CS injection of tenosynovitis in patients with chronic inflammatory arthritis: the role of US

Rheumatology (Oxford). 2012 Jul;51(7):1299-303. doi: 10.1093/rheumatology/kes027. Epub 2012 Mar 5.

Abstract

Objective: The main aim of this study was to investigate the short-term efficacy of CS loco-regional treatment performed under US guidance in tenosynovitis of patients with chronic inflammatory arthritis.

Methods: Thirty consecutive patients affected by chronic arthritis and with clinical suspicion of tenosynovitis were recruited to undergo US assessment. In the sonographically proven cases, US-guided CS injection was performed. A visual analogue scale for pain (ranging from 0 to 10) and a tenderness score (ranging from 0 to 3) were used for the clinical evaluation. Sonographic pathological findings indicative of tenosynovitis were scored using a semi-quantitative 4-grade scoring system, for both grey-scale and power Doppler US, at baseline and during a follow-up visit at 2 weeks after the CS injection.

Results: In 21 (70%) of 30 patients, the clinical suspicion of tenosynovitis was confirmed (9 with RA, 11 with PsA and 1 with ReA). In the other nine patients, US revealed synovitis of the adjacent joints, bursitis, oedema of the s.c. tissue or a partial tear. In all cases the appropriate needle placement and subsequent CS injection into the tendon sheath were obtained with US confirmation. A significant reduction in all clinical and sonographic scorings was found during the follow-up visit.

Conclusions: The present study shows the efficacy of US-guided peritendinous CS injections in the management of patients with chronic inflammatory arthritis presenting as US-proven tenosynovitis.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis / complications
  • Arthritis / diagnostic imaging
  • Arthritis / drug therapy*
  • Chronic Disease
  • Female
  • Glucocorticoids / administration & dosage*
  • Humans
  • Injections
  • Injections, Intra-Articular
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Tenosynovitis / complications
  • Tenosynovitis / diagnostic imaging
  • Tenosynovitis / drug therapy*
  • Treatment Outcome
  • Ultrasonography, Doppler*
  • Young Adult

Substances

  • Glucocorticoids