Gutierrez Marwin, Di Matteo Andrea, Rosemffet Marcos, Cazenave Tomas, Rodriguez-Gil Gustavo, Diaz Cristina Hernandez, Rios Lucio Ventura, Zamora Natalia, Guzman Maria del Carmen Gonzalez, Carrillo Ignacio, Okano Tadashi, Salaffi Fausto, Pineda Carlos
Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy.
Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli, 52, 60035 Jesi, Ancona, Italy.
Joint Bone Spine. 2016 Mar;83(2):161-6. doi: 10.1016/j.jbspin.2015.04.017. Epub 2015 Nov 29.
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.
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.
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).
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.
比较传统盲注（CBI）与超声引导注射（USGI）皮质类固醇（CS）治疗慢性关节炎患者腱鞘炎的短期疗效，并研究USGI是否为疼痛较轻的操作以及注射后随访期间超声检查结果的变化是否存在差异。
纳入需要CS注射治疗腱鞘炎的患者。经过临床和超声评估后，将患者随机分为接受CBI或USGI治疗。术后1周和4周，通过健康评估问卷（HAQ）和疼痛视觉模拟量表（VAS）的改善情况评估治疗效果，包括操作VAS、总体VAS和局部VAS。功率多普勒（PD）和灰阶（GS）超声检查结果也是随访的对象。按照当地指南，在无菌技术下使用20mg醋酸甲泼尼龙进行CBI或USGI操作。
共有114例患者被随机分配接受CBI（54例患者）或USGI（60例患者）治疗。基线时，CBI组和USGI组在性别、年龄和疼痛持续时间方面未观察到显著差异。事实证明，USGI的疼痛程度明显低于CBI（P = 0.0001）。AUC分析显示，在随访期间与CBI相比，USGI治疗在HAQ、局部VAS和总体VAS方面有显著更好的反应（分别为P = 0.0001、P = 0.012和P = 0.0001）。在随访期间，与CBI组相比，USGI组的PD评分显著降低（P = 0.0002），而两组之间的GS检查结果未发现统计学差异（P = 0.5627）。
我们的研究表明，在疼痛性腱鞘炎的CS注射中，USGI优于CBI，在功能、临床和超声评分方面具有更好的短期结果。这些数据支持在风湿病实践中的典型住院和/或门诊患者中使用USGI治疗腱鞘炎。
