A recent randomized, double-blind, placebo-controlled trial studied the long-term safety and efficacy of treatment of knee osteoarthritis with repeated steroid injections. 6 These investigators studied 66 patients aged 40 to 80 years recruited from rheumatology clinics. One half (n=33) received injections of triamcinolone acetonide 40 mg, and the other half received saline injections every 3 months for 2 years. At 1- and 2-year interval follow-ups, no statistically significant difference was seen between the 2 groups in loss of joint space and no progression of degenerative disease, as demonstrated by measurements of joint space widths by standardized fluoroscopically guided radiographs. Although the primary outcome measure of this study was to assess radiologic joint space narrowing with repeated injections, knee pain and stiffness appeared to improve after 2 years, although these results were not well quantified.
Experience is important for the proper performance of joint aspiration and injection procedures. Physicians skilled in arthrocentesis usually have had the opportunity to gain experience with a rheumatologist or other physician who performs many procedures. Each joint has different anatomic landmarks, and novice physicians may need to review a textbook for approaches to an unfamiliar joint. Although arthrocentesis is a simple technique with minimal risk, physicians should have assistance or supervision with their first attempts at any site. Family physicians wanting to perform arthrocentesis on deep joints, such as the hip or vertebral joints, should obtain extensive training in these higher risk procedures. Additional training in arthrocentesis is available from the American Academy of Family Physicians.
Information from the National Library of Medicine
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Ages Eligible for Study: 40 Years and older (Adult, Senior) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: