Tenosynovitis Responds Best to Ultrasound-Guided Steroids

Rheumatoid arthritis patients with tenosynovitis responded significantly better to ultrasound-guided peritendineus glucocorticoid injection as compared to intramuscular glucocorticoid injection, researchers reported on June 9 at the annual meeting of the European League Against Rheumatism Annual Congress (EULAR 2016) in London.

While physicians commonly use intra-articular glucocorticoid (betamethasone) during flares in rheumatoid arthritis, evidence on the best approach to treat tenosynovitis (TS) is lacking. So, researchers, led by Mads Ammitzboll ­Danielsen, M.D., Ph.D., of the University of Copenhagen in Denmark, set out to compare the effect of intramuscular (im) and ultrasound-guided peritendinous betamethasone (BM) injection after four and 12 weeks.

Fifty rheumatoid arthritis patients with tenosynovitis were randomized into two double-blinded groups. Group A (i.m. BM) received an intramuscular injection of 14 mg (2 ml) of betamethasone and ultrasound-guided saline injection in up to two tendon sheaths and group B, (the ultrasound-guided peritendinous group) received 2 ml of saline intramuscular and ultra-sound guided betamethasone injection in up to two tendon sheaths. [[{"type":"media","view_mode":"media_crop","fid":"49332","attributes":{"alt":"©PatriciaHofmeester/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_5259475980004","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5943","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©PatriciaHofmeester/Shutterstock.com","typeof":"foaf:Image"}}]]

The researchers assessed tenosynovitis at baseline, and at four and 12 weeks. They found no significant baseline difference between the groups, except that two tendon sheaths were injected more often in group A as compared to group B. The chance of achieving the primary outcome at week four was 0.25 in group A and 0.64 in group B. At week 12, the chance for group A was .08 and 0.40 in group B.

“Rheumatoid arthritis patients with tenosynovitis responded significantly better to ultrasound-guided peritendineus glucocorticoid injection compared to i.m. glucocorticoid injection, both at four and 12 weeks when assessed by ultrasound and patient-reported outcomes,” the researchers wrote in their abstract presentation.

References:

Ammitzboll ¬Danielsen M, Ostergaard M. “A Randomized, Double-blind, Controlled Study of Intramuscular Versus Ultrasound Guided Peritendinous Betamethasone Injection for Tenosynovitis in Rheumatoid Arthritis Patients.” June 9, EULAR 2016. Doi: 10.1136/annrheumdis-2016¬eular.1707.