Accuracy of intra-articular injections in peripheral joints performed blindly in patients with rheumatoid arthritis

R V Lopes, R N V Furtado, L Parmigiani, A Rosenfeld, A R C Fernandes, J Natour
Rheumatology 2008, 47 (12): 1792-4

OBJECTIVES: To assess the accuracy of blind IA injections (IAIs) in patients with RA and determine their effectiveness.

METHODS: A controlled prospective study including 96 RA patients undergoing blind IAIs in peripheral joints was carried out. Clinical evaluation was performed at baseline (T(0)), 1 (T(1)) and 4 (T(4)) weeks after IAI using the following instruments: visual analogue scale (VAS) for pain at rest and movement, VAS for oedema (range 0-10 cm) and morning stiffness. Following IAI, radiographic exam was performed in all joints for further analysis by two 'blinded' radiologists. The kappa-statistic, chi-square and analysis of variance tests were performed to determine potential differences between time-points of evaluation. Significance level was set as P < 0.05.

RESULTS: A total of 232 injections were performed. Accuracy observed for the shoulder, elbow, wrist, MCP joints, knee and ankle were 82, 100, 97, 97, 100 and 77%, respectively. A statistically significant improvement was observed for all variables at both T(1) and T(4) when compared with T(0).

CONCLUSIONS: Blind IAI proved safe and accurate when performed by a trained professional. Significant improvement was seen in the VAS for pain at rest and during movement, VAS for oedema and morning stiffness.


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