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THU0311 Transdermal Diclofenac Patch and Glucocorticoid Injection over Trochanteric Bursa on Greater Trochanter Pain Syndrome Management: A Comparative Prospective Study Based on Usual Clinical Practice
  1. C.A. Guillen Astete1,
  2. A. Boteanu1,
  3. N. García Montes2,
  4. M. Llop Vilatella1
  1. 1Rheumatology Department
  2. 2Urgency and Emergency, Ramon y Cajal University Hospital, Madrid, Spain

Abstract

Background Recently, trasndermal diclofenac patch has been introduced into the medical practice with relative success in the management of sport injuries. Our experience of its use in the greater trochanteric pain syndrome is positive however there is no study comparing its therapeutic benefits with steroids and anesthetics injection.

Objectives Purpose of present study is to assess the results of management of greater trochanteric pain syndrome with transdermal diclofenac patch compared with steroids and anesthetics injection.

Methods We conducted a prospective observational study based on usual clinical practice at our hospital urgency and emergency department. Patients with greater trochanteric pain syndrome were indentified. Only were included patients treated with steroid injections (most of them also with mepivacaine 2%) or a 140 mg transdermal diclofenac patch. Patients were contacted once clinical assessment concluded to concert an interview seven days after. Clinical and epidemiological data were collected. Therapeutic success was determined by the subjective opinion of self being of each patient (dichotomous variable) and measure using a analogical visual scale (continuous variable). This protocol was aproved by the local ethics committee.

Results Thirteen patients treated with transdermal diclofenac bid for at least three days (Group I) and 37 patients treated with a local injection of 40mg of triamcinolone and 1 or 2 cc of mepivacaine 2% (Group II) were included. Specific orocedure technic was not available in the records of 33 patients who underwent locally injected. Average age was 66 SD 6 in group I and 69 SD 8 years old in group II (p>0.05). Female proportion was 76.9% in group I and 78.3% in group II (p>0.05). Terapeutical success was achive according to patient opinion in 4 patients in group I and 11 in group II (30.7% and 29.7% respectively, p>0.05). symptoms reduction measured by in analogic visual scale was 35.6 SD 18.8% in group I and La 40.5 SD 21.1% in group II (p=0.056). Considering only male patients such reduction was 78.4 SD 22.1% and 44.4 SD 27.4%, respectively (p<0.01)

Conclusions Our results point that transdermal diclofenac and local injections of steroids are equivalent therapies in the management of greater trochanteric pain síndrome. Although our results are preliminary, they open an interesting use of diclofenac patches, for instance, in patients in whom there are contraindications for infiltrations. The fact that men benefit more than women by this therapy could be explained by the characteristics of the male pelvis in terms of fat distribution and the penetration capacity of the patch.

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.4983

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