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Can simple ultrasonography predict the clinical effect of intra-articular injection therapy of the knee joint?

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Abstract

To investigate whether ultrasonographic joint assessment can predict the clinical response to intra-articular injection therapy of the knee. Patients with persistent gonarthritis intra-articularly received in a randomized double-blinded crossover fashion radiation synovectomy or a glucocorticoid injection, both followed by clinical bed rest. Prior to treatment and 3 months afterwards, grey-scale ultrasonography (US) of the knee was performed, measuring synovial thickness and extent of effusion. The final clinical effect of these two treatments was assessed at 3 months and finally at 6 months using a composite index. Ninety-seven patients, mainly suffering from undifferentiated arthritis (40%) or rheumatoid arthritis (31%), received 165 injections (including crossovers). Clinical effect at 6 months was not related to the baseline ultrasonographic extent of effusion or synovial thickness, nor with ultrasonographic decrease of effusion after the first 3 months. Nevertheless, it was associated with ultrasonographic decrease of synovial thickness within the first 3 months. Simple baseline US measurements fail to predict the final clinical effect of intra-articular treatment of the knee at 6 months, in contrast to early US changes of synovial thickness 3 months after therapy.

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Abbreviations

CCI:

composite change index

D:

diameter

DMARD:

disease-modifying anti-rheumatic drug

GC:

glucocorticoid

MBq:

megabecquerel

mCi:

millicurie

MCSA:

mean cross-sectional area

MTX:

Methotrexate

NSAID:

non-steroidal anti-inflammatory drug

RA:

rheumatoid arthritis

RSO:

radiation synovectomy

SF:

synovial fluid

SPP:

suprapatellar pouch

SPSS:

Statistical Package for Social Sciences

TH:

triamcinolone hexacetonide

UA:

undifferentiated arthritis

US:

ultrasonography

VAS:

visual analogue scale

90Y:

90Yttrium

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Acknowledgments

The authors wish to thank the Department of Clinical Neurophysiology of the University Medical Center Utrecht (Prof. AC van Huffelen) and of the St. Antonius Hospital at Nieuwegein (Dr. RGA Akkerstaf) for making their ultrasonography machines available for this study. We also thank the following rheumatologists for referring patients for inclusion in this study: AAM Blaauw, A Hartkamp, C van Booma-Frankfort, JC Ehrlich, AA van Everdingen, HCM Haanen, DM Hofman, PM Houtman, TL Jansen, KJ Korff, AA Kruize, HK Ronday, Y Schenk, E-J Ter Borg, MJ van der Veen and CM Verhoef. Furthermore, this study is financially supported through the grant from The Netherlands Organization for Scientific Research (NWO) 920-03-053.

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Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands

    Zalima N. Jahangier, Johannes W. G. Jacobs & Johannes W. J. Bijlsma

  2. Department of Rheumatology, Medical Center Alkmaar, Alkmaar, The Netherlands

    Wijnand A. A. Swen & Jan D. Moolenburgh

  3. Department of Rheumatology, Westfries Gasthuis, Hoorn, The Netherlands

    Wijnand A. A. Swen

  4. Department of Rheumatology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands

    George A. W. Bruyn & Eduard N. Griep

  5. Department of Rheumatology and Clinical Immunology (F02.127), University Medical Center Utrecht, P.O. Box 85500, 3508, Utrecht, The Netherlands

    Johannes W. G. Jacobs

Authors
  1. Zalima N. Jahangier
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  2. Johannes W. G. Jacobs
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  3. Wijnand A. A. Swen
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  4. Jan D. Moolenburgh
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  5. George A. W. Bruyn
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  6. Eduard N. Griep
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  7. Johannes W. J. Bijlsma
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Corresponding author

Correspondence to Johannes W. G. Jacobs.

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Jahangier, Z.N., Jacobs, J.W.G., Swen, W.A.A. et al. Can simple ultrasonography predict the clinical effect of intra-articular injection therapy of the knee joint?. Clin Rheumatol 30, 749–755 (2011). https://doi.org/10.1007/s10067-010-1614-0

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  • DOI: https://doi.org/10.1007/s10067-010-1614-0

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