title: Efficacy and safety of point-of-care ultrasound-guided intra-articular corticosteroid joint injections in patients with haemophilic arthropathy.
abstract: OBJECTIVE
  Intra-articular corticosteroid injections are standard of care for managing joint pain secondary to osteoarthritis or rheumatoid arthritis but are rarely used in haemophilic arthropathy. We have introduced and evaluated the efficacy and safety of ultrasound-guided corticosteroid injections for pain relief in patients with haemophilic arthropathy.
  
  
  METHODS
  Ultrasound-guided intra-articular injections performed on haemophilia patients at UCSD between March 2012 and January 2016 were analysed. Needle placement and injection (40 mg triamcinolone; 3-5 mL lidocaine) were performed with musculoskeletal ultrasound and Power Doppler. Analysis included patient demographics, joint-specific parameters such as tissue hypervascularity and effusions, pain relief, and procedure-associated complications.
  
  
  RESULTS
  Forty-five injections (14 ankles, 13 elbows, 18 knees) were administered in 25 patients. Advanced arthropathy with hypervascularity and/or effusions was present in 91% and 61% of joints, respectively. Ninety-one per cent of injections resulted in pain relief which was significant in 84% (>30% reduction). Median pain score was reduced from 7 of 10 to 1 of 10 (P < 0.001), usually within 24 h. Median duration of pain relief was 8 weeks (range 1-16 weeks). Haemophilia B patients experienced longer periods of relief, and high Pettersson scores were associated with shorter duration of relief. There were no procedure-associated complications. Repeat ultrasound of eight joints within 4 weeks of injection demonstrated nearly complete resolution of hypervascularity.
  
  
  CONCLUSIONS
  Point-of-care ultrasound enabled intra-articular corticosteroid injections that provided highly effective, safe, and relatively long-lasting pain relief in haemophilic arthropathy. This approach should be used to improve pain management in haemophilic arthropathy.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Martin
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.|Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Cooke
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ceponis
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: R F W
authors.initials: RF
authors.lastname: Barnes
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Moran
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Holle
authors.affiliation: Department of Radiology, University of California San Diego, San Diego, CA, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Hughes
authors.affiliation: General Musculoskeletal Imaging Inc, Cincinnati, OH, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Moore
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.|Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: von Drygalski
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D005260:Female; D006467:Hemophilia A / Q000000981:diagnostic imaging*; D006801:Humans; D007270:Injections, Intra-Articular; D007592:Joint Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: arthropathy; corticosteroid injection; haemophilia; intra-articular; ultrasound