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Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis.

Abstract：

OBJECTIVE:To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS:An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg/ml), 0.5 ml Lidocaine (5mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal distribution (radio-carpal, inter-carpal, and carpo-metacarpal) as well as radio-ulnar distribution was recorded. Full distribution in one compartment was given the value 1, partial distribution 0.5 and no distribution 0. A sum of the total distribution for all four compartments was calculated and correlated to the clinical parameters and the MRI OMERACT scores. RESULTS:No uniform pattern was seen in the distribution of the contrast. Only two patients had full contrast distribution to all four compartments, and the mean distribution count for all patients was 2.4 (range 0.5-4). The distribution count correlated with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION:The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased with the MRI synovitis score, while no association was found with the erosion- and bonemarrow oedema score. These results indicate that a single injection into a standard injection site in the proximal part of the wrist cannot be assumed to distribute--and treat--the whole joint.

journal_name

Eur J Radiol

journal_title

European journal of radiology

authors

Boesen M,Jensen KE,Torp-Pedersen S,Cimmino MA,Danneskiold-Samsøe B,Bliddal H

doi

10.1016/j.ejrad.2007.08.037

subject

Has Abstract

pub_date

2009-02-01 00:00:00

pages

331-8

issue

eissn

0720-048X

issn

1872-7727

pii

S0720-048X(07)00441-X

journal_volume

pub_type

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Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis.