Intra-articular Steroid Research Articles

COMPARISON OF PAIN RELIEF EFFICACY OF PLATELET-RICH PLASMA VERSUS CORTICOSTEROIDS IN KNEE OSTEOARTHRITIS

Objective: To compare the pain relief efficacy of platelet rich plasma injection with corticosteroid injection in knee osteoarthritis using numeric rating scale.
 Study Design: Quasi experimental study.
 Place and Duration of Study: Department of Anesthesia and Pain Management, Combined Military Hospital Peshawar, from Jan 2018 to Dec 2019.
 Methodology: Total of 310 patients who underwent knee injection for osteoarthritis were included in this study. Patients were divided into two groups; group A and group B comprising of 155 patients each. Patients in group ‘A’ received intra articular corticosteroid injection while patients in group ‘B’ received intra articular platelet rich plasma injection for knee osteoarthritis. Pain assessment via numerical rating score was done at the start of the treatment and at 6 months.
 Results: In group A female to male ratio was 2.69:1 while in group B the female to male ratio was 2.78:1. Mean age of ‘group A’ was 58.52 ± 11.87 years and that of ‘group B’ was 58.79 ± 11.15 years. Numerical rating score pre-treatment in ‘group A’ vs ‘group B’ was 8.35 ± 1.17 vs 8.42 ± 1.14. While numeric rating scale post treatment in ‘group A’ vs ‘group B’ was 5.74 ± 1.37 vs 4.06 ± 1.19, respectively with p-value of 0.001, which is statistically significant.
 Conclusion: Patients who received intra-articular platelet rich plasma had significantly more pain relief as compared to patients who received intra-articular steroid on numerical rating score.

Intra-articular steroid injections in large joint arthritis: A survey of current practice.

Intra-articular corticosteroid injections are widely used as a management modality for mild large joint osteoarthritis (OA). In contrast, there is little guidance or consensus on the use of steroids in moderate to severe disease. The aim of this study is to explore the current practice of surgeons in relation to the use of therapeutic intra-articular steroid injections in patients awaiting large joint arthroplasty for OA. An anonymous questionnaire was distributed to consultants performing large joint arthroplasty in four National Health Service Trusts. Participants were questioned on their use of intra-articular therapeutic steroid injections in patients listed for elbow, shoulder, hip or knee arthroplasty. Data was collected over 6months and analysed using Microsoft Excel. A total of 42 surgeons were included in the study with the majority performing lower limb arthroplasty (73%). About 21 (50%) surgeons indicated they would perform injections in the patient group of interest. Two would perform an unlimited number of injections, whilst the remainder would perform between one and three injections. Respondents most commonly indicated they would tell patients that an injection would provide between 6 and 12weeks of benefit (14 of 39 surgeons, 36%). Most injecting surgeons (88%) leave 4months between an injection and subsequent arthroplasty due to increased risk of infection if surgery is performed sooner. This study demonstrates variation in practice in the use of intra-articular steroids in the analysed patient group, and the way surgeons council their patients. National or specialist society guidelines may help to reduce this variation in practice.

111 The Systemic Effects of Intra-Articular Steroid Injections- Should COVID-19 Change Our Practice?

Abstract Aim The COVID-19 pandemic prompted us to review and often suspend services, while patients continue to suffer with painful musculoskeletal conditions. The diagnostic and therapeutic value of intra-articular corticosteroid injections (IACSI) cannot be denied. Current BOA guidelines advise giving the lowest effective dose for inflammatory arthritis and limit use in osteoarthritis to patients with high levels of pain and disability. We aimed to evaluate the literature pertaining to the use of IACSI and the potential systemic immunosuppressive effects. Method We searched Medline, using the terms “systemic effects of intra-articular steroid” and “clinical course of Coronavirus infection in patients with steroid use”, between 1997 and 2020. Results No studies specifically looked at the systemic effects of intra-articular steroids in the presence of COVID-19 infection; however, four studies were identified which concluded that intra-articular steroid injections resulted in sufficient systemic absorption to cause suppression of the hypothalamic-pituitary-adrenal axis and endogenous cortisol production. These effects are dose dependent and are more common in patients with inflammatory joint diseases. A further four RCT’s, including one systematic review, showed that suppressed cortisol concentration was associated with a significant increase in mortality. Conclusions There is a lack of evidence in relation to the use of intra-articular steroids in COVID-19. However, evidence suggests that intra-articular steroids can result in systemic absorption and suppression of endogenous cortisol production thus increasing the potential risk of complications of COVID-19. We therefore support cautious use of low dose steroid injections in patients with inflammatory arthritis, where no alternative treatment is available.

942 Outcome of Image Guided Intra-Articular Thumb Base Steroid Injections-Retrospective Study of Consecutive Patient Over 4 Years in A Plastic and Hand Surgery Unit in West Lothian, Scotland

Abstract Introduction Osteoarthritis of the thumb base is a common condition. Usually effects the elderly population causing significant disability. Modalities of treatment of osteoarthritis which includes conservative measures, non-operative interventions, and surgery. In this study we endeavored to assess how effective are image guided steroid injections for base of thumb Osteoarthritis as assessed by subjective pain relief perceived by patient and what percentage of these patients proceed to operative treatment. Method Retrospective data between January 2015 and December 2018 of the patients who underwent Steroid injections to the Base of thumb joints (CMCJ and/or STTJ) for Osteoarthritis under image intensifier guidance was collected from Hospital management system –TRAK and eHealth services. Follow up of the patients were done for Maximum 1 to 5 years. Results A total number of 692 patients with thumb base osteoarthritis were included in the study of which 546 patients underwent Image guided steroid injection to the thumb base. The mean Age of patients was 64.5 years and the Female: Male ratio was 401:145. Mean number of injections each patient received- 3.25 (1 – 7 times). Pain relief after first, second and third injections were 3.15 months, 2.63 and 1.75 months, respectively. 127 (23.2% of injections patients) underwent trapeziectomy. Mean time between first injection & Surgery was 1.3yrs (6 months -2 years) Conclusions This study demonstrates the effectiveness of image guided steroid injections for thumb base osteoarthritis. Though about a quarter of these patients proceed to operative management, steroid injections can delay the same considerably.

Intra-articular steroid injection at the time of knee arthroscopy increases risk of post-operative infection.

To evaluate the risk of post-operative infection after intra-articular steroid injection at the time of knee arthroscopy at a single institution high-volume sports medicine practice. The electronic medical record at a single institution was queried for all patients who underwent knee arthroscopy from 2011 to 2019. Patients were included if they underwent more simple arthroscopic procedures: diagnostic arthroscopy, meniscectomy, loose body removal, synovectomy, or microfracture. Patients were excluded if they underwent more complex procedures, such as ligament reconstruction, meniscus repair, or any open procedures. These patients' medical records were then queried for current procedural terminology and international classification of disease codes indicating post-operative infection. Individual chart review was performed on this group of patients to determine if a true postoperative infection occurred within 6months of the index arthroscopy. Patients were then categorized into "intra-operative steroid injection" versus "no steroid" based on each surgeon's preferred intra-operative analgesic injection cocktail. A total of 6889 patients were identified, including 2416 (35.1%) who were given intra-articular steroid at the time of knee arthroscopy. Post-operative infection occurred in 10 patients (0.15%) at a median of 18days (range 9-42days), 7 who received intra-operative steroid injection (0.29%) and 3 who did not (0.067%), p = 0.040. The relative risk of infection for those who received intra-operative steroid injection was 4.32 times higher than those who did not, with a number needed to harm of 448. There were no significant differences in age, body mass index, smoking status, or the prevalence of diabetes between those who got infected and those who did not. Knee infection following arthroscopic surgery is rare. Intra-operative steroid injection during arthroscopic knee surgery is associated with a 4.3-fold increased risk of subsequent knee infection. While the overall risk remains low, the use of intra-operative steroids is expected to result in one additional knee infection for every 448 arthroscopic procedures performed. IV.

TIBIAL METASTASIS AS INITIAL PRESENTATION OF SQUAMOUS CELL LUNG CANCER

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Lung carcinomas are frequently detected at stage IV and pain caused by bone metastasis - usually to the ribs and thoracic vertebrae - is a frequent manifestation. Metastasis to the lower limbs are extremely rare, particularly below the knee and as solitary lesions. CASE PRESENTATION: A 57 years-old white man, former smoker (74 pack-years) with sleep apnea, presented to his physician with 2 weeks of right atraumatic knee pain, worse on exertion. No constitutional symptoms were reported. Knee radiography was normal. Considering a rheumatological disorder, non-steroidal anti-inflammatories drugs and intra-articular steroid injection were prescribed, but without improvement. The patient then underwent knee magnetic resonance imaging, which showed a mass at the proximal tibial epiphysis extending to the tibial cortex and surrounding soft tissues (figure 1). To exclude primary malignancy of the bone, a computed tomography (CT) guided bone biopsy was made. Bone scintigraphy excluded other lesions. Two months later, the patient presented to our emergency department with hemoptysis and weight loss of 22% of his body weight in the previous 3 weeks. Physical examination revealed low-pitched vesicular murmur on the left hemithorax, as well as swelling of the inferior portion of the right knee and upper third of the right tibial and severe pain at palpation with impaired gait. Chest radiograph showed a heterogeneous opacity on the upper left lung field (figure 2), and the thorax CT revealed a large mass in the central area of the upper lobe of the left lung, extending to the hilum with mediastinal adenopathies. Adrenal and hepatic metastasis were also noted (figure 3). Bone biopsy performed (previously at another hospital), revealed a carcinoma with squamous differentiation favouring a metastatic process. Bronchial biopsy by flexible bronchoscopy revealed squamous cell lung tumor, so the diagnosis of stage IV lung cancer was made. He will start palliative bone radiotherapy shortly and, pending the programmed death ligand 1 tumor proportion score, systemic treatment with chemo or immunotherapy. DISCUSSION: Lung cancer's bone metastases are usually found in the axial skeleton. The few cases of below-the-knee metastasis described in the literature are secondary to adenocarcinoma or small cell lung cancer. In this case, the diagnosis of lung cancer was delayed mainly due to the extremely atypical presentation as knee pain without respiratory or systemic symptoms. CONCLUSIONS: Although rarely, pain due to tibial metastasis may be the initial presentation of lung cancer. Therefore, this should be taken in consideration when approaching single bone lesions or localized rheumatologic disorders in order to prevent a delay in diagnosis and treatment of lung cancer, especially in current or past-smokers. REFERENCE #1: Popper HH. Progression and metastasis of lung cancer. Cancer Metastasis Rev 2016;35(1):75-91. REFERENCE #2: Gurrieri L, Longhi A, Braghetti A. Lung cancer presenting as a metastasis to the tibial bones: A case report. Tumori 2015;101(1):e18-20. REFERENCE #3: Kurishima K, Kagohashi K, Mammoto T, Satoh H. Tibia metastasis from small cell lung cancer. Tuberk Toraks 2014;62(1):89-90. DISCLOSURES: No relevant relationships by Carolina Alves, source=Web Response No relevant relationships by José Alves, source=Web Response No relevant relationships by Maria Carolina Carvalho, source=Web Response No relevant relationships by Ana Mendes, source=Web Response No relevant relationships by Ricardo Oliveira, source=Web Response No relevant relationships by Margarida Pereira, source=Web Response

Nonoperative Management of Femoroacetabular Impingement: Clinical Outcomes at 5-Years--A Prospective Study (143)

Objectives:Mid-term and long-term outcomes data on non-operative management of femoroacetabular impingement (FAI) syndrome remains sparse despite expanding research on the topic. Our purpose is to present 5-year outcomes data utilizing a non-operative protocol on a consecutive series of patients with FAI syndrome.Methods:Between 2013 and 2016, patients were prospectively recruited in a non-operative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were offered arthroscopic treatment. Patient-reported outcomes including the modified Harris Hip Score (mHHS) and Non-arthritic Hip Score (NAHS) were collected 1-, 2-, and 5-years after enrollment. We present the 5-year data. Statistical analysis was performed to determine outcomes based on FAI type and treatment.Results:133 hips in 100 patients were enrolled. Sixty-seven hips in 50 patients were available for 5-year follow up. At enrollment, the mean mHHS and NAHS were 69.6±13.1 and 76.3±14.7 respectively. In total, 73% of the cohort was managed non-operatively. Of the 11 patients requiring surgery, six (55%) converted to surgery within one year of enrollment, 4 (36%) converted to surgery between one and 2 years, and one patient converted to surgery between 2 and 5 years. At final follow up, the mean mHHS and NAHS were 89.6±10.7 and 88.0±12.1 respectively. At 1-year follow up, only the activity modification group made a significant increase in mHHS and NAHS (p<0.03), by two year follow up, all three treatment groups had made statistically significant improvements in mHHS and NAHS (p<0.05), by 5-years follow up, the activity modification group and the scope group had maintained their statistically significant improvement in mHHS and NAHS (p<0.03). There was no significant difference in mHHS or NAHS between treatment groups at 5-year follow-up (p>0.4)(Table 1), and no difference in proportion of hips meeting the MCID for mHHS based on treatment course (p=0.961). There was no difference in mHHS or NAHS between FAI types at any time point (p>0.06)(Table 2), or in the proportion of hips that met MCID among FAI types (p=0.511). 72% of patients returned to the same or similar sport/activity level, and there was no difference in the proportion of patients that returned to sports/activities among treatment type (p=0.095) or FAI type (p=0.273).Conclusions:Non-operative management of FAI syndrome is effective in a majority of adolescent patients, with robust improvements in patient-reported-outcomes persisting at 5-year follow-up.

The possibility of short-term hypothalamic-pituitary-adrenal axis suppression with high-volume, high-dose nasal mometasone irrigation in postsurgical patients with chronic rhinosinusitis.

Medically refractory chronic rhinosinusitis (CRS) is often treated with functional endoscopic sinus surgery (FESS) and high-volume steroid nasal irrigation. While budesonide is the most common steroid irrigation for this indication, mometasone has a superior pharmacokinetic profile, which may allow dose escalation. The safety and efficacy of mometasone at higher concentrations than previously used in treating CRS have not been explored. Patients were recruited from a tertiary level clinic between June 2018 and December 2019. Inclusion criteria included adults (>18 years); CRS diagnosis; previous FESS; pre-treatment morning cortisol within normal range; minimum of twice daily high-volume sinonasal mometasone irrigations (total dose of 4 mg) for 12 weeks; and post-treatment morning cortisol measured within 2 weeks following the study period. Patients with potential for endogenous or exogenous disruption of the HPA axis were excluded. 14 patients were enrolled in this prospective cohort study. In all but one patient, pre- and post-treatment morning cortisol levels were not significantly different and were within normal limits (6.7-25.4 μg/dL). Following an uninterrupted 12-week treatment course, no evidence of HPA axis suppression was found (P = 0.915). The single patient who was found to have a low (1.3 μg/dL) post-treatment morning serum cortisol level reportedly received an intraarticular steroid shot several days prior to the blood draw. She remained asymptomatic and her rechecked serum cortisol was within normal limits at 12.3 μg/dL. High-volume 2 mg twice daily sinonasal mometasone irrigations did not cause HPA axis suppression in a representative sample of patients with refractory CRS post-FESS with normal baseline cortisol levels.

Intra-articular therapy with methotrexate or tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic review

BackgroundPersistent monoarthritis in otherwise well-controlled rheumatoid arthritis presents a therapeutic challenge. Intra-articular (IA) steroids are a mainstay of treatment, though some have queried whether IA disease modifying anti-rheumatic drugs (DMARD) and biologics can be used in those who fail steroid injections.MethodsA systematic literature review was conducted using four medical databases to identify randomized, controlled trials assessing IA therapies in RA patients. Included studies underwent Cochrane Risk of Bias 2 assessment for quality.ResultsTwelve studies were included, 6 of which examined intra-articular (IA) TNF inhibitors (TNFi), and 6 studies evaluating IA methotrexate. Of those evaluating IA TNFi, one study reported statistical improvement in TNFi therapy when compared with placebo. The remaining 5 studies compared IA TNFi therapy with steroid injections. IA TNFi had statistically improved symptom scores and clinical assessments comparable with IA steroid treatments.In the 6 studies evaluating IA methotrexate, the addition of methotrexate to steroid intra-articular therapy was not found to be beneficial, and singular methotrexate injection was not superior to the control arms (saline or triamcinolone). Risk-of-bias (ROB) assessment with the Revised Cochrane ROB tool indicated that 2 of 6 TNFi studies were at some risk or high risk for bias, compared with 5 out of 6 methotrexate studies.ConclusionFor persistent monoarthritis in rheumatoid arthritis, IA methotrexate was not found to have clinical utility. Intra-articular TNFi therapy appears to have equal efficacy to IA steroids, though the optimal dose and frequency of injections is yet unknown.

COMPARISON OF EFFECTIVENESS OF INTRAARTICULAR INJECTIONS OF HYALURONIC ACID AND CORTICOSTEROIDS IN THE TREATMENT OF PATIENTS WITH KNEE OSTEOARTHRITIS SYMPTOMS

Objective: To compare the effectiveness of intraarticular injections of hyaluronic acid and corticosteroids in the treatment of patients with knee osteoarthritis symptoms.Study Design: Prospective comparative study.Place and Duration of Study: Rheumatology/General Medicine department, Pak Emirates Military Hospital Rawalpindi, from May 2019 to Jun 2020.Methodology: Patient of knee osteoarthritis with active symptoms of pain and stiffness who fulfilled American college of rheumatology criteria of 1997 were included in the study. They were randomly divided into two groups with group A receiving intraarticular hyaluronic acid. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was administered before and three months after the management to assess the efficacy of treatment in both the groups. Student ttest was applied to ascertain that the difference in the WOMAC scores before and after the management has been statistically significantly different in both groups.&#x0D; Results: A total of 150 patients of osteoarthritis of knee joint were included in the study. Mean age of the study participants was 58.439 ± 7.35. 85 (56.7%) patients were female while 65 (43.3%) were male. 81 (54%) received the intraarticular hyaluronic Acid while 69 (46%) received the intraarticular steroids. Mean difference before and after the management in WOMAC score in corticosteroids group was 9.295 ± 1.24 while in hyaluronic Acid group was 5.41 ± 4.556 (p-value &lt;0.01).&#x0D; Conclusion: Both hyaluronic Acid and corticosteroids were effective to reduce the symptoms of osteoarthritis knee in our target population, but intraarticular steroids emerged as the better option from the two in terms of.......

Nonoperative Management of Femoroacetabular Impingement in Adolescents: Clinical Outcomes at a Mean of 5 Years: A Prospective Study

Background: There is a lack of midterm or long-term outcome data on nonoperative management of femoroacetabular impingement (FAI) syndrome in adolescents despite expanding research mostly focused on arthroscopic management. Purpose: To present 5-year outcome data utilizing a nonoperative protocol on a consecutive series of patients presenting to our clinic with FAI syndrome. Study Design: Cohort study, Level of evidence, 2. Methods: A total of 100 patients (62% female; mean age 15 years) who presented to the clinic for evaluation of hip pain and had at least 1 hip with a positive impingement sign were prospectively recruited. The management protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were then offered arthroscopic treatment. Patient-reported outcomes (PROs), including the modified Harris Hip Score (mHHS) and the Nonarthritic Hip Score (NAHS) were then collected at a mean 1, 2, and 5 years after the initial evaluation. Results: At enrollment, the mean mHHS and NAHS were 69.6 ± 12.9 and 75.5 ± 15.2, respectively. A total of 51 patients (n = 69 hips) were available at a mean 5-year follow-up, with the mean mHHS and NAHS of 89.5 ± 10.8 and 88.1 ± 12, respectively. There was no significant difference in the mHHS or the NAHS between activity modification and physical therapy, injection, or arthroscopic surgery groups at 5-year follow-up (P > .6) and no difference in the proportion of hips meeting the minimal clinically important difference (MCID) for the mHHS based on treatment course (P = .99). There was no significant difference in the mHHS or the NAHS between FAI types at any time point, or in the proportion of hips that met the MCID among FAI types (P = .64). Also, 11 out of 12 hips that required surgery had surgery in less than 2 years. One hip underwent surgery at 5 years after the initial visit. There was no significant drop-off in the mHHS or the NAHS between the 2-year and 5-year time periods (P > .3). Conclusion: Nonoperative management of FAI syndrome is effective in a majority of adolescent patients, with significant improvements in PROs persisting at a mean 5-year follow-up.

Nonoperative Management of Femoroacetabular Impingement: Clinical Outcomes at 5 Years–A Prospective Study

Purpose: Our purpose is to present 5-year outcomes data utilizing a nonoperative protocol on a consecutive series of patients with FAI syndrome.&#x0D; Methods: Between 2013 and 2016, patients were prospectively recruited in a nonoperative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intraarticular steroid injection. Patients with recurrent symptoms were offered arthroscopic treatment. Patient-reported outcomes, including the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS), were collected 1-, 2-, and 5-years after enrollment. We present the 5-year data. Statistical analysis was performed to determine outcomes based on FAI type and treatment.&#x0D; Results: One hundred thirty-three hips in 100 patients were enrolled. Sixty-seven hips in 50 patients were available for 5-year follow-up. At enrollment, the mean mHHS and NAHS were 69.6±13.1 and 76.3±14.7, respectively. In total, 73% of the cohort was managed nonoperatively. Of the 11 patients requiring surgery, six (55%) converted to surgery within 1 year of enrollment, four (36%) converted to surgery between 1 and 2 years, and one patient converted to surgery between 2 and 5 years. At final follow-up, the mean mHHS and NAHS were 89.6±10.7 and 88.0±12.1, respectively. At 1-year follow-up, only the activity modification group made a significant increase in mHHS and NAHS (p&lt;0.03). By 2-year follow-up, all three treatment groups had made statistically significant improvements in mHHS and NAHS (p&lt;0.05). By 5-year follow-up, the activity modification group and the scope group had maintained their statistically significant improvement in mHHS and NAHS (p&lt;0.03). There was no significant difference in mHHS or NAHS between treatment groups at 5-year follow-up (p&gt;0.4) (Table 1) and no difference in proportion of hips meeting the MCID for mHHS based on treatment course (p=0.961). There was no difference in mHHS or NAHS between FAI types at any time point (p&gt;0.06) (Table 2) or in the proportion of hips that met MCID among FAI types (p=0.511). Seventy-two percent of patients returned to the same or similar sport/activity level, and there was no difference in the proportion of patients that returned to sports/activities among treatment type (p=0.095) or FAI type (p=0.273).&#x0D; Conclusions: Nonoperative management of FAI syndrome is effective in a majority of adolescent patients with robust improvements in patient-reported outcomes persisting at 5-year follow-up.&#x0D; Significance: Nonoperative management can be successful for a large portion of adolescent patients with symptomatic FAI syndrome with durable outcomes at 5-year follow-up.

Genicular Nerve Radiofrequency Ablation for the Treatment of Painful Knee Osteoarthritis: Current Evidence and Future Directions.

Genicular nerve radiofrequency ablation (RFA) is increasingly being performed to treat chronic pain due to knee osteoarthritis (KOA). This narrative review provides a concise summary of the relevant neuroanatomy, randomized controlled trials, appropriate patient selection, and safety relating to genicular RFA. Cadaveric studies demonstrate significant variability in the location of the genicular nerves, which has stimulated debate about the ideal target locations for genicular RFA. Despite this, favorable outcomes have been observed in studies targeting only the superior medial genicular nerve, inferior medial genicular nerve, and superior lateral genicular nerve. Several randomized controlled trials demonstrate superiority of genicular RFA compared with intra-articular steroid, viscosupplementation, and oral analgesics. Genicular RFA of the superior medial genicular nerve, inferior medial genicular nerve, and superior lateral genicular nerve appears to be an effective treatment for painful KOA, but targeting additional sensory nerves may further improve treatment success. Although genicular RFA appears relatively safe on the basis of the available data, additional large-scale studies are needed to provide greater confidence.

Genicular nerve block in rheumatoid arthritis: a randomized clinical trial.

This study highlights the effect of a genicular nerve block (GNB) on pain, function, and inflammation outcome measures in rheumatoid arthritis (RA) knees. A total of sixty-four patients diagnosed with RA using ACR/EULAR 2010 criteria with unilateral persistent knee arthritis were recruited to the study. They were randomly assigned into two groups: group 1 received GNB and group 2 received intra-articular triamcinolone. Both groups were examined by the SOLAR scoring system, visual analog scale (VAS), and Lysholm score at 0, 2, and 12weeks. A semi-quantitative score was used to assess the tenderness and swelling at the same intervals. Function and inflammation improved significantly in group 2 at a 2-week interval as compared to group 1, whereas pain improved in both groups with non-significant differences. After 12weeks, group 1 showed significant improvement as compared with group 2 for the three outcome measures. Neither the disease activity nor the current medication was related to the GNB effect. Disease duration was negatively related to GNB-induced improvement. GNB is a new promising local therapy for RA to control pain, improve function, and alleviate inflammation of the knee joint. Although it has a relatively short-term effect, yet it has outperformed the steroid effect. Key Points • Knee monoarthritis treatment in rheumatoid arthritis is always challenging • GNB has been approved for the treatment of pain in knee osteoarthritis • GNB in this study was able to control active knee arthritis and this effect persisted longer thane intra-articular steroid injection.

STUDY OF RESULT OF FROZEN SHOULDER SYNDROME TREATED WITH INTRAARTICULAR STEROIDS

OBJECTIVE: Adhesive capsulitis or frozen shoulder is a common condition that presents with pain and progressive limitation of both active and passive shoulder movements. In this study, we investigate the efcacy of intraarticular steroid injection in case of frozen shoulder. Material &amp; Methods: Study is done on 32 patients of frozen shoulder attended Orthopedic OPD at Jhalawar Medical college, Jhalawar from July 2018 to June 2019. Intra-articular injection of steroid (methyl prednisolone acetate 80 mg) given &amp; results analyzed. RESULTS: Patient follow up done every 2 weeks after giving Intraarticular steroid &amp; advised to exercise of shoulder. Improvement in shoulder pain &amp; movement of shoulder analyzed &amp; recorded up to 12 – 24 weeks. CONCLUSION: Intraarticular injection for frozen shoulder is good, safe &amp; efcient method. For better result corticosteroid injection is given in the early stages when pain is the predominant presentation.

Radiofrequency Denervation of Genicular Nerves for Advanced Knee Osteoarthritis Pain: A retrospective Observational Study

Background: Knee joint osteoarthritis is a degenerative disorder resulting in pain and disability. The treatment of knee osteoarthritis pain includes the use of oral analgesics, oral glucosamine and chondroitin sulfate, intra-articular steroid, and viscous supplementation, but with limited efficacy. Aim of the work: This retrospective observational study aimed to evaluate the efficacy of radiofrequency thermocoagulation of genicular nerves for control of the pain of knee joint osteoarthritis. Material and methods: This study included patients with knee pain of Kellgren Lawrence grade 3 and 4 osteoarthritis who underwent radiofrequency neurotomy of the knee joint from July 2015 to July 2018. The 68 joints of 60 patients were evaluated for knee pain VAS score [0–10 mm], oxford knee score [12–60] and development of any adverse effect at pre and post-procedure at 1, 3, 6 and 12 months. Results: The mean± SD values of Visual analog scale [VAS] [0–10] for knee joint pain were 7.93±1.21, 3.38±1.59, 4.10±2.30, 4.90±1.88, and 5.80±1.71 at pre-procedure and at 1, 3, 6 and 12 months post-procedure. The mean ± SD values for Oxford Knee Score [OKS] [12–60] were 40.87±7.66, 23.90±5.60, 25.93±5.48, 27.93 ± 5.48, and 31.43±5.62 at pre-procedure and at 1, 3, 6 and 12 months post-procedure. One-way repeated measures of ANOVA test showed a significant decrease in VAS and OKS scores between pre and post-procedure at 1, 3, 6 and 12 months [p <0.001]. Conclusion: Radiofrequency thermocoagulation of genicular nerves provides significant pain relief and functional improvement in advanced knee joint osteoarthritis patients for a duration of one year.

Effectiveness of the Guidelines for the Non-Operative Management of Knee Osteoarthritis.

Various treatment guidelines exist for the treatment of knee OA which is very common in the tropical countries. A multitude of treatment guidelines creates confusion for the primary physician to manage patients with OA. Therefore, a consensus treatment guideline is necessary to clarify this discrepancy and to manage the patients with evidence-based treatment modalities. Analysis of the six existing guidelines on the management of knee OA, based on the strength of their recommendations was performed. We studied six guidelines regarding various modes of non-operative treatment of knee OA. There is consensus on efficacy of self-management programmes, land-based exercise and weight loss. These guidelines do not recommend the use of acupuncture in OA and there was a mixed opinion for the use of physiotherapy modalities and orthotics. NSAIDS are recommended for pain relief, along with their topical forms, their long term use is not advisable. Role of paracetamol for early disease process and opioids for later part of the disease is debatable and use of Glucosamine and Chondroitin has been discouraged by most of these guidelines. Use of intra-articular steroids for acute pain and inflammation is recommended, but not for Stem cells and Platelet Rich Plasma therapy, by the majority.Use of HA is still debatable. Although there are multiple treatment guidelines described for the management of knee OA, there is no consensus on many treatment modalities. There are periodical changes in the treatment protocol due to new studies available with new results. Despite pharmacological and surgical modalities keep evolving, patient factors have to be considered while recommending the treatment in patients of knee OA.

Low rates of serious complications and further procedures following surgery for base of thumb osteoarthritis: analysis of a national cohort of 43 076 surgeries

ObjectivesTo determine the incidence of further procedures and serious adverse events (SAEs) requiring admission to hospital following elective surgery for base of thumb osteoarthritis (BTOA), and the patient factors associated...

Suprascapular Nerve Radiofrequency versus Intraarticular Steroid Injection in Chronic Shoulder Pain

Background: Chronic shoulder pain is a frequent clinical condition that often reduces patient’s function and rehabilitation. Objectives: We aimed to compare efficacy of pulsed radiofrequency (PRF) to intra-articular steroid (triamcinolone acetonide) injection in controlling chronic shoulder pain as regard improvement of pain and function in six-month duration. Patients and Methods: We carried out a prospective, randomized, controlled, single-blinded study enrolled 60 patients with shoulder pain randomly divided into 2 groups. Group I: PRF group enrolled 30 patients who were treated by PRF neuromodulation to the suprascapular nerve under fluoroscopy and Group II: steroid group enrolled 30 patients who were treated with intra-articular injection of 5 ml of 2% lidocaine with triamcinolone acetonide 40 mg. Results: In Group 1 (PRF group) we reported statistically significant improvement of VAS, these positive effects lasted at least 6 months and the VAS decreased through 6 months from 6.5 to 3.5. In Group 2 VAS decreased through 6 months from 7 to 3.5. Both groups showed significant Oxford Shoulder Scale (OSS) improvement. Conclusion: Intra articular injection of triamcinolone acetonide is more effective in improvement of chronic shoulder pain and function than PRF.

Cutaneous mucinosis of infancy: a rare case of joint involvement

BackgroundPrimary cutaneous mucinosis are a heterogeneous group of diseases characterized by the deposition of glycosaminoglycans in the dermis and the follicles. These diseases are rare in children therefore their diagnosis and management are still challenging. Joint involvement has been reported in patients with secondary cutaneous mucinosis and, rarely, in primary mucinosis. We describe a case of Cutaneous Mucinosis of Infancy with joint involvement.Case presentationAn healthy 5-year-old boy showed acute arthritis of the left knee and left elbow confirmed by ultrasound. Laboratory tests were within normal range. Symptoms disappeared after a course of nonsteroid anti-inflammatory drugs. One year later, the knee swelling reappeared; juvenile idiopathic arthritis was diagnosed and intra-articular steroid injection was performed. Due to persistence of arthritis of the knee he was admitted to our hospital. On physical examination variable skin-colored lesions were observed, which had been in existence for over 2 years.We performed a skin biopsy that showed an interstitial mucine deposition in the reticular dermis. Cutaneous Mucinosis of Infancy was diagnosed.Discussion and conclusionsCutaneous Mucinosis of Infancy is a persistent dermatosis with benign prognosis and no treatment is generally required. Our case report is particularly interesting because it is the first in which joint involvement has been reported in CMI, a disorder that has so far been described as limited to skin involvement. Further studies will be necessary in order to clarify the pathogenesis of joint involvement in primary mucinosis.