title: Improvement in wrist pain with ultrasound-guided glucocorticoid injections: a meta-analysis of individual patient data.
abstract: OBJECTIVE
  This meta-analysis compares change in wrist pain following ultrasound-guided (US-guided) intra-articular glucocorticoid injections with change in pain after palpation-guided injections in persons with inflammatory arthritis or osteoarthritis.
  
  
  METHODS
  Data sources included MEDLINE, Cochrane, BIOSIS, CINAHL, ACR/AHRP abstracts, and ClinicalTrials.gov. Studies that assessed change in wrist pain with direct comparison of US-guided and palpation-guided injections were included in the meta-analysis. Subject-level data was sought from authors of all relevant studies. Primary outcome was mean change in wrist pain from baseline to 1-6 week follow-up by visual analog scale (VAS). Mean difference in VAS was calculated for comparative studies. Secondary outcome was proportion attaining Minimal Clinically Important Improvement (MCII), defined as VAS reduction ≥ 20%. Odds ratios (ORs) of MCII were calculated for comparative studies. Mean differences in VAS and ORs for MCII for comparative studies were combined using fixed and random effects meta-analysis.
  
  
  RESULTS
  Ten studies were eligible, and adequate data was available from 4 studies with direct comparison of US-guided and palpation-guided treatment arms. The difference in mean VAS reduction (US-guided minus palpation-guided) ranged from-0.2 to 1.3, with a combined estimate of 1.0 (95% CI 0.3, 1.7). OR for MCII in comparative studies ranged from 1.0 to 12.4, with a combined OR of 3.2 (95% CI 1.2, 8.5) in favor of ultrasound.
  
  
  CONCLUSIONS
  US-guided glucocorticoid injections to the wrist result in greater reductions in pain, and greater likelihood of attaining MCII than palpation-guided injections at 1-6 weeks follow-up.
authors: Department of Rheumatology, Boston Medical Center, Boston, MA 02118, USA. maureen.dubreuil@bmc.org
authors: Maureen
authors: M
authors: Dubreuil
authors: Stephanie
authors: S
authors: Greger
authors: Michael
authors: M
authors: LaValley
authors: Joanna
authors: J
authors: Cunnington
authors: Wilmer L
authors: WL
authors: Sibbitt
authors: Eugene Y
authors: EY
authors: Kissin
mesh_terms: D018771:Arthralgia / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology
chemical_list: D005938:Glucocorticoids