The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee.
Although intraarticular injections are important to the management of rheumatoid arthritis, there are few studies regarding the cost-effectiveness of alternative injection techniques. This randomized controlled study addressed the cost-effectiveness of two different low-cost, anatomic landmark palpation-directed intraarticular injection techniques. Ninety-six symptomatic rheumatoid knees were randomized to two different low-cost, palpation-guided intraarticular injection techniques utilizing (1) a conventional syringe or (2) a mechanical syringe, the RPD (the reciprocating procedure device). Three milliliters of 1% lidocaine were used to anesthetize the synovial membrane, followed by arthrocentesis and hydrodissection, and injection of 80 mg of triamcinolone acetonide utilizing the one-needle two-syringe technique. Baseline pain, procedural pain, aspirated fluid volume, pain at outcome (2 weeks and 6 months), responders, reinjection rates, cost/patient/year, and cost/responder/year were determined. Pain was measured with the 10 cm Visual Analogue Pain Scale (VAS). Both techniques significantly reduced pain scores at outcome from baseline (P < 0.001). The mechanical syringe technique resulted in a greater volume of aspirated fluid (P < 0.01), a 38% reduction in procedural pain (P < 0.001), a 24% reduction in pain scores at outcome (P < 0.03), an increase in the responder rate (P < 0.025), 33% increase in the time to next injection (P < 0.001), 23% ($35 US) reduction in cost/patient/year for a patient treated in a physician office (P < 0.001), 24% reduction ($26 US) in cost/patient/year for a hospital outpatient (P < 0.001), and 51% ($151 US) reduction in cost/responder/year (P < 0.001). The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee can be improved significantly with low-cost alternations in technique.
Department of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. nchavez@salud.unm.edu
Natalia R
NR
Chavez-Chiang
Wilmer L
WL
Sibbitt
Philip A
PA
Band
Suzanne L
SL
DeLea
Kye S
KS
Park
Arthur D
AD
Bankhurst
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics; D018771:Arthralgia / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis / Q000191:economics / Q000639:trends; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000191:economics / Q000379:methods / Q000639:trends; D008297:Male; D008875:Middle Aged; D014221:Triamcinolone / Q000008:administration & dosage / Q000191:economics
D000893:Anti-Inflammatory Agents; D014221:Triamcinolone
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