Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
Reumatol Clin (Engl Ed). 2022 Nov;18(9):518-522. doi: 10.1016/j.reumae.2021.07.005. Epub 2021 Dec 24.
Trigger finger is a frequent complaint in which corticosteroid infiltrations play a relevant therapeutic role in intermediate degrees of severity when conservative treatment has not worked. However, there are no criteria to select which patients will benefit most from this procedure. The present study aimed to identify the factors leading to the therapeutic success of corticosteroid infiltration in these patients.
We designed a prospective longitudinal study based on routine clinical practice with adult patients with a clinical diagnosis of trigger finger grade II or III on the Quinnell scale, who underwent an infiltration of 20 mg of triamcinolone acetate. The outcome variables were to achieve a Quinnell grade I or reduce the severity of the symptoms by at least one category two months after the procedure. To identify the determinants of complete or partial therapeutic success, binary logistic regression predictive modelling was performed using those variables that had a satisfactory univariate correlation.
74 patients were included over three years, 42 of whom (61.8%) were classified as Quinnell grade III. After infiltration, 22 (32.4%) achieved complete resolution and 50 (73.5%) partial resolution. The variables tendon thickening (HR 10.72; 95%CI 2.88-39.93; P < .001) and progression time (HR 1.23; 95%CI 1.02-1.49; P = .027) proved to be predictors of therapeutic success in complete resolution. For the modelling for partial resolution, the same variables proved to be determining predictors (HR 5.57; 95%CI 1.38-22.41; P = .016 and HR 1.18; 95%CI .99-1.41; P = .051, respectively). Pulley thickening did not demonstrate predictive ability in either model.
Our results indicate that the demonstration of finger flexor apparatus thickening is the main determining factor for the success of corticosteroid infiltrations in this pathology. This is in agreement with the histological findings of specimens obtained from both tenosynovial and pulley tissue. In the former, in addition to an infiltrate of inflammatory characteristics, the presence of chondrocytoid cells producing hyaluronic acid is demonstrated. Although the therapeutic success of infiltrations in previous studies reaches 70%, the recurrence rate is similar after 12 months. The selection of patients with tendon thickening ensures therapeutic success in the short term, could reduce recurrence in the long term, and avoid delay in release surgery.
扳机指是一种常见的疾病，当保守治疗无效时，皮质类固醇浸润在中度严重程度的患者中具有重要的治疗作用。然而，目前尚无标准来选择哪些患者将从该治疗中获益最多。本研究旨在确定导致皮质类固醇浸润治疗成功的因素。
我们基于常规临床实践设计了一项前瞻性纵向研究，纳入了临床诊断为 Quinnell 分级 II 或 III 级的扳机指成年患者，这些患者接受了 20mg 曲安奈德的浸润治疗。主要疗效指标是在治疗后 2 个月达到 Quinnell 分级 I 或症状严重程度至少降低一个等级。为了确定完全或部分治疗成功的决定因素，我们使用那些具有满意单变量相关性的变量进行了二元逻辑回归预测建模。
在三年期间共纳入 74 例患者，其中 42 例（61.8%）被分类为 Quinnell 分级 III 级。浸润治疗后，22 例（32.4%）完全缓解，50 例（73.5%）部分缓解。肌腱增厚（HR 10.72；95%CI 2.88-39.93；P<0.001）和进展时间（HR 1.23；95%CI 1.02-1.49；P=0.027）是完全缓解的预测因素。对于部分缓解的建模，同样的变量被证明是决定因素（HR 5.57；95%CI 1.38-22.41；P=0.016 和 HR 1.18；95%CI.99-1.41；P=0.051）。滑液增厚在两个模型中都没有表现出预测能力。
我们的结果表明，手指屈肌装置增厚的表现是皮质类固醇浸润在该病理中的主要决定因素。这与从腱鞘和滑液鞘组织获得的标本的组织学发现一致。在前一种情况下，除了炎症特征的浸润外，还存在产生透明质酸的软骨样细胞。尽管以前的研究中皮质类固醇浸润的治疗成功率达到 70%，但 12 个月后复发率相似。选择肌腱增厚的患者可以确保短期的治疗成功，可能减少长期的复发，并避免延迟释放手术。
