Marwin Gutierrez1, Andrea Di Matteo2, Marcos Rosemffet3, Tomas Cazenave3, Gustavo Rodriguez-Gil4, Cristina Hernandez Diaz5, Lucio Ventura Rios5, Natalia Zamora3, Maria del Carmen Gonzalez Guzman3, Ignacio Carrillo3, Tadashi Okano6, Fausto Salaffi5, Carlos Pineda5. 1. Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy. Electronic address: dr.gmarwin@gmail.com. 2. Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy. 3. Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina. 4. Secion de Reumatologia, Hospital Municipal de Bahìa Blanca, Calle Estomba 968, 8000 Bahia Blanca, Argentina. 5. Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico. 6. Department of Orthopedic Surgery, Osaka City, University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, 545-8585 Osaka, Japan.
Abstract
OBJECTIVE: To compare the short-term efficacy of conventional blind injection (CBI) versus ultrasound-guided injection (USGI) of corticosteroids (CS) injection in tenosynovitis in patients with chronic arthritis and to investigate if the USGI is a less painful procedure and if there are differences in the changes of US findings during the post injection follow-up. METHODS:Patients presenting tenosynovitis requiring CS injection were involved. After clinical and US evaluation, patients were randomized to receive CBI or USGI. Efficacy of procedure was assessed by the improvement in both Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), including procedure-VAS global-VAS and local-VAS, after 1 and 4 weeks post-procedure. Power Doppler (PD) and greyscale (GS) US findings were also object of the follow-up. CBI or USGI under an aseptic technique were performed according the local guidelines using 20mg of methylprednisolone acetate. RESULTS: A total of 114 patients were randomized to receive CBI (54 patients) or USGI (60 patients) procedure. No significant difference was observed in terms of gender, age and pain duration among CBI and USGI groups at baseline. USGI proved to be significantly less painful than CBI (P=0.0001). AUC analysis showed that during the follow up visits, the USGI procedure had significantly better response in HAQ, local-VAS and global-VAS (P=0.0001, P=0.012 and P=0.0001 respectively) compared to CBI. During the follow up period, a significant greater reduction in the PD scores was found in the USGI group compared to the CBI group (P=0.0002), whereas no statistical differences were found in the GS findings between the groups (P=0.5627). CONCLUSION: Our study demonstrates superiority of USGI over CBI for CS injections in painful tenosynovitis, having better short-term outcomes measured by functional, clinical and US scores. These data support the use of USGI for tenosynovits in typical inpatient and/or outpatient in rheumatological practices.
RCT Entities:
OBJECTIVE: To compare the short-term efficacy of conventional blind injection (CBI) versus ultrasound-guided injection (USGI) of corticosteroids (CS) injection in tenosynovitis in patients with chronic arthritis and to investigate if the USGI is a less painful procedure and if there are differences in the changes of US findings during the post injection follow-up. METHODS:Patients presenting tenosynovitis requiring CS injection were involved. After clinical and US evaluation, patients were randomized to receive CBI or USGI. Efficacy of procedure was assessed by the improvement in both Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), including procedure-VAS global-VAS and local-VAS, after 1 and 4 weeks post-procedure. Power Doppler (PD) and greyscale (GS) US findings were also object of the follow-up. CBI or USGI under an aseptic technique were performed according the local guidelines using 20mg of methylprednisolone acetate. RESULTS: A total of 114 patients were randomized to receive CBI (54 patients) or USGI (60 patients) procedure. No significant difference was observed in terms of gender, age and pain duration among CBI and USGI groups at baseline. USGI proved to be significantly less painful than CBI (P=0.0001). AUC analysis showed that during the follow up visits, the USGI procedure had significantly better response in HAQ, local-VAS and global-VAS (P=0.0001, P=0.012 and P=0.0001 respectively) compared to CBI. During the follow up period, a significant greater reduction in the PD scores was found in the USGI group compared to the CBI group (P=0.0002), whereas no statistical differences were found in the GS findings between the groups (P=0.5627). CONCLUSION: Our study demonstrates superiority of USGI over CBI for CS injections in painful tenosynovitis, having better short-term outcomes measured by functional, clinical and US scores. These data support the use of USGI for tenosynovits in typical inpatient and/or outpatient in rheumatological practices.
Authors: Marwin Gutierrez; Cristina Hernandez-Diaz; Lucio Ventura-Rios; Lina María Saldarriaga-Rivera; Santiago Ruta; Magaly Alva; Claudia Mora -Trujillo; Wilkerson Pérez; Henry Terrazas; Rodolfo Del Carmen Arape Toyo; Maritza Quintero; Carla Solano; Oscar Sedano Santiago; Janet Grisel Huamán Sotomayor; Cesar Cefferino; Guillermo E Py; Marcelo J Audisio; Walter Javier Spindler; Horacio Berman; Carla Airoldi; Rómulo Wong; Ana Laura Álvarez Del Castillo Araujo; Mario E Díaz; Carmen Cerón Villaquiran; Rubén Darío Mantilla; José Alexandre Mendonça; Inês Guimarães da Silveira; Aline Defaveri do Prado; Melissa Cláudia Bisi; Violeta Rosario; Jeannette Medrano-Sánchez; Roberto Muñoz-Louis; Ana Cecilia Lozada-Navarro; Araceli Bernal; Maribel Lozano; Carlos Pineda Journal: Clin Rheumatol Date: 2016-08-30 Impact factor: 2.980
Authors: John P Hynes; Meadhbh Ni Fhlatharta; James W Ryan; Peter J MacMahon; Stephen J Eustace; Eoin C Kavanagh Journal: Skeletal Radiol Date: 2020-07-30 Impact factor: 2.199
Authors: Shannon E Peters; Ronald M Laxer; Bairbre L Connolly; Dimitri A Parra Journal: Pediatr Rheumatol Online J Date: 2017-04-11 Impact factor: 3.054