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THU0299 The Risk of Intraarticular Steroid Injections Are Overestimated
  1. R.A. Andreasen,
  2. S.A. Just,
  3. I.M.J. Hansen
  1. Rheumatology, Odense University Hospital, Svendborg, Denmark

Abstract

Background Intraarticular (IA) puncture is used both for diagnostic purposes as well as for treating e.g. discharge of larger effusions or installation of medications e.g. glucocorticoids (GC) in inflammatory disorders, the latter is described as an efficient treatment combined with Methotrexate in early rheumatoid arthritis (1) IA puncture seems to be used with varying, uncertain and difficult to find frequencies, both with in rheumatological departments in a given country as well as between countries. A barrier for joint puncture might be the risk of, inducing an iatrogenic septic arthritis (SA) sometimes leading to severe sepsis (2)

Objectives The purpose of this study is to evaluate the risk of inducing a SA in all patients, who have undergone an arthrocentesis or joint puncture at our out-patient department. Furthermore the frequency of the procedures in patients with Rheumatoid arthritis (RA), Psoriasis arthritis (PsA) and Gout were numbered in 2013

Methods In this retrospective design, all patients in our out-patient department, having an IA puncture +/- subsequent GC injection from 1.1 2007 until 31.12.2013, at our department were evaluated for a subsequent SA, within the first month after puncture. SA is defined as a clinical inflamed joint and positive synovial fluid culture. According to the local recommendation, joint puncture was done using sterile non-touch technique and patients were informed of the risk of joint infection, and urged to contact us if any suspicion of infection was found or lack of improvement

Results A total of 3921 IA GC injections and 1147 arthrocentesis were registered. Two patients developed subsequently a SA respectively 7 and 18 days after the injections. Both patients, one with RA and one with gout, contacted us as advised, none of these two got irreversible join damage (0,05% of all GC injections). Evaluating the three most common diagnostic groups at our department in 2013 it was discovered that among 652 patients with RA 2 had done an arthrocentesis, 261 a GC injection and 76 had both procedures performed. For Pts with PsA the corresponding numbers were 11, 57 and 11 and for the Gout patients 35, 74 and 19. None of these procedures resulted in an iatrogenic arthritis

Conclusions IA joint puncture plus/minus subsequent GC injection is a safe procedure, when using an aseptic technique and proper information to the patients. The overestimated risk of inducing a SA might mean that patients do not get a prompt and sufficient treatment of the individual joint problem. Of course this should not lead to contraindications to arthrocentesis and relevant information to the patients overridden. Because patients were urged to contact us in case of signs of infection after joint puncture, we think data are complete concerning the numbers of patients having a SA secondary to the procedures. It does not appear, that there is any difference between the frequencies of the procedures between the patients with RA, PsA or gout

References

  1. Hetland ML, Hørslev-Petersen K. The CIMESTRA study: Intra-articular glucocorticosteroids and synthetic DMARDs in treat-to-target strategi in early rheumatoid arthritis. Clin Exp Rheumatol 2012;30 (4 Suppl 73): S44-9

  2. Holland C, Jaeger L, Smentkowski U, Weber B, Otto C. Septic and Aseptic complications of corticoid injections. Expert Commision and medication boards from 2005 to 2009. Deutsches Ärtzeblatt International 2012;109 (24): 425-30

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.3356

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