PT  - JOURNAL ARTICLE
AU  - Wilmer L. Sibbitt, Jr
AU  - Philip A. Band
AU  - Natalia R. Chavez-Chiang
AU  - Suzanne L. DeLea
AU  - Hillary E. Norton
AU  - Arthur D. Bankhurst
TI  - A Randomized Controlled Trial of the Cost-Effectiveness of Ultrasound-Guided Intraarticular Injection of Inflammatory Arthritis
AID  - 10.3899/jrheum.100866
DP  - 2010 Nov 15
TA  - The Journal of Rheumatology
PG  - jrheum.100866
4099  - http://www.jrheum.org/content/early/2010/11/12/jrheum.100866.short
4100  - http://www.jrheum.org/content/early/2010/11/12/jrheum.100866.full
AB  - Objective We studied whether sonographic needle guidance affected the outcomes of intraarticular (IA) injection for inflammatory arthritis. Methods Joints with inflammatory arthritis (n = 244; 76% rheumatoid arthritis, 3% small joints, 51% intermediate, and 46% large) were randomized to injection by conventional palpation-guided anatomic injection (120 joints) or sonographic image-guided injection enhanced with a 1-handed reciprocating procedure device mechanical syringe (124 joints). A 1-needle, 2-syringe technique was used. After IA placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and triamcinolone acetonide was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost, and cost per responder were determined. Results Relative to conventional palpation-guided methods, sonographic guidance for injection of inflammatory arthritis resulted in an 81% reduction in injection pain (p < 0.001), 35% reduction in pain scores at outcome (p < 0.02), 38% increase in the responder rate (p < 0.003), 34% reduction in the non-responder rate (p < 0.003), 32% increase in therapeutic duration (p = 0.01), 8% reduction ($7) in cost/patient/year, and a 33% ($64) reduction in cost/responder/year for a hospital outpatient (p < 0.001). Conclusion Sonographic needle guidance improves the performance, clinical outcomes, and cost-effectiveness of IA injections for inflammatory arthritis. (Clinical Trial Identifier NCT00651625)