Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study

Akihiro Fukui; Takashi Yoshii; Hideki Yamada

doi:doi:10.11648/j.js.20190706.14

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Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study

Akihiro Fukui, Takashi Yoshii, Hideki Yamada

Received: 5 October 2019 Accepted: 5 November 2019 Published: 8 November 2019

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Abstract

Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 females and 21 men) rheumatoid arthritis patients with wrist, elbow and shoulder pain by analyzing the number of injections, decrease in pain measured on a visual analog scale (VAS), changes in carpal height ratio (CHR), radio carpal distance ratio (RCDR) and radial rotation angle (RRA) on X-ray imaging, and adverse effects in the subcutaneous tissue and extensor tendons. Results: Over the 8-year study period (average 6 yrs.), the mean numbers of intra-articular triamcinolone acetonide injections per patient were 3.7 for 180 wrists in 118 patients, 2.2 for 45elbows in 36 patients, 2.8 for 60 shoulders in 44 patients. Mean improvements in VAS pain scores from baseline were as follows: wrist, from 75 to 11 mm; elbow, from 79 to 17mm; shoulder, from 54 to 11mm. The group that received the injections showed no significant changes in CHR or RCDR, whereas RRA changed significantly decrease (P < 0.05). In the group that did not receive intra-articular injections, no significant changes were observed in CHR, RCDR and RRA over a mean follow-up period of 8 years. No abnormalities were observed in subcutaneous tissue. Conclusions: Overall, >90% of the patients of all disease grades responded to an average of 1–4 intra-articular triamcinolone acetonide injections, which were effective for pain relief in the wrist, elbow and shoulder joints over both the short and long term. Skin atrophy or extensor tendon rupture due to injection did not occur.

DOI	10.11648/j.js.20190706.14
Published in	Journal of Surgery (Volume 7, Issue 6, December 2019)
Page(s)	168-179
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Rheumatoid Arthritis, Triamcinolone Acetonide, Joint Pain, Larsen Scoring System, Biologic

References

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APA Style

Akihiro Fukui, Takashi Yoshii, Hideki Yamada. (2019). Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study. Journal of Surgery, 7(6), 168-179. https://doi.org/10.11648/j.js.20190706.14

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ACS Style

Akihiro Fukui; Takashi Yoshii; Hideki Yamada. Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study. J. Surg. 2019, 7(6), 168-179. doi: 10.11648/j.js.20190706.14

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AMA Style

Akihiro Fukui, Takashi Yoshii, Hideki Yamada. Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study. J Surg. 2019;7(6):168-179. doi: 10.11648/j.js.20190706.14

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@article{10.11648/j.js.20190706.14,
  author = {Akihiro Fukui and Takashi Yoshii and Hideki Yamada},
  title = {Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study},
  journal = {Journal of Surgery},
  volume = {7},
  number = {6},
  pages = {168-179},
  doi = {10.11648/j.js.20190706.14},
  url = {https://doi.org/10.11648/j.js.20190706.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20190706.14},
  abstract = {Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 females and 21 men) rheumatoid arthritis patients with wrist, elbow and shoulder pain by analyzing the number of injections, decrease in pain measured on a visual analog scale (VAS), changes in carpal height ratio (CHR), radio carpal distance ratio (RCDR) and radial rotation angle (RRA) on X-ray imaging, and adverse effects in the subcutaneous tissue and extensor tendons. Results: Over the 8-year study period (average 6 yrs.), the mean numbers of intra-articular triamcinolone acetonide injections per patient were 3.7 for 180 wrists in 118 patients, 2.2 for 45elbows in 36 patients, 2.8 for 60 shoulders in 44 patients. Mean improvements in VAS pain scores from baseline were as follows: wrist, from 75 to 11 mm; elbow, from 79 to 17mm; shoulder, from 54 to 11mm. The group that received the injections showed no significant changes in CHR or RCDR, whereas RRA changed significantly decrease (P 90% of the patients of all disease grades responded to an average of 1–4 intra-articular triamcinolone acetonide injections, which were effective for pain relief in the wrist, elbow and shoulder joints over both the short and long term. Skin atrophy or extensor tendon rupture due to injection did not occur.},
 year = {2019}
}

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TY  - JOUR
T1  - Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study
AU  - Akihiro Fukui
AU  - Takashi Yoshii
AU  - Hideki Yamada
Y1  - 2019/11/08
PY  - 2019
N1  - https://doi.org/10.11648/j.js.20190706.14
DO  - 10.11648/j.js.20190706.14
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 168
EP  - 179
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20190706.14
AB  - Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 females and 21 men) rheumatoid arthritis patients with wrist, elbow and shoulder pain by analyzing the number of injections, decrease in pain measured on a visual analog scale (VAS), changes in carpal height ratio (CHR), radio carpal distance ratio (RCDR) and radial rotation angle (RRA) on X-ray imaging, and adverse effects in the subcutaneous tissue and extensor tendons. Results: Over the 8-year study period (average 6 yrs.), the mean numbers of intra-articular triamcinolone acetonide injections per patient were 3.7 for 180 wrists in 118 patients, 2.2 for 45elbows in 36 patients, 2.8 for 60 shoulders in 44 patients. Mean improvements in VAS pain scores from baseline were as follows: wrist, from 75 to 11 mm; elbow, from 79 to 17mm; shoulder, from 54 to 11mm. The group that received the injections showed no significant changes in CHR or RCDR, whereas RRA changed significantly decrease (P 90% of the patients of all disease grades responded to an average of 1–4 intra-articular triamcinolone acetonide injections, which were effective for pain relief in the wrist, elbow and shoulder joints over both the short and long term. Skin atrophy or extensor tendon rupture due to injection did not occur.
VL  - 7
IS  - 6
ER  -

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Author Information

Akihiro Fukui

Department of Orthopedic Surgery, Nishinokyo Hospital, Nara, Japan
Takashi Yoshii

Department of Orthopedic Surgery, Saiseikai Cyuwa Hospital, Nara, Japan
Hideki Yamada

Department of Internal Medicine, Nijyo-Ekimae Clinic, Nara, Japan

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APA Style

Akihiro Fukui, Takashi Yoshii, Hideki Yamada. (2019). Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study. Journal of Surgery, 7(6), 168-179. https://doi.org/10.11648/j.js.20190706.14

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ACS Style

Akihiro Fukui; Takashi Yoshii; Hideki Yamada. Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study. J. Surg. 2019, 7(6), 168-179. doi: 10.11648/j.js.20190706.14

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AMA Style

Akihiro Fukui, Takashi Yoshii, Hideki Yamada. Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study. J Surg. 2019;7(6):168-179. doi: 10.11648/j.js.20190706.14

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@article{10.11648/j.js.20190706.14,
  author = {Akihiro Fukui and Takashi Yoshii and Hideki Yamada},
  title = {Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study},
  journal = {Journal of Surgery},
  volume = {7},
  number = {6},
  pages = {168-179},
  doi = {10.11648/j.js.20190706.14},
  url = {https://doi.org/10.11648/j.js.20190706.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20190706.14},
  abstract = {Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 females and 21 men) rheumatoid arthritis patients with wrist, elbow and shoulder pain by analyzing the number of injections, decrease in pain measured on a visual analog scale (VAS), changes in carpal height ratio (CHR), radio carpal distance ratio (RCDR) and radial rotation angle (RRA) on X-ray imaging, and adverse effects in the subcutaneous tissue and extensor tendons. Results: Over the 8-year study period (average 6 yrs.), the mean numbers of intra-articular triamcinolone acetonide injections per patient were 3.7 for 180 wrists in 118 patients, 2.2 for 45elbows in 36 patients, 2.8 for 60 shoulders in 44 patients. Mean improvements in VAS pain scores from baseline were as follows: wrist, from 75 to 11 mm; elbow, from 79 to 17mm; shoulder, from 54 to 11mm. The group that received the injections showed no significant changes in CHR or RCDR, whereas RRA changed significantly decrease (P 90% of the patients of all disease grades responded to an average of 1–4 intra-articular triamcinolone acetonide injections, which were effective for pain relief in the wrist, elbow and shoulder joints over both the short and long term. Skin atrophy or extensor tendon rupture due to injection did not occur.},
 year = {2019}
}

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TY  - JOUR
T1  - Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study
AU  - Akihiro Fukui
AU  - Takashi Yoshii
AU  - Hideki Yamada
Y1  - 2019/11/08
PY  - 2019
N1  - https://doi.org/10.11648/j.js.20190706.14
DO  - 10.11648/j.js.20190706.14
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 168
EP  - 179
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20190706.14
AB  - Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 females and 21 men) rheumatoid arthritis patients with wrist, elbow and shoulder pain by analyzing the number of injections, decrease in pain measured on a visual analog scale (VAS), changes in carpal height ratio (CHR), radio carpal distance ratio (RCDR) and radial rotation angle (RRA) on X-ray imaging, and adverse effects in the subcutaneous tissue and extensor tendons. Results: Over the 8-year study period (average 6 yrs.), the mean numbers of intra-articular triamcinolone acetonide injections per patient were 3.7 for 180 wrists in 118 patients, 2.2 for 45elbows in 36 patients, 2.8 for 60 shoulders in 44 patients. Mean improvements in VAS pain scores from baseline were as follows: wrist, from 75 to 11 mm; elbow, from 79 to 17mm; shoulder, from 54 to 11mm. The group that received the injections showed no significant changes in CHR or RCDR, whereas RRA changed significantly decrease (P 90% of the patients of all disease grades responded to an average of 1–4 intra-articular triamcinolone acetonide injections, which were effective for pain relief in the wrist, elbow and shoulder joints over both the short and long term. Skin atrophy or extensor tendon rupture due to injection did not occur.
VL  - 7
IS  - 6
ER  -

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