title: Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis - an observational study.
abstract: Intra-articular corticosteroid injections (IACI) are effective treatments for pain in knee osteoarthritis (KOA) but treatment response varies. There is uncertainty as to whether structural factors such as accurate placement of IACI affect outcome. We examined this question in a pragmatic observational study, using ultrasound (US) to verify accuracy of IACI.
  
  
  
  105 subjects with KOA (mean age 63.1 years, 59% female) routinely referred for IACI underwent assessment of demographic factors, x-ray and US of the knee before aspiration and IACI (based on clinical landmarks) with 40 mg triamcinolone acetonide with lignocaine plus a small amount of atmospheric air by an independent physician. US demonstration of intra-articular mobile air, i.e. a positive air arthrosonogram, was used to determine accurate placement of injection. Both patients and injecting physicians were blind to the US findings. Pain at baseline, three and nine weeks post injection was assessed using the 500 mm WOMAC pain subscale and response defined as ≥ 40% reduction in pain from baseline. Inter-observer reliability of air-arthrosonogram assessment was good: κ 0.79 (three raters).
  
  
  
  Sixty-three subjects (60.6%) were responders at three weeks and 43 (45.7%) at nine weeks. Seventy-four subjects (70.5%) had a positive arthrosonogram. A positive air arthrosonogram did not associate with a higher rate of response to treatment (p 0.389 at three weeks, p 0.365 at nine weeks). There was no difference in US effusion depth, power Doppler signal or radiographic grade between responders and non-responders to the injection, but female gender associated with response at 3 weeks and previous injection with non-response at 9 weeks.
  
  
  
  Accurate intra-articular injection of corticosteroid results did not result in superior outcome in terms of pain compared to inaccurate injection in symptomatic knee OA.
authors.affiliation: Department of Rheumatology, Dudley Group for Health (DGH) NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, DY1 2HQ, UK. g.hirsch@nhs.net.
authors.forename: G
authors.identifier: 0000-0001-5189-9501
authors.initials: G
authors.lastname: Hirsch
authors.affiliation: Faculty of Medical and Human Sciences, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: T W
authors.initials: TW
authors.lastname: O'Neill
authors.affiliation: Department of Rheumatology, Dudley Group for Health (DGH) NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, DY1 2HQ, UK.
authors.forename: G
authors.initials: G
authors.lastname: Kitas
authors.affiliation: Department of Radiology, DGH NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Department of Rheumatology, Dudley Group for Health (DGH) NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, DY1 2HQ, UK.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: R
authors.initials: R
authors.lastname: Klocke
mesh_terms: D000368:Aged; D059925:Anatomic Landmarks; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D007719:Knee Joint / Q000000981:diagnostic imaging; D008012:Lidocaine / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000627:therapeutic use; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D008012:Lidocaine; D014222:Triamcinolone Acetonide
keywords: Intra-articular steroid injection; Knee osteoarthritis; Predictors of response; Ultrasound