Image-guided steroid injections urged in hip OA.AMSTERDAM -- Radiologically guided corticosteroid corticosteroid /cor·ti·co·ster·oid/ (-ster´oid) any of the steroids elaborated by the adrenal cortex (excluding the sex hormones) or any synthetic equivalents; divided into two major groups, the glucocorticoids and injections brought marked symptomatic improvement to patients with advanced hip osteoarthritis osteoarthritis
or osteoarthrosis or degenerative joint disease
Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. in a double-blind, placebo-controlled randomized trial, Dr. Walter P. Maksymowych reported at the annual European Congress of Rheumatology rheumatology /rheu·ma·tol·o·gy/ (-tol´ah-je) the branch of medicine dealing with rheumatic disorders, their causes, pathology, diagnosis, treatment, etc.
Many physicians perform these injections without imaging-guided assistance--and as a result, they often miss the mark, according to Dr. Maksymowych, professor of medicine at the University of Alberta, Edmonton. That's the likely explanation for the negative results of some previous studies of intraarticular steroid injections for hip osteoarthritis, he added.
Dr. Maksymowych and his colleague Dr. Robert Lambert, professor of radiology also at Alberta, reported on 52 patients who were randomized to fluoroscopically guided injections of 40 mg of triamcinolone hexacetonide or 2 mL of normal saline normal saline Physiologic saline solution, see there . All patients had hip osteoarthritis (OA) with marked structural joint damage on X-ray. All were experiencing high levels of pain and other symptoms that were no longer adequately relieved by NSAIDs and pain medications. Many were on the waiting list for hip replacement surgery.
The primary study end point was change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOM-AC) pain scores 2 months post treatment. Scores in the active-treatment group were reduced from a mean of 310 mm at baseline to 157 mm. The placebo group's scores remained unchanged. Results of all secondary end points were also significantly better in patients who received steroid injections (see chart).
Misconceptions regarding intraarticular steroid injections for OA abound among physicians and patients. Many physicians, overconfident o·ver·con·fi·dent
Excessively confident; presumptuous.
over·con in their manual skills, dismiss the need for imaging guidance of the needle--a big mistake, Dr. Maksymowych noted.
And many patients worry that repeated steroid injections into the hip may be harmful. However, Dr. Maksymowych stressed that there is no evidence that the injections induce structural joint damage or are otherwise harmful to patients.
"On the other hand, there's no evidence at this point in time that repeated corticosteroid injections prevent progression of joint damage," the rheumatologist rheumatologist /rheu·ma·tol·o·gist/ (roo?mah-tol´ah-jist) a specialist in rheumatology.
A specialist in the diagnosis and treatment of rheumatic disorders. added at the congress sponsored by the European League Against Rheumatism rheumatism (r`mətĭzəm), general term for a number of disorders that cause inflammation and pain in muscles, bones, joints, or nerves. .
Both EULAR and the American College of Rheumatology endorse the use of corticosteroid injections as a key recommendation in the management of OA. But the guidelines also characterize the supporting evidence as weak, which was certainly the case up until this new randomized trial, he said. Some physicians have declined to offer steroid injections, despite the recommendations, because the practice was not backed by a solid evidence base. The procedure is likely to win converts because of these convincingly positive new data, Dr. Maksymowych predicted.
BY BRUCE JANCIN
Intraarticular Steroids Bring Big Improvement Steroid group Placebo group Patients with more than 50% improvement in WOMAC pain scores at 1 month 71% 14% at 2 months 61% 14% Mean WOMAC stiffness scores (mm) at baseline 137 124 at 2 months 76 135 Mean WOMAC stiffness scores (mm) at baseline 901 914 at 2 months 502 897 Note: Based on a study of 52 patients. Source: Dr. Maksymowych ELSEVIER GLOBAL MEDICAL NEWS