Plant M J, Borg A A, Dziedzic K, Saklatvala J, Dawes P T
Department of Rheumatology, Wrexham Maelor Hospital.
Ann Rheum Dis. 1997 Aug;56(8):476-80. doi: 10.1136/ard.56.8.476.
A prospective, open study of corticosteroid hip injection (CHI) was performed to determine if different radiological patterns of arthritis vary in their response.
Forty five patients (15 with rheumatoid arthritis, 27 with osteoarthritis, and three with anklyosing spondylitis) underwent hip injection with 80 mg methylprednisolone and lignocaine under x ray control. Outcome was assessed at two, 12, and 26 weeks for pain, range of hip movement, and graded functional questionnaire. Patients estimated their pain in four components, night pain, rest pain, weight bearing, and referred pain, each measured by 10 cm visual analogue score and summed to give a total score out of 40 cm. Hip radiographs were evaluated blindly for pattern and severity of arthritis, as well as for progression between 0 and 26 weeks.
Median total pain score decreased from 29 cm at baseline to 22 cm at two weeks (p = 0.0001), 24 cm at 12 weeks (p = 0.03), but had returned nearly to baseline by 26 weeks (25 cm, p = 0.3). Greatest improvement was seen for night pain. Mean range of internal rotation increased from 16 to 28 degrees at two weeks (p = 0.03) and 21 degrees at 12 weeks (p = 0.06). Functional ability did not change. Hips with an atrophic pattern of arthritis on plain radiography gained negligible pain relief at two weeks compared with hips with a hypertrophic or mixed bone response (p = 0.04). The degree of pain relief was similar in patients with OA and RA, and was not influenced by radiographic severity or by the direction of migration of the femoral head.
Pain and internal rotation improve for up to 12 weeks after CHI. CHI offers a useful and safe therapeutic option for patients with hip arthritis, with the exception of those with a purely atrophic radiological pattern.
开展一项关于皮质类固醇髋关节注射（CHI）的前瞻性开放性研究，以确定不同放射学模式的关节炎其反应是否存在差异。
45例患者（15例类风湿关节炎、27例骨关节炎、3例强直性脊柱炎）在X线控制下接受了80mg甲泼尼龙和利多卡因的髋关节注射。在第2、12和26周评估疼痛、髋关节活动范围和功能分级问卷的结果。患者对疼痛的四个方面进行评估，即夜间疼痛、静息痛、负重痛和牵涉痛，每个方面通过10cm视觉模拟评分进行测量，然后将各项得分相加得出总分，满分40cm。对髋关节X线片进行盲法评估，观察关节炎的模式和严重程度，以及0至26周期间的病情进展。
疼痛总分中位数从基线时的29cm降至第2周时的22cm（p = 0.0001），第12周时为24cm（p = 0.03），但到第26周时几乎恢复到基线水平（25cm，p = 0.3）。夜间疼痛改善最为明显。内旋平均范围在第2周时从16度增加到28度（p = 0.03），第12周时增加到21度（p = 0.06）。功能能力未发生变化。与具有肥大性或混合性骨反应的髋关节相比，平片显示为萎缩性关节炎模式的髋关节在第2周时疼痛缓解可忽略不计（p = 0.04）。骨关节炎和类风湿关节炎患者的疼痛缓解程度相似，且不受放射学严重程度或股骨头移位方向的影响。
CHI后疼痛和内旋在长达12周的时间内有所改善。CHI为髋关节关节炎患者提供了一种有用且安全的治疗选择，但纯萎缩性放射学模式的患者除外。
