Article Text

PDF

Intra-articular corticosteroid injections in acute rheumatoid monoarthritides
  1. Jane Sholsberg, Medical Student,
  2. Rupert Jackson, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether intra-articular corticosteroid injections were effective at reducing pain in patients with acute rheumatoid monoarthritis. Altogether 215 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

    Statistics from Altmetric.com

    Report by Jane Sholsberg, Medical StudentChecked by Rupert Jackson, Consultant

    Clinical scenario

    A 42 year old woman known to suffer from rheumatoid arthritis presents to the emergency department with an acutely inflammed swollen knee. The patient is given an intra-articular corticosteroid injection. You know this is a standard treatment but wonder how effective it actually is.

    Three part question

    In [patients with acute rheumatoid monoarthritis] are [intra-articular corticosteroid injections] effective in [reducing pain and swelling and improving mobility]?

    Search strategy

    Medline 1966-11/03 using the Ovid interface, including Medline in progress and non-indexed citations. (exp arthritis, rheumatoid/OR monoarthritis.mp. OR exp arthritis OR exp rheumatic diseases/OR monoarthropathy.mp.) AND (exp steroids/or steroid$’.mp. OR exp methylprednisolone/OR methylprednisolone.mp OR exp hydrocortisone/OR hydrocortisone.mp OR exp prednisolone/OR prednisolone.mp) AND (exp injections, intra-articular/) LIMIT to human AND English AND abstracts.

    Search outcome

    Altogether 215 papers found of which 214 were irrelevant or of insufficient quality. The remaining paper is shown in table 5.

    Table 5

    Comment(s)

    Acute rheumatoid monoarthritides are commonly treated with intra-articular corticosteroid injections. Although this paper indicates a favourable outcome using intra-articular rimexolone injections particularly at 40 mg, the small number used in each group may have introduced bias and the high drop out rate in the placebo group in the later stages of the study prevents efficacious comparisons to be made.

    CLINICAL BOTTOM LINE

    The available evidence suggests that a single intra-articular injection of 40 mg rimexolone significantly reduces pain, tenderness and stiffness, and increases mobility in patients with acute rheumatoid arthritis.

    Report by Jane Sholsberg, Medical StudentChecked by Rupert Jackson, Consultant

    References

    View Abstract

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.