Ultrasound-guided procedure for the treatment of trapeziometacarpal osteoarthritis

Initial treatment of trapeziometacarpal osteoarthritis (TMO) often consists of intra-articular injection of corticosteroids or hyaluronic acid. Several studies have shown that ultrasound (US)-guided injections demonstrate greater precision and effectiveness when compared to blind techniques. The aim of our study was to describe a simple and reliable procedure of US-guided intra-articular injection of hyaluronic acid solution in patients with TMO. Thirty-one patients with TMO received one administration per week, for 3 weeks, of US-guided intra-articular injection with 1 ml of hyaluronic acid solution. Patients were evaluated before treatment and at 1, 3, and 6 months after the first injection with visual analog scale (VAS) score and Duruoz Hand Index (DHI). One month after the end of treatment, subjective patient response to therapy was evaluated using a 6-point Likert scale. A statistically significant VAS score reduction was observed at 1 and 3 months after the end of treatment (P < 0.01) but not at 6-month follow-up (P = 0.6). No statistically significant difference was found on the DHI total score at 1- (P = 0.08), 3- (P = 0.1) and 6-month (P = 0.9) follow-ups. One month after the end of treatment, 29 (93.5%) patients reported a Likert scale score of "1" or "2." The described US-guided technique of trapeziometacarpal joint injection is easy to perform and revealed excellent accuracy. Nevertheless, intra-articular injections of hyaluronic acid provided significant pain relief only for a 6-month follow-up period and did not improve hand function. No pain relief was detected at 6-month follow-up, suggesting that periodic injections should be required to gain long-term effectiveness

Pharmacology of intra-articular triamcinolone

Introduction: The inflammatory joint diseases of juvenile inflammatory arthritis (JIA), rheumatoid arthritis (RA) and osteoarthritis (OA): and also mild to moderate joint injury, all require a multidisciplinary approach to management. Intra-articular injections of corticosteroids have been shown to be a very beneficial adjunctive treatment in the management of the above disorders. It is, therefore, important that clinicians have a good understanding of the clinical actions of intra-articular injections. Objective: This article explores the pharmacokinetics, pharmacodynamics, and clinical pharmacology of triamcinolone acetonide (TA) and triamcinolone hexacetonide (TH) in JIA, RA, and OA. Methods: Literature search of TA and TH articles was conducted using key word searches in the PubMed and Google Scholar databases and through references within found articles. Results: TA and TH intra-articular injections have been shown to provide good clinical benefit for up to 6 months and even longer. TH has been shown to decrease in the expression of citrullinated proteins, the monoclonal antibody F95, and peptidylarginine deiminase 4 in RA synovium. TA and TH intra-articular injections have a low side effect profile which is similar to other corticosteroid. They have minimal to no mineralocorticoid adverse effects and facial flushing 2–3 days post injections is the most common side effect recorded, and in almost all cases is no worse than nuisance. Conclusion: TA and TH are useful adjunct therapies in the management of JIA, RA, OA, and mild to moderate joint injury.</p