Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill, CV4 7AL, UK.
University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
J Foot Ankle Res. 2023 Oct 17;16(1):71. doi: 10.1186/s13047-023-00672-6.
The first metatarsophalangeal joint is the most common site of osteoarthritis (OA) in the foot and ankle. Intra-articular corticosteroid injections are widely used for this condition, but little is known about their use in practice. This study explored current practice within the UK National Health Service (NHS) relating to the administration of intra-articular corticosteroids for people with painful first metatarsophalangeal joint (MTPJ) OA.
A cross-sectional survey using Qualtrics online survey platform (Qualtrics, Provo, UT, USA), distributed through professional bodies, special interest groups, and social media.
One hundred forty-four healthcare professionals responded, including podiatrists (53/144; 39%), orthopaedic surgeons (28/144; 19%), podiatric surgeons (26/144; 17%) and physiotherapists (24/144; 16%). Half of respondents administered up to 25 corticosteroid injections per year (67/136; 49%) but some administered more than fifty (21/136; 15%). Injections were administered across the healthcare system but were most common in hospital settings (64/136; 44%) followed by community (38/136; 26%), with less delivered in primary care (11/136; 8%). Half of respondents routinely used image-guidance, either ultrasound or x-ray/fluoroscopy (65/136; 48%) although over one third used none (52/136; 38%). Imaging guidance was more common amongst medical professionals (21/31; 68%) compared to non-medical health professionals (45/105; 43%). Overall, methylprednisolone acetate was the most common corticosteroid used. Medical professionals mostly injected methylprednisolone acetate (n = 15/27; 56%) or triamcinolone acetonide (n = 11/27; 41%), whereas premixed methylprednisolone acetate with lidocaine hydrochloride was the most common preparation used by non-medical health professionals (41/85; 48%). When injecting non premixed steroid, lidocaine hydrochloride (15/35; 43%) was the most common choice of local anaesthetic for non-medical health professionals but medical professionals showed more variation between lidocaine hydrochloride (8/23; 35%) levobupivacaine hydrochloride (9/23; 39%) and bupivacaine hydrochloride (5/23; 22%).
Multiple professional groups regularly administer intra-articular corticosteroids for symptomatic first MTPJ OA across a range of NHS healthcare settings. Overall, methylprednisolone acetate was the most commonly administered steroid and lidocaine hydrochloride the most common local anaesthetic. There was large variation in the use of imaging guidance, type and dose of steroid, local anaesthetic, and clinical pathways used in the intra-articular injection of corticosteroids for people with first MTPJ OA.
第一跖趾关节是足部和踝关节最常见的骨关节炎（OA）部位。关节内皮质类固醇注射广泛用于治疗这种疾病，但对其在实践中的应用知之甚少。本研究探讨了英国国民保健制度（NHS）中与治疗第一跖趾关节（MTPJ）OA 疼痛人群的关节内皮质类固醇注射相关的当前实践。
使用 Qualtrics 在线调查平台（Qualtrics，普罗沃，犹他州，美国）进行横断面调查，通过专业机构、特殊利益团体和社交媒体进行分发。
共有 144 名医疗保健专业人员做出了回应，其中包括足病医生（53/144；39%）、矫形外科医生（28/144；19%）、足病外科医生（26/144；17%）和物理治疗师（24/144；16%）。一半的受访者每年管理多达 25 次皮质类固醇注射（67/136；49%），但有些受访者注射超过 50 次（21/136；15%）。注射在整个医疗保健系统中进行，但最常见于医院环境（64/136；44%），其次是社区（38/136；26%），初级保健中注射较少（11/136；8%）。一半的受访者常规使用影像学引导，包括超声或 X 射线/荧光透视（65/136；48%），尽管超过三分之一的受访者未使用影像学引导（52/136；38%）。医学专业人员比非医学健康专业人员更常使用影像学引导（21/31；68%）。总体而言，醋酸甲泼尼龙是最常用的皮质类固醇。医学专业人员主要注射醋酸甲泼尼龙（n=15/27；56%）或曲安奈德（n=11/27；41%），而非医学健康专业人员最常使用混合的醋酸甲泼尼龙和盐酸利多卡因（41/85；48%）。当注射非混合类固醇时，盐酸利多卡因（15/35；43%）是非医学健康专业人员最常选择的局部麻醉剂，但医学专业人员在选择盐酸利多卡因（8/23；35%）、左布比卡因盐酸盐（9/23；39%）和布比卡因盐酸盐（5/23；22%）之间存在更大差异。
多个专业团体在 NHS 医疗保健机构中定期为第一跖趾关节 OA 症状患者管理关节内皮质类固醇注射。总体而言，醋酸甲泼尼龙是最常使用的类固醇，盐酸利多卡因是最常使用的局部麻醉剂。在第一跖趾关节 OA 人群的关节内皮质类固醇注射中，影像学引导、类固醇、局部麻醉剂的使用类型和剂量以及临床途径的使用存在很大差异。
