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Do intra-articular steroid/splints work in RA?

Summaries of two new Cochrane reviews that could apply to your next consultation

Summaries of two new Cochrane reviews that could apply to your next consultation

It is not clear if steroid injections work and if people should rest their joints after injections.

Resting or immobilising a joint to enhance outcomes following intra-articular (IA) steroid injection is generally advocated.This systematic review aimed to determine the efficacy of IA steroid injections and the influence of post-injection rest. Our objectives were to:

  • compare IA steroid injections and no treatment or placebo
  • determine the effects of rest following IA steroid injection in rheumatoid or juvenile idiopathic arthritis

Method

Using several search tools we looked for randomised controlled trials of IA steroid injections or of rest following IA steroid injections in rheumatoid or juvenile idiopathic arthritis.

Five trials (n=346) examining IA steroid injection in the knee joint were included. It was not possible to pool data as outcome measures, timing of follow-up and the methods of data reporting differed between trials.

There was inconclusive conflicting evidence from two trials that walking time was reduced. There was evidence from one moderate- quality trial that pain was reduced at one day post-injection (0-100 VAS from 28.33 to 13.46; McGill Pain Scale from 8.89 to 3.96) but not at one week or seven to 12 weeks post-injection. There is some evidence that IA injections improved knee flexion (by 14 degrees) and reduced knee extension lag (by 20 degrees), knee circumference (median reduction = 0.3cm) and morning stiffness (reduced from 60 minutes to 7.6 minutes).

One trial (n=91) examined the effects of rest following injection in the knee. The rested group achieved significant improvement in pain, stiffness, knee circumference and walking time when compared with the non-rested group (no point estimates provided).One trial evaluated rest following injection of the wrist (n=117). Relapse rate was higher in the rested group (rest relapse rate = 24/58, no-rest group = 14/59); but there were no differences between the rested and non-rested groups on pain, joint circumference, wrist function, grip strength or ROM.

There is some evidence to support the use of IA steroid injections and resting a knee following injections but that wrists should not be rested following injections. The included studies involved adult participants so any conclusions can only cautiously be applied to children. Further research is required to examine the use and type of rest and the differential responses of different joints following injections.Wallen M and Gillies D. Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. The Cochrane Database of Systematic Reviews, 2006, Issue 1

The Cochrane Library (see right) contains high-quality information about the effects of health care from the Cochrane Collaboration, a UK-registered international charity and the world's leading producer of systematic reviews.UK residents are able to access the Cochrane Library free.

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