title: Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care.
abstract: OBJECTIVE
  We undertook a study to evaluate the effectiveness of corticosteroid injections in primary care patients with greater trochanteric pain syndrome (GTPS).
  
  
  METHODS
  We evaluated the effect of corticosteroid injections compared with expectant treatment (usual care) in a pragmatic, multicenter, open-label, randomized clinical trial in the Netherlands. Patients (aged 18 to 80 years) with GTPS visiting 81 participating primary care physicians were randomly allocated to receive either local corticosteroid injections (n = 60) or usual care (n = 60). Primary outcomes of pain severity (numerical rating scale 0 to 10) and recovery (yes or no total or major recovery) were evaluated at 3-month and 12-month follow-up visits. Adverse events were collected at 6 weeks.
  
  
  RESULTS
  At the 3-month follow-up visit, 34% of the patients in the usual care group had recovered compared with 55% in the injection group (adjusted OR = 2.38; 95% CI, 1.14-5.00, number needed to treat = 5). Pain severity at rest and on activity decreased in both groups, but the decrease was greater in the injection group, for an adjusted difference in pain at rest of 1.18 (95% CI, 0.31-2.05) and in pain with activity of 1.30 (95% CI, 0.32-2.29). At the 12-month follow-up, 60% of the patients in the usual care group had recovered compared with 61% in the injection group (OR = 1.05; 95% CI, 0.50-2.27). Pain severity at rest and on activity decreased in both groups and the 12-month follow-up showed no significant differences, with adjusted differences of 0.14 (95% CI, -0.75 to 1.04) for pain at rest and 0.45 (95% CI, -0.55 to 1.46) for pain with activity. Aside from a short period with superficial pain at the site of the injection, no differences in adverse events were found.
  
  
  CONCLUSIONS
  In this first randomized controlled trial assessing the effectiveness of corticosteroid injections vs usual care in GTPS, a clinically relevant effect was shown at a 3-month follow-up visit for recovery and for pain at rest and with activity. At a 12-month follow-up visit, the differences in outcome were no longer present.
authors.affiliation: Department of General Practice, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands. a.brinks@erasmusmc.nl
authors.forename: Aaltien
authors.initials: A
authors.lastname: Brinks
authors.forename: Rogier M
authors.initials: RM
authors.lastname: van Rijn
authors.forename: Sten P
authors.initials: SP
authors.lastname: Willemsen
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Bohnen
authors.forename: Jan A N
authors.initials: JA
authors.lastname: Verhaar
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000188:drug therapy*; D002062:Bursitis / Q000188:drug therapy* / Q000523:psychology; D016001:Confidence Intervals; D005260:Female; D005269:Femur / Q000473:pathology*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000188:drug therapy*; D011320:Primary Health Care / Q000379:methods*; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids