Background/Purpose:

Despite being a very prevalent joint condition, there is a lack of studies on the effectiveness of the intra-articular injection (IAI) of corticosteroids in interphalangeal joints (IPs) with osteoarthritis (OA).

Methods: A randomized, controlled, double-blind trial was carried out involving 60 OA hands patients (proximal or distal IPs), allocated in two groups. The TH/LD group (n=30) received IAI in the most symptomatic IP with 0.1ml of 2% lidocaine and triamcinolone hexacetonide(TH) at a dose of 4mg(0.2ml) and 6mg(0.3ml) in the distal and proximal IPs, respectively. The LD group (n=30) received IAI with only 0.1ml of 2% lidocaine.The patients were evaluated by blinded raters at baseline (T0) and one, four, eight and twelve weeks (T1, T4, T8 and T12) after the procedure. Outcome measures:Visual Analogic Scale(VAS: 0 to 10cm) for pain in the IP at rest (VASr) and during movement (VASm), VAS for swelling (VASs), goniometry(⁰), grip strength(kgf), pinch strength(kgf) and hand function (COCHIN questionnaire and AUSCAN index). Ultrasound evaluation: Quantitative measure (in mm) of synovial hypertrophy in palmar and dorsal joint recesses of IP injected. The level of significance in the statistical analysis was set to 5% (p<0.05).

Results:

Females accounted for 96.67%of the sample (58 patients). Mean age was 60.7 ± 8.2 years. Mean disease duration was 5.0 ± 3.6 years.Twenty-nine proximal (48.3%) and 31 distal (51.7%) IPs received IAI, with no significant differences between groups. Significant intra-group improvements (p<0.05) were found in both groups, with the exception of grip and pinch strength. Reductions in the VAS for pain at rest and during movement were found in both groups one week after IAI (p=0.000). A reduction in the VASs occurred from T4 to T12 in the TH/LD group (p=0.000), whereas a reduction in VASs only occurred at T8 in the LD group(p=0.008).Both groups exhibited goniometric improvements only at T8(p=0.02). Pulp-to-pulp and tripod pinch strength exhibited improvements beginning at T4(p=0.001) and T8(p=0.000), respectively. Hand function (COCHIN and AUSCAN) exhibited significant improvement beginning at T4(p=0.047 and p=0.000, respectively), which was maintained through to the end of the study only with regard to the AUSCAN index (p=0.001).In the ultrasound evaluation, reductions in the quantitative measure of dorsal and palmar synovial hypertrophy occurred in both groups at T4(p=0.024)and T8(p=0.005), respectively. In the intergroup evaluation VASm (p=0,014) and VASs (p=0,022) showed better response in group TH/LD. There were no statistically significant differences intergroup for other variables. No substantial adverse effects were observed.

Conclusion: Proximal and distal IPs IAI with TH was effective in reducing swelling and joint movement pain in OA hands patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/interphalangeal-intra-articular-injection-with-triamcinolone-hexacetonide-assessment-of-effectiveness-in-hand-osteoarthritis/