Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis
Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis
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DOI：
10.1136/ard.2009.127183
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发表时间：
2011-01-01
影响因子：
27.4
通讯作者：
Birrell, Fraser
中科院分区：
文献类型：
--
作者：
Atchia, Ismael;Kane, David;Birrell, Fraser
背景关节内注射对骨关节炎有效，但最佳的单次注射策略尚不清楚，也没有确定的反应预测因子。本研究的目的是评估和预测单次超声引导注射对中重度髋关节骨关节炎的反应。方法77例髋关节骨关节炎患者进入一项前瞻性、随机对照试验，随机分为四组：标准治疗组（不注射）；生理盐水;非动物稳定透明质酸（杜洛兰）或醋酸甲基强的松龙（depomedrone）。主要结果测量数值评定量表（NRS 0-10）“最严重疼痛”，西安大略省和麦克马斯特大学关节炎指数（WOMAC）疼痛/功能。使用单变量logistic回归分析和Fisher精确检验检查反应的潜在预测因素（包括x线片严重程度、超声滑膜炎和基线症状严重程度）。结果单纯类固醇治疗组NRS疼痛、WOMAC疼痛及功能均有明显改善。第1周的效应量是惊人的：NRS疼痛1.5，WOMAC疼痛1.9，WOMAC功能1.3。类风湿关节炎临床试验的结果测量-骨关节炎研究协会应答标准确定了22个应答者（意向治疗）：类固醇14个（74%；需要治疗的数量2个）；生理盐水4例（21%）；杜洛兰，两个（11%）；与未注射者相比，两组（10%;chi(2)组间检验，p < 0.001）。皮质类固醇臂反应维持超过8周（汇总测量方差分析，NRS疼痛p < 0.002）。滑膜炎是第4周和第8周疗效的重要预测因子（p < 0.05， Fisher精确检验；第4周OR为16.7,95% CI为1.4至204）。结论超声引导下皮质类固醇注射疗效显著；此外，超声显示滑膜炎是注射反应的生物标志物。
Background Intra-articular injection is effective for osteoarthritis, but the best single injection strategy is not known, nor are there established predictors of response. The objectives of this study were to assess and predict response to a single ultrasound-guided injection in moderate to severe hip osteoarthritis.Methods 77 hip osteoarthritis patients entered a prospective, randomised controlled trial, randomised to one of four groups: standard care (no injection); normal saline; non-animal stabilised hyaluronic acid (durolane) or methylprednisolone acetate (depomedrone).Main Outcome Measures Numerical rating scale (NRS 0-10) 'worst pain', Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain/function. Potential predictors of response (including radiographic severity, ultrasound synovitis and baseline symptom severity) were examined using univariate logistic regression analysis and Fisher's exact test.Results NRS pain, WOMAC pain and function improved significantly for the steroid arm alone. Effect sizes at week 1 were striking: NRS pain 1.5, WOMAC pain 1.9 and WOMAC function 1.3. Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society responder criteria identified 22 responders (intention-to-treat): steroid 14 (74%; number needed to treat, two); saline, four (21%); durolane, two (11%); and no injection, two (10%; chi(2) test between groups, p < 0.001). Corticosteroid arm response was maintained over 8 weeks (summary measures analysis of variance, p < 0.002 for NRS pain). Synovitis was a significant predictor of response at weeks 4 and 8 (p < 0.05, Fisher's exact test; week 4 OR 16.7, 95% CI 1.4 to 204).Conclusions Ultrasound-guided corticosteroid injections are highly efficacious; furthermore synovitis on ultrasound is a biomarker of response to injection.