title: Short-term efficacy to conventional blind injection versus ultrasound-guided injection of local corticosteroids in tenosynovitis in patients with inflammatory chronic arthritis: A randomized comparative study.
abstract: OBJECTIVE
  To compare the short-term efficacy of conventional blind injection (CBI) versus ultrasound-guided injection (USGI) of corticosteroids (CS) injection in tenosynovitis in patients with chronic arthritis and to investigate if the USGI is a less painful procedure and if there are differences in the changes of US findings during the post injection follow-up.
  
  
  METHODS
  Patients presenting tenosynovitis requiring CS injection were involved. After clinical and US evaluation, patients were randomized to receive CBI or USGI. Efficacy of procedure was assessed by the improvement in both Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), including procedure-VAS global-VAS and local-VAS, after 1 and 4 weeks post-procedure. Power Doppler (PD) and greyscale (GS) US findings were also object of the follow-up. CBI or USGI under an aseptic technique were performed according the local guidelines using 20mg of methylprednisolone acetate.
  
  
  RESULTS
  A total of 114 patients were randomized to receive CBI (54 patients) or USGI (60 patients) procedure. No significant difference was observed in terms of gender, age and pain duration among CBI and USGI groups at baseline. USGI proved to be significantly less painful than CBI (P=0.0001). AUC analysis showed that during the follow up visits, the USGI procedure had significantly better response in HAQ, local-VAS and global-VAS (P=0.0001, P=0.012 and P=0.0001 respectively) compared to CBI. During the follow up period, a significant greater reduction in the PD scores was found in the USGI group compared to the CBI group (P=0.0002), whereas no statistical differences were found in the GS findings between the groups (P=0.5627).
  
  
  CONCLUSIONS
  Our study demonstrates superiority of USGI over CBI for CS injections in painful tenosynovitis, having better short-term outcomes measured by functional, clinical and US scores. These data support the use of USGI for tenosynovits in typical inpatient and/or outpatient in rheumatological practices.
authors.affiliation: Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy. Electronic address: dr.gmarwin@gmail.com.
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
authors.affiliation: Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Matteo
authors.affiliation: Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina.
authors.forename: Marcos
authors.initials: M
authors.lastname: Rosemffet
authors.affiliation: Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina.
authors.forename: Tomas
authors.initials: T
authors.lastname: Cazenave
authors.affiliation: Secion de Reumatologia, Hospital Municipal de Bahìa Blanca, Calle Estomba 968, 8000 Bahia Blanca, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rodriguez-Gil
authors.affiliation: Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico.
authors.forename: Cristina Hernandez
authors.initials: CH
authors.lastname: Diaz
authors.affiliation: Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico.
authors.forename: Lucio Ventura
authors.initials: LV
authors.lastname: Rios
authors.affiliation: Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina.
authors.forename: Natalia
authors.initials: N
authors.lastname: Zamora
authors.affiliation: Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina.
authors.forename: Maria del Carmen Gonzalez
authors.initials: Mdel C
authors.lastname: Guzman
authors.affiliation: Instituto de Rehabilitación Psicofísica, Calle Echeverria 955, (C1428DQG), Buenos Aires, Argentina.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Carrillo
authors.affiliation: Department of Orthopedic Surgery, Osaka City, University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, 545-8585 Osaka, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Okano
authors.affiliation: Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico.
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.affiliation: Instituto Nacional de Rehabilitación, Calzada Mexico-Xochimilco, 289, 143898 Mexico City, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Pineda
mesh_terms: D001168:Arthritis / Q000150:complications*; D001172:Arthritis, Rheumatoid / Q000150:complications; D002908:Chronic Disease; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects / Q000379:methods*; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D010146:Pain / Q000209:etiology; D025241:Spondylarthritis / Q000150:complications; D013717:Tenosynovitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D005938:Glucocorticoids; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone
keywords: Chronic arthritis; Costicosteroids; Local injections; Ultrasound