A Randomized Controlled Trial of the Cost-Effectiveness of Ultrasound-Guided Intraarticular Injection of Inflammatory Arthritis

• Published in: Journal of rheumatology 2011-02, Vol.38 (2), p.252-263
• Main Authors: SIBBITT, Wilmer L, BAND, Philip A, CHAVEZ-CHIANG, Natalia R, DELEA, Suzanne L, NORTON, Hillary E, BANKHURST, Arthur D
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Arthritis - diagnostic imaging; Arthritis - drug therapy; Arthritis - economics; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Cost-Benefit Analysis - economics; Diseases of the osteoarticular system; Female; Humans; Inflammation - diagnostic imaging; Inflammation - drug therapy; Inflammation - economics; Inflammatory joint diseases; Injections, Intra-Articular - economics; Injections, Intra-Articular - methods; Joints - diagnostic imaging; Logistic Models; Male; Medical sciences; Pain Measurement; Pharmacology. Drug treatments; Treatment Outcome; Ultrasonography
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.100866

We studied whether sonographic needle guidance affected the outcomes of intraarticular (IA) injection for inflammatory arthritis. Joints with inflammatory arthritis (n = 244; 76% rheumatoid arthritis, 3% small joints, 51% intermediate, and 46% large) were randomized to injection by conventional palpation-guided anatomic injection (120 joints) or sonographic image-guided injection enhanced with a 1-handed reciprocating procedure device mechanical syringe (124 joints). A 1-needle, 2-syringe technique was used. After IA placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and triamcinolone acetonide was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost, and cost per responder were determined. Relative to conventional palpation-guided methods, sonographic guidance for injection of inflammatory arthritis resulted in an 81% reduction in injection pain (p < 0.001), 35% reduction in pain scores at outcome (p < 0.02), 38% increase in the responder rate (p < 0.003), 34% reduction in the non-responder rate (p < 0.003), 32% increase in therapeutic duration (p = 0.01), 8% reduction ($7) in cost/patient/year, and a 33% ($64) reduction in cost/responder/year for a hospital outpatient (p < 0.001). Sonographic needle guidance improves the performance, clinical outcomes, and cost-effectiveness of IA injections for inflammatory arthritis. (Clinical Trial Identifier NCT00651625).