title: A randomized controlled trial of the reciprocating procedure device for intraarticular injection of corticosteroid.
abstract: OBJECTIVE
  Injection of intraarticular corticosteroid remains an important therapy for inflammatory arthritis. In a randomized controlled trial we compared the new reciprocating procedure device (RPD) to the traditional syringe for injection of intraarticular corticosteroid.
  
  
  METHODS
  One hundred fifty-four intraarticular corticosteroid injection procedures were randomized to the conventional syringe or the RPD. Using the syringe or RPD, the needle was introduced into the joint, any effusion that was present was aspirated, and the corticosteroid (methylprednisolone acetate) was injected. Outcome measures included patient pain measured by visual analog scale (VAS pain), procedure duration, operator satisfaction, complications, and immediate and delayed response to the injected medication.
  
  
  RESULTS
  The RPD reduced pain scores by 49% (RPD VAS pain score: 2.40 +/- 2.17; conventional syringe VAS pain score: 4.73 +/- 3.39; p < 0.001), reduced procedure time by 31% (RPD: 1.28 +/- 1.08 min, conventional syringe: 1.86 +/- 1.26; p < 0.01), and improved physician satisfaction with the joint procedure device by 63% (RPD visual analog satisfaction scale score: 9.12 +/- 0.80, conventional syringe 5.59 +/- 1.28; p < 0.001). Fifty-five percent (43/78) of patients experienced moderate to severe pain (VAS pain > or = 5) with the conventional syringe, while 17% (13/76) experienced moderate to severe pain with the RPD. The same beneficial response was present when intermediate or large joints were analyzed separately. Longterm outcomes were equivalent.
  
  
  CONCLUSIONS
  When a conventional syringe is used for corticosteroid injection, many patients experience significant procedural pain. The RPD significantly reduces patient pain, reduces procedure time, and improves operator satisfaction. The RPD is superior to the traditional syringe for injection of intraarticular corticosteroid.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA.
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Bankhurst
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Nunez
authors.forename: Hilda T
authors.initials: HT
authors.lastname: Draeger
authors.forename: Sharon C
authors.initials: SC
authors.lastname: Kettwich
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Kettwich
authors.forename: Wilmer L
authors.initials: WL
authors.lastname: Sibbitt
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D013594:Syringes / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone