Cargando…

Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study

BACKGROUND: Intra-articular corticosteroid injections (IACI) are effective treatments for pain in knee osteoarthritis (KOA) but treatment response varies. There is uncertainty as to whether structural factors such as accurate placement of IACI affect outcome. We examined this question in a pragmatic...

Descripción completa

Detalles Bibliográficos
Autores principales: Hirsch, G., O’Neill, T. W., Kitas, G., Sinha, A., Klocke, R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5267419/
https://www.ncbi.nlm.nih.gov/pubmed/28122535
http://dx.doi.org/10.1186/s12891-017-1401-z
_version_ 1782500635790278656
author Hirsch, G.
O’Neill, T. W.
Kitas, G.
Sinha, A.
Klocke, R.
author_facet Hirsch, G.
O’Neill, T. W.
Kitas, G.
Sinha, A.
Klocke, R.
author_sort Hirsch, G.
collection PubMed
description BACKGROUND: Intra-articular corticosteroid injections (IACI) are effective treatments for pain in knee osteoarthritis (KOA) but treatment response varies. There is uncertainty as to whether structural factors such as accurate placement of IACI affect outcome. We examined this question in a pragmatic observational study, using ultrasound (US) to verify accuracy of IACI. METHODS: 105 subjects with KOA (mean age 63.1 years, 59% female) routinely referred for IACI underwent assessment of demographic factors, x-ray and US of the knee before aspiration and IACI (based on clinical landmarks) with 40 mg triamcinolone acetonide with lignocaine plus a small amount of atmospheric air by an independent physician. US demonstration of intra-articular mobile air, i.e. a positive air arthrosonogram, was used to determine accurate placement of injection. Both patients and injecting physicians were blind to the US findings. Pain at baseline, three and nine weeks post injection was assessed using the 500 mm WOMAC pain subscale and response defined as ≥ 40% reduction in pain from baseline. Inter-observer reliability of air-arthrosonogram assessment was good: κ 0.79 (three raters). RESULTS: Sixty-three subjects (60.6%) were responders at three weeks and 43 (45.7%) at nine weeks. Seventy-four subjects (70.5%) had a positive arthrosonogram. A positive air arthrosonogram did not associate with a higher rate of response to treatment (p 0.389 at three weeks, p 0.365 at nine weeks). There was no difference in US effusion depth, power Doppler signal or radiographic grade between responders and non-responders to the injection, but female gender associated with response at 3 weeks and previous injection with non-response at 9 weeks. CONCLUSIONS: Accurate intra-articular injection of corticosteroid results did not result in superior outcome in terms of pain compared to inaccurate injection in symptomatic knee OA.
format Online
Article
Text
id pubmed-5267419
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-52674192017-02-01 Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study Hirsch, G. O’Neill, T. W. Kitas, G. Sinha, A. Klocke, R. BMC Musculoskelet Disord Research Article BACKGROUND: Intra-articular corticosteroid injections (IACI) are effective treatments for pain in knee osteoarthritis (KOA) but treatment response varies. There is uncertainty as to whether structural factors such as accurate placement of IACI affect outcome. We examined this question in a pragmatic observational study, using ultrasound (US) to verify accuracy of IACI. METHODS: 105 subjects with KOA (mean age 63.1 years, 59% female) routinely referred for IACI underwent assessment of demographic factors, x-ray and US of the knee before aspiration and IACI (based on clinical landmarks) with 40 mg triamcinolone acetonide with lignocaine plus a small amount of atmospheric air by an independent physician. US demonstration of intra-articular mobile air, i.e. a positive air arthrosonogram, was used to determine accurate placement of injection. Both patients and injecting physicians were blind to the US findings. Pain at baseline, three and nine weeks post injection was assessed using the 500 mm WOMAC pain subscale and response defined as ≥ 40% reduction in pain from baseline. Inter-observer reliability of air-arthrosonogram assessment was good: κ 0.79 (three raters). RESULTS: Sixty-three subjects (60.6%) were responders at three weeks and 43 (45.7%) at nine weeks. Seventy-four subjects (70.5%) had a positive arthrosonogram. A positive air arthrosonogram did not associate with a higher rate of response to treatment (p 0.389 at three weeks, p 0.365 at nine weeks). There was no difference in US effusion depth, power Doppler signal or radiographic grade between responders and non-responders to the injection, but female gender associated with response at 3 weeks and previous injection with non-response at 9 weeks. CONCLUSIONS: Accurate intra-articular injection of corticosteroid results did not result in superior outcome in terms of pain compared to inaccurate injection in symptomatic knee OA. BioMed Central 2017-01-26 /pmc/articles/PMC5267419/ /pubmed/28122535 http://dx.doi.org/10.1186/s12891-017-1401-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hirsch, G.
O’Neill, T. W.
Kitas, G.
Sinha, A.
Klocke, R.
Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study
title Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study
title_full Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study
title_fullStr Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study
title_full_unstemmed Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study
title_short Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study
title_sort accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5267419/
https://www.ncbi.nlm.nih.gov/pubmed/28122535
http://dx.doi.org/10.1186/s12891-017-1401-z
work_keys_str_mv AT hirschg accuracyofinjectionandshorttermpainrelieffollowingintraarticularcorticosteroidinjectioninkneeosteoarthritisanobservationalstudy
AT oneilltw accuracyofinjectionandshorttermpainrelieffollowingintraarticularcorticosteroidinjectioninkneeosteoarthritisanobservationalstudy
AT kitasg accuracyofinjectionandshorttermpainrelieffollowingintraarticularcorticosteroidinjectioninkneeosteoarthritisanobservationalstudy
AT sinhaa accuracyofinjectionandshorttermpainrelieffollowingintraarticularcorticosteroidinjectioninkneeosteoarthritisanobservationalstudy
AT klocker accuracyofinjectionandshorttermpainrelieffollowingintraarticularcorticosteroidinjectioninkneeosteoarthritisanobservationalstudy