title: Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial.
abstract: OBJECTIVE
  To compare the advantages of prolotherapy in the treatment of first carpometacarpal osteoarthritis (OA) with those of corticosteroid local injection in the short and long term.
  
  
  METHODS
  We performed a randomized controlled trial from March 2010 to March 2011 in an outpatient clinic at a university hospital. Sixty participants (60 hands) with OA of the first carpometacarpal joint were assigned equally to two groups. For the corticosteroid group, after 2 monthly saline placebo injections, a single dose of 40 mg methylprednisolone acetate (0.5 ml) mixed with 0.5 ml of 2% lidocaine was injected. For the dextrose (DX) group, 0.5 ml of 20% DX was mixed with 0.5 ml of 2% lidocaine and the injection was repeated monthly for 3 months. Pain intensity, hand function and the strength of lateral pinch grip were measured at the baseline and at 1, 2, and 6 months after the treatment.
  
  
  RESULTS
  Mean age (STD) was 63.6 (9.7) years, and mean (STD) visual analog scale (VAS) was 6 (2). The two groups were comparable at 2 months, but significantly different at 1 month, with better results for corticosteroid, and at 6 months with apparently more favorable outcome for DX [mean difference (95% CI) in VAS = 1.1 (0.2, 2.0), p = 0.02]. After 6 months of treatment, both DX and corticosteroid injection increased functional level, but DX seemed to be more effective [mean difference (95% CI) in total function score = 1.0 (0.2, 1.8), p = 0.01].
  
  
  CONCLUSIONS
  For the long term, DX seems to be more advantageous, while the two treatments were comparable in the short term. Because of the satisfactory pain relief and restoring of function, we would prefer DX prolotherapy for the treatment of patients with OA.
  
  
  METHODS
  Therapeutic studies--investigating the results of treatment; level I.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Islamic Republic of Iran Army University of Medical Sciences, Tehran, Iran, jahangiry.a@dums.ac.ir.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Jahangiri
authors.forename: Farid Rezaiee
authors.initials: FR
authors.lastname: Moghaddam
authors.forename: Sharif
authors.initials: S
authors.lastname: Najafi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D052737:Carpometacarpal Joints; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D005950:Glucose Solution, Hypertonic / Q000627:therapeutic use*; D018737:Hand Strength; D006801:Humans; D007270:Injections, Intra-Articular; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D020127:Recovery of Function; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D005950:Glucose Solution, Hypertonic; D000077555:Methylprednisolone Acetate; D008012:Lidocaine; D008775:Methylprednisolone