@article {Ammitzb{\o}ll-Danielsen666, author = {Mads Ammitzb{\o}ll-Danielsen and Mikkel {\O}stergaard and Viktoria Fana and Daniel Glinatsi and Uffe M{\o}ller D{\o}hn and Lykke Midtb{\o}ll {\O}rnbjerg and Esperanza Naredo and Lene Terslev}, title = {Intramuscular versus ultrasound-guided intratenosynovial glucocorticoid injection for tenosynovitis in patients with rheumatoid arthritis: a randomised, double-blind, controlled study}, volume = {76}, number = {4}, pages = {666--672}, year = {2017}, doi = {10.1136/annrheumdis-2016-209840}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective The aim of this study was to compare the efficacy of intramuscular versus ultrasound (US)-guided intratenosynovial glucocorticoid injection in providing disease control after 2, 4 and 12 weeks in patients with rheumatoid arthritis(RA) with tenosynovitis.Methods Fifty patients with RA and tenosynovitis were randomised into two double-blind groups: (A) {\textquoteleft}intramuscular group{\textquoteright}, receiving intramuscular injection of betamethasone and US-guided intratenosynovial isotonic saline injection and (B) {\textquoteleft}intratenosynovial group{\textquoteright} receiving saline intramuscularly and US-guided intratenosynovial betamethasone injection. All patients were in stable disease-modifying anti-rheumatic drug treatment prior to and during the study. Patients were excluded, and considered non-responders, if any treatments were altered during the follow-up period. {\textquoteleft}US tenosynovitis remission{\textquoteright}, defined as US tenosynovitis grey-scale score <=1 and colour Doppler score=0, was assessed at week 4 (primary outcome), and weeks 2 and 12, using non-responder imputation for missing data.Results US tenosynovitis remission at week 4 was achieved in 25\% (6/24) in the {\textquoteleft}intramuscular group{\textquoteright} versus 64\% (16/25) in the {\textquoteleft}intratenosynovial group{\textquoteright}, that is, a difference of -39 percentage point (pp) (CI -65pp to -13pp), Fisher exact test p=0.001. Corresponding values for the {\textquoteleft}intramuscular group{\textquoteright} versus the {\textquoteleft}intratenosynovial group{\textquoteright} at 2 and 12 weeks were 21\% (5/24) versus 48\% (13/25), that is, a difference of -27pp (CI -53pp to -2pp), p=0.072 and 8\% (2/24) versus 44\% (11/25), that is, difference of -36pp (-58pp to -13pp), p=0.003. Most US, clinical and patient-reported scores improved more in the {\textquoteleft}intratenosynovial group{\textquoteright} at all follow-up visits.Conclusions In this randomised double-blind clinical trial, patients with RA and tenosynovitis responded significantly better to US-guided intratenosynovial glucocorticoid injection than to intramuscular glucocorticoid injection, both at 4 and 12 weeks follow-up.Trial registration number EudraCT nr: 2013-003486-34.}, issn = {0003-4967}, URL = {https://ard.bmj.com/content/76/4/666}, eprint = {https://ard.bmj.com/content/76/4/666.full.pdf}, journal = {Annals of the Rheumatic Diseases} }