The rheumatoid knee before and after arthrocentesis and prednisolone injection: evaluation by Gd-enhanced MRI.
In patients with rheumatoid arthritis, intraarticular injection of corticosteroids is an accepted means of treating a symptomatic joint. It has previously been impossible to precisely quantitate the effects of these injections on synovial effusion and pannus. Magnetic resonance imaging (MRI) is a safe, effective means of evaluating joint anatomy, and the use of intravenous gadolinium (Gd)-containing contrast allows clear differentiation of fluid from abnormal synovial tissue. The current study utilized MRI and Gd-labeled diethylene-triamene pentacetic acid (Gd-DTPA) contrast to evaluate serial changes in 6 knees of 6 patients with rheumatoid arthritis, following arthrocentesis and intraarticular injection of prednisolone. One week after the corticosteroid was injected, 2 patients had reduction of pannus width to 20% and 68% of baseline measurements. In these same individuals, follow-up sagittal views showed decreases of total effusion and fluid-plus-pannus width. The other 4 patients, who were followed for 4 weeks, had minimal changes in fluid and synovium. Gd-DTPA-enhanced MRI permits precise assessment of effects of intraarticular injections on synovial fluid and pannus in the rheumatoid knee.
Leitch
R
R
Department of Internal Medicine, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA.
Walker
S E
SE
Hillard
A E
AE
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D004322:Drainage / Q000379:methods*; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives*; D011239:Prednisolone / Q000008:administration & dosage*; D012189:Retrospective Studies; D013582:Synovial Fluid
D005938:Glucocorticoids; D009942:Organometallic Compounds; D004369:Pentetic Acid; D011239:Prednisolone; D019786:Gadolinium DTPA