title: The effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps strength and pain in individuals with knee synovitis: a prospective observational study.
abstract: BACKGROUND
  Substantial weakness of the quadriceps muscles is typically observed in patients with arthritis. This is partly due to ongoing neural inhibition that prevents the quadriceps from being fully activated. Evidence from animal studies suggests enhanced flexion reflex excitability may contribute to this weakness. This prospective observational study examined the effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps muscle strength and knee pain in individuals with knee synovitis.
  
  
  METHODS
  Sixteen patients with chronic arthritis and clinically active synovitis of the knee participated in this study. Knee pain flexion reflex threshold, and quadriceps peak torque were measured at baseline, immediately after knee joint aspiration alone and 5 ± 2 and 15 ± 2 days after knee joint aspiration and the injection of 40 mg of methylprednisolone acetate.
  
  
  RESULTS
  Compared to baseline, knee pain was significantly reduced 5 (p = 0.001) and 15 days (p = 0.009) post intervention. Flexion reflex threshold increased immediately after joint aspiration (p = 0.009) and 5 (p = 0.01) and 15 days (p = 0.002) post intervention. Quadriceps peak torque increased immediately after joint aspiration (p = 0.004) and 5 (p = 0.001) and 15 days (p <0.001) post intervention.
  
  
  CONCLUSIONS
  The findings from this study suggest that altered sensory output from an inflamed joint may increase flexion reflex excitability in humans, as has previously been shown in animals. Joint aspiration and corticosteroid injection may be a clinically useful intervention to reverse quadriceps muscle weakness in individuals with knee synovitis.
authors.affiliation: Health and Rehabilitation Research Institute, Auckland University of Technology, 55 Wellesley Street East, Auckland, 1010, New Zealand. david.rice@aut.ac.nz.|Waitemata Pain Services, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, 15 Shea Terrace, Auckland, 0740, New Zealand. david.rice@aut.ac.nz.
authors.forename: David Andrew
authors.initials: DA
authors.lastname: Rice
authors.affiliation: Health and Rehabilitation Research Institute, Auckland University of Technology, 55 Wellesley Street East, Auckland, 1010, New Zealand. peter.mcnair@aut.ac.nz.
authors.forename: Peter John
authors.initials: PJ
authors.lastname: McNair
authors.affiliation: Health and Rehabilitation Research Institute, Auckland University of Technology, 55 Wellesley Street East, Auckland, 1010, New Zealand. gwyn.lewis@aut.ac.nz.
authors.forename: Gwyn Nancy
authors.initials: GN
authors.lastname: Lewis
authors.affiliation: Department of Medicine, University of Auckland, 2 Park Road, Auckland, 1023, New Zealand. n.dalbeth@auckland.ac.nz.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D018771:Arthralgia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects / Q000473:pathology; D008297:Male; D053580:Muscle Strength / Q000187:drug effects / Q000502:physiology*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000187:drug effects / Q000502:physiology*; D012018:Reflex / Q000187:drug effects / Q000502:physiology*; D013396:Suction / Q000379:methods; D013585:Synovitis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones