title: Can simple ultrasonography predict the clinical effect of intra-articular injection therapy of the knee joint?
abstract: To investigate whether ultrasonographic joint assessment can predict the clinical response to intra-articular injection therapy of the knee. Patients with persistent gonarthritis intra-articularly received in a randomized double-blinded crossover fashion radiation synovectomy or a glucocorticoid injection, both followed by clinical bed rest. Prior to treatment and 3 months afterwards, grey-scale ultrasonography (US) of the knee was performed, measuring synovial thickness and extent of effusion. The final clinical effect of these two treatments was assessed at 3 months and finally at 6 months using a composite index. Ninety-seven patients, mainly suffering from undifferentiated arthritis (40%) or rheumatoid arthritis (31%), received 165 injections (including crossovers). Clinical effect at 6 months was not related to the baseline ultrasonographic extent of effusion or synovial thickness, nor with ultrasonographic decrease of effusion after the first 3 months. Nevertheless, it was associated with ultrasonographic decrease of synovial thickness within the first 3 months. Simple baseline US measurements fail to predict the final clinical effect of intra-articular treatment of the knee at 6 months, in contrast to early US changes of synovial thickness 3 months after therapy.
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. zjahangier@tergooiziekenhuizen.nl
authors.forename: Zalima N
authors.initials: ZN
authors.lastname: Jahangier
authors.forename: Johannes W G
authors.initials: JW
authors.lastname: Jacobs
authors.forename: Wijnand A A
authors.initials: WA
authors.lastname: Swen
authors.forename: Jan D
authors.initials: JD
authors.lastname: Moolenburgh
authors.forename: George A W
authors.initials: GA
authors.lastname: Bruyn
authors.forename: Eduard N
authors.initials: EN
authors.lastname: Griep
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001168:Arthritis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002951:Citrates / Q000008:administration & dosage / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D013583:Synovial Membrane / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D002951:Citrates; D009942:Organometallic Compounds; C045937:yttrium citrate; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide