Effectiveness of imaging-guided intra-articular injection: a comparison study between fluoroscopy and ultrasound.

Objective: Compare the effectiveness of ultrasound and fluoroscopy to guide intra-articular injections (IAI) in selected cases. Material and methods: A prospective study in our outpatient clinics at the Rheumatology Division at Universidade Federal de Sao Paulo (UNIFESP), Brazil, was conducted to compare the short-term (4 weeks) effectiveness of ultrasound and fluoroscopy-guided IAI in patients with rheumatic diseases. Inclusion criteria were: adults with refractory synovitis undergoing IAI with glucocorticoid. All patients had IAI performed with triamcinolone hexacetonide (20mg/ml) with varying doses according to the joint injected. Results: A total of 71 rheumatic patients were evaluated (52 women, 44 whites). Mean age was 51.9 +/- 13 years and 47 of them (66.2%) were on regular DMARD use. Analysis of the whole sample (71 patients) and hip sub-analysis (23 patients) showed that significant improvement was observed for both groups in terms of pain (P < 0.001). Global analysis also demonstrated better outcomes for patients in the FCG in terms of joint flexion (P < 0.001) and percentage change in joint flexion as compared to the USG. Likert scale score analyses demonstrated better results for the patients in the USG as compared to the FCG at the end of the study (P < 0.05). No statistically significant difference between groups was observed for any other study variable. Discussion and conclusion: Imaging-guided IAI improves regional pain in patients with various types of synovitis in the short term. For the vast majority of variables, no significant difference in terms of effectiveness was observed between fluoroscopy and ultrasound-guided IAI. (C) 2013 Elsevier Editora Ltda. All rights reserved.