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The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee

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Abstract

Although intraarticular injections are important to the management of rheumatoid arthritis, there are few studies regarding the cost-effectiveness of alternative injection techniques. This randomized controlled study addressed the cost-effectiveness of two different low-cost, anatomic landmark palpation-directed intraarticular injection techniques. Ninety-six symptomatic rheumatoid knees were randomized to two different low-cost, palpation-guided intraarticular injection techniques utilizing (1) a conventional syringe or (2) a mechanical syringe, the RPD (the reciprocating procedure device). Three milliliters of 1% lidocaine were used to anesthetize the synovial membrane, followed by arthrocentesis and hydrodissection, and injection of 80 mg of triamcinolone acetonide utilizing the one-needle two-syringe technique. Baseline pain, procedural pain, aspirated fluid volume, pain at outcome (2 weeks and 6 months), responders, reinjection rates, cost/patient/year, and cost/responder/year were determined. Pain was measured with the 10 cm Visual Analogue Pain Scale (VAS). Both techniques significantly reduced pain scores at outcome from baseline (P < 0.001). The mechanical syringe technique resulted in a greater volume of aspirated fluid (P < 0.01), a 38% reduction in procedural pain (P < 0.001), a 24% reduction in pain scores at outcome (P < 0.03), an increase in the responder rate (P < 0.025), 33% increase in the time to next injection (P < 0.001), 23% ($35 US) reduction in cost/patient/year for a patient treated in a physician office (P < 0.001), 24% reduction ($26 US) in cost/patient/year for a hospital outpatient (P < 0.001), and 51% ($151 US) reduction in cost/responder/year (P < 0.001). The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee can be improved significantly with low-cost alternations in technique.

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Acknowledgments

There was no industry support for this study. NC, PB, SD, KP, AD have nothing to disclose. WS is funded by grants from the US National Institutes of Health and the Public Health Service. WS has been an expert consultant for Becton–Dickinson, Inc., IMS, Inc., Ferring, Inc., Avanca, Inc., Avasca, Inc., and MediTech Duopross, Inc. WS holds stock in Apple Inc, Celgene Corp, Inc, Avanca, Inc, Avasca, Inc., Sun Microsystems, Inc, Symantec Corp, and Java, Inc. In 2009 Abbott Vascular, Inc. acquired 4 patents invented by WS but not relevant to the present research.

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Authors and Affiliations

  1. Department of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

    Natalia R. Chavez-Chiang, Suzanne L. DeLea & Kye S. Park

  2. Department of Internal Medicine, Division of Rheumatology and Neurology, University of New Mexico Health Sciences Center, MSC10–5550 5th FL ACC, Albuquerque, NM, 87131, USA

    Wilmer L. Sibbitt & Arthur D. Bankhurst

  3. Department of Orthopaedic Surgery and Pharmacology, New York University Medical Center, New York, NY, USA

    Philip A. Band

Authors
  1. Natalia R. Chavez-Chiang
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  2. Wilmer L. Sibbitt
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  3. Philip A. Band
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  4. Suzanne L. DeLea
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  5. Kye S. Park
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  6. Arthur D. Bankhurst
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Corresponding author

Correspondence to Wilmer L. Sibbitt.

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Chavez-Chiang, N.R., Sibbitt, W.L., Band, P.A. et al. The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee. Rheumatol Int 32, 513–518 (2012). https://doi.org/10.1007/s00296-010-1718-5

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  • DOI: https://doi.org/10.1007/s00296-010-1718-5

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