South Egypt Cancer Institute, Assuit University, Egypt.
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assuit University, Assiut, Egypt.
Pain Physician. 2019 Jul;22(4):E295-E302.
The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression.
We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability.
A prospective randomized, controlled clinical trial.
An interventional pain unit in a tertiary center at a university hospital in Egypt.
Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed >/= 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated.
There was significant reduction in the percentage of patients who showed ≥50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041).
The study follow-up period was limited to only 3 months.
For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage.
Rheumatoid arthritis, atlantoaxial joint injection.
寰枢关节（AAJ）在颈椎运动中起着关键作用。不幸的是，它是类风湿关节炎患者最常受影响的颈椎关节。AAJ 的炎症会导致颈部残疾、神经根受压，最终导致脊髓受压。
我们旨在评估 AAJ 关节内曲安奈德注射对颈部疼痛和残疾的疗效。
一项前瞻性随机对照临床试验。
埃及一所大学医院的介入疼痛单位。
60 名患有类风湿关节炎并抱怨 AAJ 关节炎的患者被随机分为 2 组。AAJI 组（n = 30）接受 AAJ 注射，每侧关节注射 1.0 毫升混合液，其中含有 0.5 毫升 0.5%布比卡因和 0.5 毫升 20 毫克曲安奈德，此外还口服安慰剂片剂（每 8 小时 2 片，持续一周）。SS 组（n = 30）接受全身皮质类固醇治疗，口服泼尼松龙片剂（5 毫克，每 8 小时 2 片，持续一周），此外还接受 AAJ 注射，每侧关节注射 1.0 毫升混合液，其中含有 0.5 毫升 0.5%布比卡因和 0.5 毫升生理盐水。评估术后 1、2 和 3 个月（术后）>/= 50%的患者视觉模拟量表（VAS）疼痛评分、VAS 疼痛评分和颈部残疾指数（NDI）（术后 2、4、6、8 和 12 周）、以及 AAJ 的磁共振成像（MRI）变化（术后 4 周评估）。
与 SS 组相比，AAJI 组术后 1 个月（75% vs. 46.45%；P = 0.033）、2 个月（60.7% vs. 25%；P = 0.009）和 3 个月（53.6% vs. 17.9%；P = 0.007）>/= 50%的患者 VAS 疼痛评分降低的比例显著增加。与 SS 组相比，AAJI 组的总体 VAS 和总体 NDI 均显著降低（平均值±标准误差）（41.5 ± 2.6 vs. 52.1 ± 2.6；P = 0.005）和（43.7 ± 3.1 vs. 52.4 ± 3.1；P = 0.040）。术后 MRI 检查结果分析显示，AAJI 组骨髓水肿明显改善（AAJI 组 vs. SS 组）（71.4% vs. 42.9%；P = 0.033），同时 AAJI 组滑膜增强也明显消失与 SS 组相比，（16/22 [72.7%] vs. 10/23 [43.5%]；P = 0.026），此外，AAJI 组的滑膜增生明显减少与 SS 组相比，（6/10 [60%] vs. 1/9 [11%]；P = 0.041）。
研究随访时间仅为 3 个月。
对于类风湿关节炎引起的急性炎症性 AAJ，AAJ 类固醇注射是一种潜在的治疗选择；它可以减轻颈部疼痛，改善颈部活动度，并加速关节从急性炎症阶段的恢复。
类风湿关节炎，寰枢关节注射。
