title: A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis.
abstract: OBJECTIVE
  Most corticosteroid injections into the joint are guided by the clinical examination (CE), but up to 70% are inaccurately placed, which may contribute to an inadequate response. The aim of this study was to investigate whether ultrasound (US) guidance improves the accuracy and clinical outcome of joint injections as compared with CE guidance in patients with inflammatory arthritis.
  
  
  METHODS
  A total of 184 patients with inflammatory arthritis and an inflamed joint (shoulder, elbow, wrist, knee, or ankle) were randomized to receive either US-guided or CE-guided corticosteroid injections. Visual analog scales (VAS) for assessment of function, pain, and stiffness of the target joint, a modified Health Assessment Questionnaire, and the EuroQol 5-domain questionnaire were obtained at baseline and at 2 weeks and 6 weeks postinjection. The erythrocyte sedimentation rate and C-reactive protein level were measured at baseline and 2 weeks. Contrast injected with the steroid was used to assess the accuracy of the joint injection.
  
  
  RESULTS
  One-third of CE-guided injections were inaccurate. US-guided injections performed by a trainee rheumatologist were more accurate than the CE-guided injections performed by more senior rheumatologists (83% versus 66%; P = 0.010). There was no significant difference in clinical outcome between the group receiving US-guided injections and the group receiving CE-guided injections. Accurate injections led to greater improvement in joint function, as determined by VAS scores, at 6 weeks, as compared with inaccurate injections (30.6 mm versus 21.2 mm; P = 0.030). Clinicians who used US guidance reliably assessed the accuracy of joint injection (P < 0.001), whereas those who used CE guidance did not (P = 0.29).
  
  
  CONCLUSIONS
  US guidance significantly improves the accuracy of joint injection, allowing a trainee to rapidly achieve higher accuracy than more experienced rheumatologists. US guidance did not improve the short-term outcome of joint injection.
authors.affiliation: Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Cunnington
authors.forename: Nicola
authors.initials: N
authors.lastname: Marshall
authors.forename: Geoff
authors.initials: G
authors.lastname: Hide
authors.forename: Claire
authors.initials: C
authors.lastname: Bracewell
authors.forename: John
authors.initials: J
authors.lastname: Isaacs
authors.forename: Philip
authors.initials: P
authors.lastname: Platt
authors.forename: David
authors.initials: D
authors.lastname: Kane
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D002983:Clinical Competence; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D020127:Recovery of Function; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids