Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

Mikael Boesen; Karl Erik Jensen; Søren Torp-Pedersen; Marco A Cimmino; Bente Danneskiold-Samsøe; Henning Bliddal

doi:10.1016/j.ejrad.2007.08.037

Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

Mikael Boesen, Karl Erik Jensen, Søren Torp-Pedersen, Marco A Cimmino, Bente Danneskiold-Samsøe, Henning Bliddal

Department of Clinical Medicine

10 Citations (Scopus)

Abstract

OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg/ml), 0.5 ml Lidocaine (5mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal distribution (radio-carpal, inter-carpal, and carpo-metacarpal) as well as radio-ulnar distribution was recorded. Full distribution in one compartment was given the value 1, partial distribution 0.5 and no distribution 0. A sum of the total distribution for all four compartments was calculated and correlated to the clinical parameters and the MRI OMERACT scores. RESULTS: No uniform pattern was seen in the distribution of the contrast. Only two patients had full contrast distribution to all four compartments, and the mean distribution count for all patients was 2.4 (range 0.5-4). The distribution count correlated with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased with the MRI synovitis score, while no association was found with the erosion- and bonemarrow oedema score. These results indicate that a single injection into a standard injection site in the proximal part of the wrist cannot be assumed to distribute--and treat--the whole joint
Udgivelsesdato: 2009/2

Original language	English
Journal	European Journal of Radiology
Volume	69
Issue number	2
Pages (from-to)	331-338
Number of pages	7
ISSN	0720-048X
DOIs	https://doi.org/10.1016/j.ejrad.2007.08.037
Publication status	Published - 2007

Access to Document

10.1016/j.ejrad.2007.08.037

Cite this

@article{68cc99705cfb11df928f000ea68e967b,

title = "Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis",

abstract = "OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg/ml), 0.5 ml Lidocaine (5mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal distribution (radio-carpal, inter-carpal, and carpo-metacarpal) as well as radio-ulnar distribution was recorded. Full distribution in one compartment was given the value 1, partial distribution 0.5 and no distribution 0. A sum of the total distribution for all four compartments was calculated and correlated to the clinical parameters and the MRI OMERACT scores. RESULTS: No uniform pattern was seen in the distribution of the contrast. Only two patients had full contrast distribution to all four compartments, and the mean distribution count for all patients was 2.4 (range 0.5-4). The distribution count correlated with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased with the MRI synovitis score, while no association was found with the erosion- and bonemarrow oedema score. These results indicate that a single injection into a standard injection site in the proximal part of the wrist cannot be assumed to distribute--and treat--the whole joint Udgivelsesdato: 2009/2",

author = "Mikael Boesen and Jensen, {Karl Erik} and S{\o}ren Torp-Pedersen and Cimmino, {Marco A} and Bente Danneskiold-Sams{\o}e and Henning Bliddal",

note = "Keywords: Adrenal Cortex Hormones; Adult; Aged; Arthritis, Rheumatoid; Female; Gadolinium DTPA; Humans; Injections, Intra-Articular; Magnetic Resonance Imaging; Male; Middle Aged; Tissue Distribution; Ultrasonography, Interventional; Wrist Joint",

year = "2007",

doi = "10.1016/j.ejrad.2007.08.037",

language = "English",

volume = "69",

pages = "331--338",

journal = "European Journal of Radiology",

issn = "0720-048X",

publisher = "Elsevier Ireland Ltd",

number = "2",

}

TY - JOUR

T1 - Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

AU - Boesen, Mikael

AU - Jensen, Karl Erik

AU - Torp-Pedersen, Søren

AU - Cimmino, Marco A

AU - Danneskiold-Samsøe, Bente

AU - Bliddal, Henning

N1 - Keywords: Adrenal Cortex Hormones; Adult; Aged; Arthritis, Rheumatoid; Female; Gadolinium DTPA; Humans; Injections, Intra-Articular; Magnetic Resonance Imaging; Male; Middle Aged; Tissue Distribution; Ultrasonography, Interventional; Wrist Joint

PY - 2007

Y1 - 2007

N2 - OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg/ml), 0.5 ml Lidocaine (5mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal distribution (radio-carpal, inter-carpal, and carpo-metacarpal) as well as radio-ulnar distribution was recorded. Full distribution in one compartment was given the value 1, partial distribution 0.5 and no distribution 0. A sum of the total distribution for all four compartments was calculated and correlated to the clinical parameters and the MRI OMERACT scores. RESULTS: No uniform pattern was seen in the distribution of the contrast. Only two patients had full contrast distribution to all four compartments, and the mean distribution count for all patients was 2.4 (range 0.5-4). The distribution count correlated with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased with the MRI synovitis score, while no association was found with the erosion- and bonemarrow oedema score. These results indicate that a single injection into a standard injection site in the proximal part of the wrist cannot be assumed to distribute--and treat--the whole joint Udgivelsesdato: 2009/2

AB - OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg/ml), 0.5 ml Lidocaine (5mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal distribution (radio-carpal, inter-carpal, and carpo-metacarpal) as well as radio-ulnar distribution was recorded. Full distribution in one compartment was given the value 1, partial distribution 0.5 and no distribution 0. A sum of the total distribution for all four compartments was calculated and correlated to the clinical parameters and the MRI OMERACT scores. RESULTS: No uniform pattern was seen in the distribution of the contrast. Only two patients had full contrast distribution to all four compartments, and the mean distribution count for all patients was 2.4 (range 0.5-4). The distribution count correlated with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased with the MRI synovitis score, while no association was found with the erosion- and bonemarrow oedema score. These results indicate that a single injection into a standard injection site in the proximal part of the wrist cannot be assumed to distribute--and treat--the whole joint Udgivelsesdato: 2009/2

U2 - 10.1016/j.ejrad.2007.08.037

DO - 10.1016/j.ejrad.2007.08.037

M3 - Journal article

C2 - 17935920

SN - 0720-048X

VL - 69

SP - 331

EP - 338

JO - European Journal of Radiology

JF - European Journal of Radiology

IS - 2

ER -