title: A randomized controlled trial of the cost-effectiveness of ultrasound-guided intraarticular injection of inflammatory arthritis.
abstract: OBJECTIVE
  We studied whether sonographic needle guidance affected the outcomes of intraarticular (IA) injection for inflammatory arthritis.
  
  
  METHODS
  Joints with inflammatory arthritis (n = 244; 76% rheumatoid arthritis, 3% small joints, 51% intermediate, and 46% large) were randomized to injection by conventional palpation-guided anatomic injection (120 joints) or sonographic image-guided injection enhanced with a 1-handed reciprocating procedure device mechanical syringe (124 joints). A 1-needle, 2-syringe technique was used. After IA placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and triamcinolone acetonide was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost, and cost per responder were determined.
  
  
  RESULTS
  Relative to conventional palpation-guided methods, sonographic guidance for injection of inflammatory arthritis resulted in an 81% reduction in injection pain (p < 0.001), 35% reduction in pain scores at outcome (p < 0.02), 38% increase in the responder rate (p < 0.003), 34% reduction in the non-responder rate (p < 0.003), 32% increase in therapeutic duration (p = 0.01), 8% reduction ($7) in cost/patient/year, and a 33% ($64) reduction in cost/responder/year for a hospital outpatient (p < 0.001).
  
  
  CONCLUSIONS
  Sonographic needle guidance improves the performance, clinical outcomes, and cost-effectiveness of IA injections for inflammatory arthritis. (Clinical Trial Identifier NCT00651625).
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, MSC10-5550 5th FL ACC, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA. wsibbitt@salud.unm.edu
authors.forename: Wilmer L
authors.initials: WL
authors.lastname: Sibbitt
authors.forename: Philip A
authors.initials: PA
authors.lastname: Band
authors.forename: Natalia R
authors.initials: NR
authors.lastname: Chavez-Chiang
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Delea
authors.forename: Hillary E
authors.initials: HE
authors.lastname: Norton
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Bankhurst
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001168:Arthritis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000191:economics*; D007270:Injections, Intra-Articular / Q000191:economics / Q000379:methods; D007596:Joints / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D010147:Pain Measurement; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000305:Adrenal Cortex Hormones