Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Musculoskeletal Corticosteroid and Local Anesthetic Injections; A Survey of Practice Patterns Among Members of the American College of Rheumatology.
Alon1, Leah, Ramessar1, Nina, Cabas-Vargas2, Jenny, Stefanov1, Dimitre, Lazaro3, Deana M.
Corticosteroid and lidocaine injections into joints, bursae, tendon sheaths and trigger points are performed by rheumatologists and other practitioners. There is little evidence-based medicine for guidance on techniques, choice of injectable medications and on possible adverse effects. Most practice is based upon local standards of care. We undertook a descriptive study on the current practice patterns among members of the American College of Rheumatology (ACR). We hypothesized that corticosteroid and local anesthetic injection techniques will depend upon experience of the physician and type of practice.
We conducted an email survey of members of the ACR regarding corticosteroid and local anesthetic injection techniques. An email list was compiled from the 2010 ACR Directory. All members were included and all names in the first five pages of each alphabetical letter from the directory were chosen for the survey. Surveys were sent to 2616 members of the ACR with 275 responses (10.5% response rate). Respondents were asked about consent, frequency of injections, types and amounts of medication used, and complications experienced.
Physicians who answered the survey included 64% males, 46% in private practice, and 41% in academic medicine. Forty-five percent indicated that they perform 215 injections per month, and 46% perform >15 injections monthly. The most common indications for the injections were rheumatoid arthritis, osteoarthritis, bursitis, tendonitis, gout, pseudogout and trigger finger. Most respondents use aseptic technique to prepare the area of injection. Written consent rate was 22% higher in academic/government practice group when compared to private practice (p<.001). Fifty-two percent perform a time out procedure and this was also more common in academic practice (p=.03). The most commonly used corticosteroid medications were methylprednisolone (47%), triamcinolone acetonide (26%) and triamcinolone hexacetonide (23%). Most respondents reported that they use an equivalent of 40mg prednisone to inject large joints, 20mg prednisone equivalent dose for intermediate structures, and 10mg for smaller structures. When injection technique was analyzed by years in practice (<5 years of practice, 520 years, >20 years) more experienced clinicians tend to use lower doses of corticosteroids for shoulder injections (p=0.003) and knee injections (p=0.02). Most respondents indicated that they wait 24 months before repeating an injection to the same anatomic structure, with a frequency of 34 injections per year for large joints and 12 injections per year for smaller structures. The most common adverse effects, reported in 110% of cases, were painful injection (45%) and elevated serum glucose (37%). In <1% of cases, fat atrophy (58% reported), skin discoloration (57%), bruising (43%), and infection (19%) were noted.
Corticosteroid injections were considered safe and well-tolerated by the physicians we surveyed. Although there are no official guidelines for corticosteroid injection, we found good agreement on the dose of steroid used and frequency of injections. There are some differences in practice based upon experience and practice type.
To cite this abstract, please use the following information:
Alon, Leah, Ramessar, Nina, Cabas-Vargas, Jenny, Stefanov, Dimitre, Lazaro, Deana M.; Musculoskeletal Corticosteroid and Local Anesthetic Injections; A Survey of Practice Patterns Among Members of the American College of Rheumatology. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :921