Background In recent years, ultrasound (US)-guided injections are commonly used for the management of rheumatic diseases, probably because a better outcome and safer profile is presumed due to higher anatomic accuracy. To our knowledge, it has never been critically evaluated.

Objectives To assess the efficacy and safety of US-guided injections in patients with inflammatory arthritis.

Methods A systematic literature search was performed in Medline, EMBASE and the Cochrane library from 1950 to May 2012, and also a hand search on references of the included studies. Search was limited to rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA). Only controlled intervention studies using palpation-guided injection, injection guided by other imaging techniques, or placebo as the control group, were included. The Cochrane Risk of Bias tool for intervention studies was used to assess the quality of the included studies.

Results From a total of 945 identified references, only 5 papers fulfilled the inclusion criteria and were selected. All were randomised controlled trials including a total of 702 adult patients with RA [1] or mixed populations (RA and PsA [2,3] or RA and osteoarthritis [4,5]). Risk of bias was considered low to moderate. The study intervention was US-guided injections of glucocorticoid plus lidocaine versus palpation-guide injections in patients with active synovitis in all included studies. Pain was the main outcome assessed, which differing results: two studies with good quality [1,2] noted no differences between techniques, whereas three studies [3-5] showed significant pain improvement with US-guided injections, but with a moderate risk of bias. Function and stiffness were assessed in two studies [1,2], with no significant differences. Accuracy was higher overall for US-guided injections (83% vs 66%, p=0.01) in one study [2], but not in wrists (90% vs 90%, p=1.00) in other study [1]. No safety evaluation was done in included studies. No studies focused on enthesitis or tenosynovitis, or enrolling patients with SpA or JIA, were identified.

Conclusions Despite the extensive use in clinical practice, superiority of US-guided injections over palpation remains controversial in patients with RA, whereas no evidence for SpA or JIA was found. Accordingly, further studies are warranted.

References

1. Luz. Ann Rheum Dis 2008; 67:1198.

2. Cunnington. Arthritis Rheum 2010; 62:1862.

3. Sibbitt. J Rheumatol 2011; 38:252.

4. Sibbitt. J Rheumatol 2009; 36:1892.

5. Sibbitt, Jr. Scand J Rheumatol 2012; 41:66.

References

Disclosure of Interest None Declared