Interphalangeal Intra-articular Injections Reduce Pain, Swelling in Hand Osteoarthritis

SAN DIEGO, CA—Lidocaine and triamcinolone hexacetonide injected intra-articularly in interphalangeal joints reduced swelling and pain during movement in the hands of patients with osteoarthritis, results of a randomized, double-blind trial presented at the 2013 ACR/ARHP Annual Meeting concluded.

Despite hand osteoarthritis being a prevalent joint condition, studies on the effectiveness of corticosteroid injections in interphalangeal joints are lacking, noted Nátalia de Oliva Spolidoro, MD, of the Universidade Federal de São Paulo, São Paulo, Brazil, and colleagues.

They randomized 60 patients—58 female—with osteoarthritis of the hand (proximal or distal interphalangeal joints) to two groups. Group 1 (n=30) received intra-articular injection in the most symptomatic interphalangeal joint with 2% lidocaine 0.1mL and triamcinolone hexacetonide 4mg (0.2mL) in the distal and 6mg (0.3mL) in the proximal interphalangeal joints. Those in Group 2 (n=30) received intra-articular injection with 2% lidocaine 0.1mL of only.

Patients were evaluated by blinded raters at baseline (T0) and 1, 4, 8, and 12 weeks (T1, T4, T8, and T12) following the procedure. Outcome measures were Visual Analog Scale (VAS) for pain in the interphalangeal joint at rest and during movement; VAS for swelling, goniometry, grip strength, pinch strength, and hand function (COCHIN questionnaire and AUSCAN index).

The investigators used ultrasound to evaluate synovial hypertrophy (in mm) in the palmar and dorsal joint recesses of the injected interphalangeal joint.

Mean patient age was 60.7 years and mean disease duration, 5.0 years.

“Twenty-nine proximal (48.3%) and 31 distal (51.7%) interphalangeal joints received intra-articular injection, with no significant differences between groups,” they found.

“Significant intra-group improvements (P<0.05) were found in both groups, with the exception of grip and pinch strength.” One week following intra-articular injection, both groups reported reductions in VAS for pain at rest (P=0.513) and during movement (P=0.014). In Group 1, a reduction in VAS swelling occurred from T4 to T12 (P=0.022); however, in Group 2, a similar reduction occurred only at T8 (P=0.008). Both groups exhibited goniometric improvements only at T8 (P=0.02).

“Pulp-to-pulp and tripod pinch strength exhibited improvements beginning at T4 (P=0.001) and T8 (P=0.000), respectively,” they found. “Hand function exhibited significant improvement beginning at T4 (P=0.047 and P=0.000, respectively), which was maintained through to the end of the study only with regard to the AUSCAN index (P=0.501).”

Ultrasound showed reductions in dorsal and palmar synovial hypertrophy occurred in both groups at T4 (P=0.024) and T8 (P=0.005), respectively.