Steroid (Triamcinolone Acetate) for the Treatment of Primary Knee Osteoarthritis Grade I &amp; II

Objective: To assess the effectiveness of PRP (Platelet Rich Plasma), and to compare with Triamcinolone 40mg (Steroid) on functional activity, stiffness and pain in Grade I &amp; II Knee OA. Method: A comparative cross sectional study was conducted at outdoor departments of Advanced Pain Relief Center, Lifeline Hospital Lahore (Pakistan) from January 2022 to December 2022. The present study included a total of 235 participants, out of whom 190 individuals were deemed eligible for inclusion based on predetermined criteria. The remaining 45 participants were excluded from the study due to non-adherence to eligibility criteria and lack of approval from institutional ethical committee. Out of a total of 190 subjects enrolled in the study, 64 (33%) were characterized as male while 126 (67%) were classified as female. The participants' mean age was 53.5 ± 6.4 years. Alternative patients were treated with intra-articular injection of either triamcinolone 40mg or PRP. Patients randomized in Steroid group (n=95) were gives intraarticular 40mg Triamcinolone acetate (1ml) along with 2ml of Local anaesthetic Lignocaine 1%, whereas patients randomized in PRP group (n=95) were injected 5ml PRP. “The Western Ontario and McMaster Universities Arthritis Index” (WOMAC) Scale was used for functional disability and pain before and after the therapy for the targeted knee joint at the baseline 1 week, 5 weeks, 8 weeks and 20 weeks follow-ups. Visual Analogue Scale (VAS) scores were also recorded for pain. Data analysis was done by using SPSS version 20. Results: There wasn't any serious adverse effect observed during the study and follow-ups. 25 WOMAC functional activity scale showed statistically significant improvement with Intraarticular knee injection of PRP compared to steroids(40.64±1.87vs.27.17±6.01)(p=0.000). WOMACpainscaleresultsalsodemonstrated that intraarticular knee injection of PRP was more effective in reducing knee pain than steroids (p = 0.000) at 20 weeks follow-up. Conclusion: On the basis of the results of our study, we concluded that platelet rich plasma is more effective than intra-articular steroids in terms of improvement in functional activity and reduction of pain in patients with Grade I &amp; II knee osteoarthritis. Both PRPand steroid intraarticular injections are safe.

Factors Influencing the Acceptability of Intra-Articular Corticosteroid Injections among Pakistani Patients with Arthritis

Objective: Toassesspatients' awareness andattitude towardsintra-articulartherapy.Todetermine the frequency of refusal among patients who were offered intra-articularsteroid injections and to identify the variousreasons for this refusal. Method: This was a cross-sectional study done at the Rheumatology CMH Lahore outpatient clinic from 1st June to 31st July 2022. A total of 204 patients 16 years or above who were potential candidates for intraarticular corticosteroids (IACS) or who had received injections in the past were asked about their knowledge, beliefs, and consent for intra-articular injections as per pre-defined questionnaire. Results: Out of the total 204 patients, 34% refused to get the intra-articular injection. Their major concern was fear of injection, dependence, and only temporary pain relief. Consent was directly correlated with disease severity as determined by pain visual analogue score (VAS) and affected activities of daily living (ADLs), and physician guidance (p=0.001). A negative review from a relative or a personal bad experience leads to rejection of IACS (p=0.001). Those who did not have prior knowledge of IACS, and its response variability agreed more (p=0.01). Conclusion: The patients' fear of dependency, partial effectiveness, and pain were major concerns that lead to the refusal of IACS in almost one-third of the patients. Information gathered from different sources apart from doctors misleads the patients.

Comparison of intra-articular steroid injection versus hydrodilatation with saline and corticosteroid for the treatment of refractory adhesive capsulitis of the shoulder.

Objective: To compare the outcome of intra-articular steroid injection versus hydrodilatation with saline and corticosteroid for the treatment of refractory adhesive capsulitis of the shoulder. Study Design: Randomized Controlled Trial. Setting: Department of Orthopaedic Surgery, Sahiwal Teaching Hospital Sahiwal. Period: February 2021 to January 2022. Material &amp; Methods: A total of 156 patients with refractory adhesive capsulitis were randomized. In Group-A, patients were treated with intra articular steroid injection alone and in Group-B, patients were treated with hydrodilatation using corticosteroid and saline. The patients were followed up at 3rd, 6th and 12th week and their functional outcomes was assessed in terms of pain and range of motion (disability) using “Shoulder Pain and Disability Index (SPADI)” scoring system. Results: In a total of 156 patients, 81 (51.9%) were females. The mean age was 51.4±10.6 years (ranged between 33 to 68 years). History of steroid intake was reported in 30 (19%) patients. The mean pain scores on the basis of SPADI scoring at 3-week (p=0.0001), 6-week (p=0.0001) and 12-week (p&lt;0.0001) were significantly less in Group-B when compared to Group-A. The disability scores on the basis of SPADI scoring at 3-week (p&lt;0.0001), 6-week (p&lt;0.0001) and 12-week (p&lt;0.0001) were significantly less in Group-B when compared to Group-A. In comparison to Group-A, functional outcomes were significantly better among patients of Group-B at 6-week (p&lt;0.0001) and 12-week (p&lt;0.0001) intervals. Conclusion: Hydrodilatation along with corticosteroid injection were better treatment options when compared to intra-articular steroid injection alone for reduction in pain and improvement in range of motion among patients with refractory frozen shoulder.

Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial

BACKGROUND: A diseased shoulder due to pain, stiffness, or weakness negatively affects patients’ quality of life and their ability to carry out activities of daily living. Adhesive capsulitis is a disease characterized by shoulder pain and global limitation of movement in the shoulder joint. Many interventions have been proposed for the treatment of primary adhesive capsulitis. The current study compares the effect of ultrasound-guided intraarticular injection of ozone versus steroid versus intraarticular application of pulsed radiofrequency. OBJECTIVES: The primary outcome of the current study was to compare the improvement in the Visual Analog Scale (VAS) after the 3 treatment modalities. The secondary outcomes included functional improvement measured by the Shoulder Pain and Disability Index (SPADI) and level of inflammatory biomarkers measured by serum intercellular adhesion molecule (ICAM-1) and high-sensitivity C-reactive protein(hs-CRP). STUDY DESIGN: The current study is a prospective, double blinded, randomized controlled trial. We employed a double blinding technique for both the patients and the outcome assessors. SETTING: Our study was carried out at the Medical Research Institute, Alexandria University, Egypt, after approval of the local ethical committee (IORG0008812). The study was registered in the “clinical trials library for protocol registration and results system” with number NCT04724317. The study included 45 patients with a diagnosis of primary adhesive capsulitis. METHODS: Patients were randomly assigned to 3 equal groups: steroid group, ozone group, and pulsed radiofrequency group. Pain and global shoulder functions were assessed using the VAS at rest and with movement, range of motion (ROM), and the SPADI. Moreover, ICAM-1 and hs-CRP were measured as inflammatory markers. RESULTS: The results of the current study reveal that all patients in all groups have had a statistically significant improvement after their intervention regarding pain, disability, ROM, and inflammatory markers. Pairwise comparisons revealed that improvement of the VAS during movement had a statistically significant improvement starting from the second week and continuing to the fourth and eighth week. VAS during rest had a significant improvement starting from follow-up week one in the steroid group. Moreover, improvement in the ROM and SPADI scores started from the second week follow-up. Percent improvement was calculated for each group and there was a statistically significant difference between groups in VAS at rest and ROM in the pulsed radiofrequency group compared to the steroid group. Regarding inflammatory markers, both ICAM-1 and hs-CRP had a significant improvement after all 3 interventions with no statistically significant difference among the groups. LIMITATIONS: This study is a single-center study. A shortage of previously published data, and heterogeneity in the published methodology of the 3 interventions limited our discussion data for comparison with the previous literature. CONCLUSION: Ultrasound-guided shoulder joint intraarticular injection of steroid, ozone, or pulsed radiofrequency application all result in a significant improvement in pain, disability, and ROM in primary adhesive capsulitis. They can be used as an effective treatment modality for this condition. Comparing groups statistically, the pulsed radiofrequency group had a more delayed, but statistically better long-term improvement compared to the other 2 groups. KEY WORDS: Adhesive capsulitis, pulsed radiofrequency, ozone, shoulder, glenohumeral joint, pain, hs-CRP, triamcinolone acetonide

Neutrophils extracellular traps formation may serve as a biomarker for disease activity in oligoarticular juvenile idiopathic arthritis: a pilot study

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children, causing significant morbidity. Despite the dramatic improvement in treatment, many patients do not achieve complete remission, and biomarkers for subclinical disease, flares, and response to treatment are lacking. Neutrophils and neutrophil extracellular traps (NETs) play key roles in the pathogenesis of autoimmune and inflammatory conditions. In this study, we characterized neutrophil enzyme activity and NETs formation in oligoarticular and polyarticular JIA and explored their association with disease activity.MethodsNeutrophils from 6 healthy controls and 7 patients with oligoarticular and polyarticular JIA were freshly isolated at time of diagnosis and after glucocorticoid intra-articular injection. Enzymatic activity of neutrophil granular enzymes was monitored by colorimetry and PMA-activated NETs formation was assessed using fluorescent microscopy.ResultsIn this pilot and feasibility study, we revealed that NETs were significantly increased in oligoarticular JIA patients at time of diagnosis compared to healthy controls. Anti-inflammatory treatment using intra-articular steroid injection normalized NETs formation in these patients. Correlation between NETs formation and clinical Juvenile Activity Disease Activity Score-10 (cJADAS-10) was linear and significant (P = 0.007) in oligo but not in poly JIA patients.ConclusionsThis is the first study exploring the link of NETs formation with oligo and poly JIA activity. We demonstrated a statistically significant linear correlation between cJADAS-10 and NETs formation in oligo but not in poly JIA patients. Hence, we suggest that NETs may reflect clinical disease activity in JIA, and may serve as a putative biomarker. Further work is needed to validate these initial results and determine the dynamics of NETs formation in JIA.

Comparative Analysis of Knee Replacement Surgery who follow up by Physical Therapy and Intra-articular Steroid Injections for Obese Patients.

Knee osteoarthritis (KOA) is the most common chronic articular disease, and its prevalence has doubled since the mid-20th century. It affects 16% of the adult population over 50 years of age in the post-industrial era [1].&#x0D; Obesity is one of the only modifiable risk factors for both incidence and progression of Osteoarthritis (OA).[2]&#x0D; Although OA was previously regarded as a disease of the elderly, its development starts much earlier than originally thought, and OA is ranked among the top 20 diseases in the 40–45 years age group [3].&#x0D; This review aims to provide a comprehensive analysis of the outcomes of knee replacement surgery following up physical therapy, versus intra-articular steroid injections for obese patients (BMI &gt;30)&#x0D; The study design employed in this review is narrative, and articles published after 2010 from PubMed were considered for inclusion. The review examines the impact of each intervention on the complete regain of knee function in this specific population.&#x0D; Through the analysis of relevant studies, this review seeks to inform clinical decision-making and guide the management of obese patients with knee osteoarthritis.&#x0D; Conclusion. &#x0D; Based on the reviewed literature, knee replacement surgery appears to offer a better chance of achieving complete regain of knee function in obese patients (BMI &gt;30) undergoing physical therapy compared to intra-articular steroid injections. However, the findings are limited by the availability of studies and the heterogeneity in the research methodologies.&#x0D;

Risk and management of osteoporosis due to inhaled, epidural, intra-articular or topical glucocorticoids

Glucocorticoids (GCs) are widely used by several specialties for the treatment of a variety of diseases and conditions. The unfavorable effect of oral GCs on bone health is well-documented. The ensuing from their use glucocorticoid-induced osteoporosis (GIOP) is the most common cause of medication-induced osteoporosis and fractures. It is uncertain, however, if, and in what extent, GCs administered by other routes affect the skeleton. In the present review, we quote current evidence on the effect of inhaled GCs, epidural and intra-articular steroid injections, and topical GCs on bone outcomes. Although evidence is limited and weak, it seems that a small proportion of the administered GCs may be absorbed, enter the systemic circulation, and adversely affect the skeleton. Potent GCs, higher doses, and longer treatment duration seem to infer the greater risk for bone loss and fractures. There are scarce data, and only for inhaled GCs, regarding the efficacy of antiosteoporotic medications in patients receiving GCs through routes other than oral. Further studies are needed to clarify the relationship between GC administration through these routes and bone outcomes and to help establishing guidelines for the optimal management of such patients.

Republication of "Current Concepts Review: Hallux Rigidus".

Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intra-articular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.

Comparison of the Functional OutcomeBetween Intra-Articular Corticosteroid Injection versus Platelet-Rich Plasma in Patients with Adhesive Capsulitis

Objective: To compare mean resting pain relief and passive external rotation improvement by Intra-articular Steroid versus intra-articular Platelet Rich Plasma injection in patients with adhesive capsulitis.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi Pakistan, from Jan to Jun 2019.&#x0D; Methodology: A total of 60 patients were included in the study. Group-A and B received Intra-articular 40mg Triamcinolone Acetonide with 1 ml 1% Lignocaine and platelet-rich plasma injections in affected shoulders, respectively. Pain severity was assessed on the Numeric Rating Scale, and passive external rotation was assessed by goniometry at baseline, i.e., preintervention, six weeks and 12 weeks intervals.&#x0D; Results: In our study, the NRS scale for pain was 3.030.76 at six weeks and 1.230.77 at 12 weeks with PRP versus 5.070.87 at six weeks and 3.200.89 with Corticosteroids at 12 weeks post-intervention, with the p-value of &lt;0.001 showing increased efficacy of PRP. While passive external rotation was 70.275.26 at six weeks and 82.304.84 at 12 weeks with PRP versus 61.35.28 at six weeks and 71.806.99 with corticosteroids at 12 weeks post-intervention, with the p-value of &lt;0.001 showing increased efficacy of PRP.&#x0D; Conclusion: There was a significant improvement in mean resting pain relief and passive external rotation after platelet-rich plasma injection in the shoulder joint adhesive capsulitis compared to intra-articular Steroids.

The Utility of Ultrasound in Evaluating Joint Pain in Systemic Lupus Erythematosus: Looking beyond Fibromyalgia.

Systemic lupus erythematosus (SLE) is a complex autoimmune condition with varied clinical presentations, and musculoskeletal pain is one of the most commonly associated symptoms. However, fibromyalgia (FM) is a prevalent co-existing condition in SLE patients that can also cause widespread pain, and in patients with both conditions, it is often difficult to distinguish the underlying cause of musculoskeletal pain and provide optimal therapy. A retrospective cohort study was conducted including all adult SLE patients who received musculoskeletal ultrasound (US) examinations for joint pain at the Ohio State University Wexner Medical Center between 1 July 2012, and 30 June 2022. Binary and multiple logistic regression analyses were performed to determine predictors of US-detected inflammatory arthritis as well as improved musculoskeletal pain. A total of 31 of 72 SLE patients (43.1%) had a co-existing diagnosis of FM. In binary logistic regression, a co-existing diagnosis of FM was not significantly associated with US-detected inflammatory arthritis. In multiple logistic regression analysis, clinically detected synovitis was significantly associated with US-detected inflammatory arthritis (aOR, 142.35, p < 0.01), and there was also a weak association with erythrocyte sedimentation rate (ESR) (aOR 1.04, p = 0.05). In separate multiple logistic regression analysis, US-guided intra-articular steroid injection was the only predictor of improved joint pain at follow-up visit (aOR 18.43, p < 0.001). Musculoskeletal US can be an effective modality to detect inflammatory arthritis as well as to guide targeted intra-articular steroid injection to alleviate joint pain in SLE patients with or without FM.

Comparison of intra-articular lumbar facet joint injection of platelet-rich plasma and steroid in the treatment of chronic low back pain: A prospective study

Study design: Prospective randomized clinical study. Purpose: To compare the effectiveness and safety of intra-articular platelet-rich plasma (PCP) and steroid along with radiofrequency ablation (RFA) in the treatment of chronic low back pain (LBP) due to facet joint arthropathy. Overview of literature: Facet joint pathology is an important cause of LBP—15–30% of all LBP cases. Lumbar intra-articular PRP is a relatively new method in the treatment of LBP. PRP stimulates the cells involved in regeneration. Hence, it seems a suitable option for the treatment of lumbar facet joint syndrome. Methods: We evaluated the efficacy and safety of facet joint injections in LBP secondary to facet joint arthropathy. Chronic LBP for ≥3 months (visual analogue scale (VAS) &gt; 4), failed conservative treatment, no neurological deficit, unilateral facet joint pain, focal tenderness with hyperextension pain, and relief by diagnostic medial branch block were included. Patients were randomly allocated to Group S: Steroid (Triamcinolone) + RFA or Group P: PRP + RFA or Group R: 0.9% saline + RFA as control. Demographic, clinico-radiological, and outcome parameters were recorded till 6 months. Data were analyzed using SPSS and p &lt; 0.05 was considered significant. Results: We studied 45 patients (n = 15 in each group) in the final analysis. Mean age was 45.7 ± 13.6 years and 60% were females in all groups. VAS decreased to 1.6 ± 0.8 (Group S) and 3.2 ± 0.8 (Group P) on day 1 ( p &lt; 0.05). At 3 and 6 months, VAS reduced more in Group P (0.47 ± 0.5; 0.07 ± 0.2) versus Group S (2.53 ± 0.5; 3.07 ± 0.2) ( p &lt; 0.001). Mean Oswestry Disability Index (ODI) score at baseline was 72.8 ± 7.6 (all groups). At 1 month, Group S (17.2 ± 3.2) showed better improvement than Group P (23.2 ± 3.1) ( p &lt; 0.05). At 6 months, Group P (8.9 ± 1.2) had more decrease in ODI than Group S (29.0 ± 2.1) ( p &lt; 0.001). NSAIDs usage and Patient Satisfaction Score (PSS) were significantly better at 6 months in Group P than Group S ( p &lt; 0.01; p &lt; 0.05, respectively). Conclusion: Both PRP and corticosteroid injections were determined to be effective and safe for the treatment of lumbar facet joint syndrome after 6 months of follow-up. However, autologous PRP may be a superior treatment option for longer efficacy.

Intra-articular Steroid alone vs Hydrodilatation with intra-articular Steroid in Frozen Shoulder - A Randomised Control Trial.

Various non-operative treatment modalities have been advocated for a frozen shoulder. In the present study we compared the efficacy of single intra-articular steroid injection vs hydrodilatation with intra-articular steroids for frozen shoulder (FS) in the frozen phase. This was a prospective, randomised control trial (RCT) done at a tertiary care centre. A total of 108 participants were randomised into two groups-one group received intra-articular steroid with hydrodilatation (HDS) and other group received intra-articular steroid injection only (S). Shoulder Pain and Disability Index (SPADI) scores were taken, and statistical analysis was done to measure the outcome at two weeks, six weeks and three-month intervals after the injection. There was significant improvement in symptoms at each interval for both the groups (p=0.0). There was no statistically significant difference in the SPADI score between the two groups at two weeks post injection, however at six weeks (p=0.04) and 3 months (p=0.001) significant difference in the SPADI score was demonstrated with better scores in group S. The mean duration of analgesia required in group HDS was 5.17 days (S.D.=1.73) and for group S was 4.28 days (S.D.=1.01), with a statistical significance (p=0.002). Better clinical results were obtained at six weeks and three months with the group receiving corticosteroid only and also had a lesser requirement of analgesia post-intervention. Thus, intra-articular steroid injection only seems to be a more desirable method of management during the frozen phase of FS than that of hydrodilatation with intra-articular steroid injection.

Subtype frequency, demographic features, treatment and outcome of Juvenile Arthritis in one Centre in Abu Dhabi in the United Arab Emirates

BackgroundJuvenile Idiopathic Arthritis is a chronic inflammatory disease that affects 1 in 1000 children worldwide. Our population in the United Arab Emirates is diverse.The objective of this study is to describe the subtype frequency, demographic features and treatments received and outcome of our patients.MethodsPatients with the diagnosis of Juvenile Arthritis identified through the hospital electronic medical records system (EMR), which was implemented for all medical documentation in January 2011. All patients included are patients who presented to our center for treatment and follow up from 2011 to end of 2021. Retrospective case notes review of patients electronic medical records with the diagnosis of JIA was performed.ResultsOne hundred thirty-eight patients in total. Oligoarticular subtype was the most represented with 75 patients (55%) followed by Rheumatoid factor negative polyarticular JIA with 32 patients (23%) then Enthesitis related arthritis (ERA) with 10 patients (7%) then psoriatic (6%) then systemic JIA (5%). Undifferentiated subtype of 2%.The most diagnostic delay is in enthesitis related arthritis subtype with a mean of 11.4 months (6–25) followed by undifferentiated JIA with a mean of 7.5 months (4–8.5).131 (96%) out of 138 received steroid treatment. Only 6 patients did not receive steroids.Out of 138 patients, 101 (73%) were on synthetic disease modifying medication methotrexate. Sixty-eight patients out of the total 138 required biologic treatment (49%).In total 93 patients achieved clinical remission (67%). In remission on treatment 78 patients which is (56%) of the total number of patients with follow up ranging from 1 to 5 years and 84% of patients in remission. In remission off treatment 15 patients (11% of all patients and 16% of patients in remission).ConclusionThe most common subtype in our cohort of patients is oligoarticular JIA. Longest delay is for ERA subtype.All our patients with oligoarticular JIA received Intra articular steroid injection as first line treatment. 49% of our patients received biologic treatment similar to rate in Northern Europe. Our remission rate is 67% with 11% of patients are in remission off treatment.Access to care remains a priority to treat patients effectively.

Comparison of functional outcome of intra-articular steroid injection versus steroid injection in rotator interval in the treatment of early frozen shoulder

Adhesive capsulitis (AC) is a painful frozen shoulder disease that continues for more than 3 months, is also known as frozen shoulder. The glenohumeral joint capsule fibrosis that results from this inflammatory disease is accompanied by substantial range of motion limitation and gradually advancing stiffness (typically external rotation). The findings of this study will support better outcomes for adhesive capsulitis patients in our local population in terms of pain reduction and a decline in SPADI score. Objective: To compare functional outcome of steroid injection vs intra-articular steroid injection in rotator interval in the treatment of early frozen shoulder. Place and Duration of study: Department of Orthopedic Surgery, MTI-HMC, Peshawar from 27 Feb, 2021 to 27 Aug, 2021. Study Design: Randomized Control Trial. Methods: Patients were randomly allocated to both groups through blocked randomization. Patients in Group A was subjected to intra-articular steroid injections whereas patients in Group B were subjected to steroid Injection in rotator interval. Results: As per functional outcome in both groups, in Group A, 51 (85.0%) patients were showed effective results while in Group B, 42 (70.0%) patients showed effective results.

A comparative analysis of pain reduction following a single intra-articular injection of platelet-rich plasma, steroid or normal saline in chronic external shoulder impingement syndrome

Background: Shoulder impingement is a common diagnosis for patients with pain and dysfunction of shoulder joint. Due to its chronicity of clinical manifestation of the impingement syndrome, there is a need to find new therapies that collaborate to improve pain management. Methods: A hospital based descriptive, epidemiological study was conducted with 150 patients. The patients were divided in the following three groups of 50 patients each: Platelet-rich plasma (PRP) group: 50 patients received PRP, steroid group: 50 patients received steroid injection normal saline group: 50 patients received normal saline injection. Baseline visual analogue scale (VAS) score on overhead activities were recorded. After the 4th week, 12th week, and 24th week, patients were examined in the outpatient clinic. The main outcome measure was pain with overhead activities using a VAS. Results: The VAS score improved significantly in PRP group and Steroid group compared to normal saline group at the 4th week, 12th-week and 24th-week follow-up periods post injection, as per ANOVA test (p&lt;0.05). Conclusions: PRP and steroids, both can be considered effective methods to treat pain in chronic shoulder impingement syndrome (SIS) and less invasive compared to surgical treatment. They improve the pain and hence shoulder function in chronic impingement syndrome.

Comparative study between suprascapular nerve block versus platelet rich plasma in the treatment of adhesive capsulitis of shoulder joint

Introduction: Adhesive capsulitis of shoulder is a condition characterised by painful restriction of active and passive glenohumeral range of motion in at least two directions most notably shoulder abduction and external rotation. [1] Therapeutic options for the management of adhesive capsulitis are NSAIDs, intra-articular steroid injections, Suprascapular nerve block (SSNB), platelet rich plasma Injection (PRP), manipulation under general anaesthesia or arthroscopic capsular release. SSNB is an old and effective method for the treatment of adhesive capsulitis. Recently USG guided nerve blocks have been found to be safer and more efficacious compared to blind, landmark guided nerve blocks. PRP is newer modality of treatment in regenerative medicine to enhance the healing process in adhesive capsulitis.AIM: To evaluate & compare the outcome of adhesive capsulitis after either injection of PRP or SSNB. Materials and Methods: Patients with Adhesive capsulitis either received single injection of SSNB (n=45) (40 mg methylprednisolone + 5ml 2% lignocaine) or PRP (n=45) after randomization. All participants were also advised to perform a home based 10 minute exercise therapy after injection. The outcome were measured by using Constant and Murley shoulder score. Participants were evaluated at 0 (post-procedure), 3rd day,1 and 6 month. One way ANOVA-F has been used to compare between groups. Results: PRP showed significant difference in improvement than SSNB. No major adverse effect were seen in both groups. Conclusion: Both treatment modalities are effective with better result in PRP group than SSNB in long term follow-ups.