Abstract

FERREIRA, Ana Rita; CARRAPICO, Eunice  and  PIMENTAO, José Bravo. Corticosteroid injections for periarticular rheumatic diseases: an evidence-based review. Rev Port Med Geral Fam [online]. 2013, vol.29, n.1, pp.38-52. ISSN 2182-5173.

Introduction: Periarticular rheumatic diseases are common and cause a significant economic and social burden. They are frequent causes of visits to family doctors. Corticosteroid injections are important adjuvants in the treatment of rheumatic diseases. They can be performed by doctors with the necessary skills. The aim of this paper is to review the evidence for the effectiveness of corticosteroid injections in seven common periarticular rheumatic diseases. Methodology: We selected seven common periarticular rheumatic diseases for review: carpal tunnel syndrome, epicondylitis, De Quervain’s disease, trigger finger, shoulder pain, trochanteric bursitis, and anserine bursitis. A systematic search for systematic reviews, randomized controlled trials and clinical guidelines was conducted for each condition. The searches were done in March 2011 for papers with the following eligibility criteria: (1) a population of patients diagnosed with one of the selected rheumatic diseases, (2) an intervention with corticosteroid injection versus no treatment, placebo or other treatments, (3) patient-oriented outcomes regarding effectiveness, (4) publication in or after 2000. We excluded studies not available in full text. Results: Thirty-six studies were included in this review. For carpal tunnel syndrome, corticosteroid injection was found to be more effective than placebo. Corticosteroid infiltration is also beneficial in reducing symptoms in the short-term for epicondylitis. In de Quervain’s disease, corticosteroid infiltration is recommended as the initial treatment. For trigger finger, infiltration is effective and safe compared to placebo. Is was not possible to make clear recommendations for corticosteroid injections for shoulder pain. For trochanteric bursitis, there is weak evidence for the use of infiltration. No eligible studies were found to evaluate the effectiveness of corticosteroid injection for anserine bursitis. Conclusion: The infiltration of corticosteroids steroids proved effective in treating four of the seven periarticular rheumatic diseases chosen for this review. There are considerable differences in the magnitude and duration of therapeutic effects in different conditions which makes it impossible to generalize regarding the effectiveness of corticosteroid injection for all periarticular rheumatic diseases.

Keywords : Injections; Corticosteroid; Effectiveness; Rheumatic Disease; Periarthritis.

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