Efficacy and safety of point‐of‐care ultrasound‐guided intra‐articular corticosteroid joint injections in patients with haemophilic arthropathy

Introduction and Objectives Intra‐articular corticosteroid injections are standard of care for managing joint pain secondary to osteoarthritis or rheumatoid arthritis but are rarely used in haemophilic arthropathy. We have introduced and evaluated the efficacy and safety of ultrasound‐guided cortico...

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Bibliographic Details
Published in:Haemophilia : the official journal of the World Federation of Hemophilia 2017-01, Vol.23 (1), p.135-143
Main Authors: Martin, E. J., Cooke, E. J., Ceponis, A., Barnes, R. F. W., Moran, C. M., Holle, S., Hughes, T. H., Moore, R. E., Drygalski, A.
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - administration & dosage
Adrenal Cortex Hormones - therapeutic use
Adult
Analgesia
Arthritis
arthropathy
corticosteroid injection
Corticosteroids
Demography
Doppler effect
Factor IX deficiency
Female
haemophilia
Hemophilia
Hemophilia A - diagnostic imaging
Humans
Injection
Injections, Intra-Articular
intra‐articular
Joint diseases
Joint Diseases - drug therapy
Knee
Lidocaine
Male
Middle Aged
Osteoarthritis
Pain
Point-of-Care Systems
Rheumatoid arthritis
Treatment Outcome
Ultrasonic imaging
Ultrasonography - methods
Ultrasound
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Summary:Introduction and Objectives Intra‐articular corticosteroid injections are standard of care for managing joint pain secondary to osteoarthritis or rheumatoid arthritis but are rarely used in haemophilic arthropathy. We have introduced and evaluated the efficacy and safety of ultrasound‐guided corticosteroid injections for pain relief in patients with haemophilic arthropathy. Patients and methods Ultrasound‐guided intra‐articular injections performed on haemophilia patients at UCSD between March 2012 and January 2016 were analysed. Needle placement and injection (40 mg triamcinolone; 3–5 mL lidocaine) were performed with musculoskeletal ultrasound and Power Doppler. Analysis included patient demographics, joint‐specific parameters such as tissue hypervascularity and effusions, pain relief, and procedure‐associated complications. Results Forty‐five injections (14 ankles, 13 elbows, 18 knees) were administered in 25 patients. Advanced arthropathy with hypervascularity and/or effusions was present in 91% and 61% of joints, respectively. Ninety‐one per cent of injections resulted in pain relief which was significant in 84% (>30% reduction). Median pain score was reduced from 7 of 10 to 1 of 10 (P < 0.001), usually within 24 h. Median duration of pain relief was 8 weeks (range 1–16 weeks). Haemophilia B patients experienced longer periods of relief, and high Pettersson scores were associated with shorter duration of relief. There were no procedure‐associated complications. Repeat ultrasound of eight joints within 4 weeks of injection demonstrated nearly complete resolution of hypervascularity. Conclusions Point‐of‐care ultrasound enabled intra‐articular corticosteroid injections that provided highly effective, safe, and relatively long‐lasting pain relief in haemophilic arthropathy. This approach should be used to improve pain management in haemophilic arthropathy.
ISSN:1351-8216
1365-2516
DOI:10.1111/hae.13057