Factors Influencing the Acceptability of Intra-Articular Corticosteroid Injections among Pakistani Patients with Arthritis
DOI:
https://doi.org/10.51273/esc23.251926Keywords:
intra-articular injections, osteoarthritis, total knee replacementAbstract
Objective: Toassesspatients' awareness andattitude towardsintra-articulartherapy.Todetermine the frequency of
refusal among patients who were offered intra-articularsteroid injections and to identify the variousreasons for
this refusal.
Method: This was a cross-sectional study done at the Rheumatology CMH Lahore outpatient clinic from 1st June to 31st July 2022. A total of 204 patients 16 years or above who were potential candidates for intraarticular corticosteroids (IACS) or who had received injections in the past were asked about their knowledge, beliefs, and consent for intra-articular injections as per pre-defined questionnaire.
Results: Out of the total 204 patients, 34% refused to get the intra-articular injection. Their major concern was fear of injection, dependence, and only temporary pain relief. Consent was directly correlated with disease severity as determined by pain visual analogue score (VAS) and affected activities of daily living (ADLs), and physician guidance (p=0.001). A negative review from a relative or a personal bad experience leads to rejection of IACS (p=0.001). Those who did not have prior knowledge of IACS, and its response variability agreed more (p=0.01).
Conclusion: The patients' fear of dependency, partial effectiveness, and pain were major concerns that lead to the refusal of IACS in almost one-third of the patients. Information gathered from different sources apart from doctors misleads the patients.
References
Shamim R, Jan MD, Urooj Z. Prevalence of rheumatoid arthritis in population with arthralgia presenting to a tertiary care hospital JPMA 2015;65:1202-5. DOIhttps://jpma.org.pk/article-details/7526
“About Arthritis and RA.” Global RA Network, 27th Mar ‘22 https:// globalranetwork.org/project/ disease info/#_ftn1
Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006; 54:226-9. DOI: 10.1002/ art. 21562.
Moradi-Lakeh, Maziar, et al. “Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013:findingsfrom the GlobalBurden of Disease Study 2013.” Annals of the rheumatic diseases 2017; 76:1365-73.DOI:10.1136/annrheumdis-2016-210146
Kolasinski SL, NeogiT, Hochberg MC, Oatis C, Guyatt G, Block J, et al.American CoIlege of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72:220-33.DOI:10.1002/art.41142.
Canoso J, Naredo E. Aspiration and injection of joints and periarticular tissue intralesional therapy. In: Rheumatology. 5 ed. Philadelphia: Mosby Elsevier, 2011: 617–27.
David J. Kennedy, Andrew Engel, D. Scott Kreiner, Devi Nampiaparampil,Belinda Duszynski,John MacVicar, et al. Fluoroscopically Guided Diagnostic and Therapeutic Intra-Articular Sacroiliac Joint Injections: A Systematic Review, Pain Medicine 2015; 16: 1500– 1518. DOI: 10.1111/pme.12833
Ayhan E, Kesmezacar H,Akgun I. Intraarticular injections(corticosteroid, hyaluronic acid, plateletrich plasma)
for the knee osteoarthritis. World J Orthop. 2014; 5: 351-61. DOI: 10.5312/wjo.v5.i3.351
Mohamed, Mujtaba et al. “Retrospective Analysis of Septic Arthritis Caused by Intra-Articular Visco supplementation and Steroid Injectionsin a Single Outpatient Center.” Journal of clinical medicine research 2019; 11: 480-483. DOI:10.14740/jocmr3838
Ballantyne,Peri&Gignac,Monique&Hawker,Gillian. A patient-centered perspective on surgery avoidance for hip or knee arthritis:Lessonsforthe future.Arthritis and rheumatism 2007; 57:27-34. DOI: 10.1002/ art. 22472.
Dysart S, Utkina K, Stong L, Nelson W, Sacks N, Healey B, et al. Insights from Real-World Analysis of Treatment Patterns in Patients with Newly Diagnosed Knee Osteoarthritis. Am Health Drug Benefits. 2021; 14:56-62.
Martin,Cody L,Browne,JamesA.Intra-articularCorticosteroid Injectionsfor Symptomatic Knee Osteoarthritis:What the Orthopaedic Provider Needs to Know. Journal of the American Academy of Orthopaedic Surgeons 2019;27: e758-e766. DOI: 10.5435/ JAAOSD-18-00106
Wehling,P.,Evans,C.,Wehling,J.,&Maixner,W.Effectiveness of intra-articular therapies in osteoarthritis: a literature review. Therapeutic Advances in Musculoskeletal Disease 2017; 9:183-196. DOI: 10.1177/ 1759720X17712695
Rashid M, Iqbal W, Butt AW, Jamshed O, Noor MB, MehdiSAA.Comparisonbetweenintra-articularsteroid
injection and ultrasound therapy in management of chronic knee osteoarthritis. Pak Armed Forces Med J 2022; 72:181-84.
Snijders GF, den Broeder AA, van Riel PL, Straten VH, de Man FH, van den Hoogen FH, et al; NOAC Study Group. Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing. Scand J Rheumatol 2011; 40:225-31. DOI: 10.3109/03009742.2010.530611.
Richardson, Shawn S, William W, Thomas P, Peter K. Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty. The Journal of Bone and Joint Surgery 2019; 101: p 112-118. DOI: 10.2106/JBJS.18.00454
Ghaznavi S, Saleem R, Yousuf B. Treatment trends in osteo-arthritis patients attending out-patient clinics in
a tertiary care hospital.J Pak OrthopAssoc 2013; 25(3): 1-5.
Ahmad A, Khan MU, Ali Z. Non-operative strategies in the treatment of osteoarthritis of knee joint. Pak J Surg 2008;24(2):122-6.
Pitsillidou I, De la Torre-Aboki J, Uson Jaeger J, et al. Pare0027 Patient Perspective on Intra-articular Therapies in Rmds: Results from a European Survey.Annals of the Rheu-matic Diseases 2020; 79:1299-1300.
Dela Torre-Aboki J, Pitsillidou I, Uson Jaeger J, et al. AB1362-HPR Common Practice In Delivery Of Intraarticular Therapies in Rmds by Health Professionals:Results from a European Survey. Annals of the Rheumatic Diseases 2020; 79:1968.
de la Torre-Aboki J, Uson J, Pitsillidou I, Vardanyan V, Nikiphorou E, Rodriguez-Garcia SC, et al. Intra-arcticular therapies: patient preferences and professional practices in European countries. Rheumatology International 2022; 42:869-78.
Uson Jaeger J, Naredo E, Rodriguez-García SC, et al. FRI0427 Eular Recommendations for Intra-articular Treatments for Arthro-pathies. Ann Rheum Dis 2021;80:1299–1305. DOI: 10.1136/annrheumdis-2021-220266
Lenhard NK, Williams EE, Lape EC, MacFarlane LA,Losina E, Katz JN. Patient Perspectives Surrounding
Intraarticular Injections for Knee Osteoarthritis: AQualitative Study.Arthritis Care Res(Hoboken) 2022; 74:410-19. DOI: 10.1002/acr.24477.
SeltenEM,Vriezekolk JE,GeenenR, van derLaanWH, van derMeulen-DillingRG,NijhofMW, et al.Reasons
for treatment choices in knee and hip osteoarthritis: a qualitative study. Arthritis Care Res (Hoboken) 2016; 68:1260–7.
Alami, S., Boutron, I., Desjeux, D., Hirschhorn, M., Meric, G., Rannou, F., et al. Patients' and Practitioners'
Views of Knee Osteoarthritis and Its Management: A Qualitative Interview Study. PLOS ONE, 2011;6: e19634. DOI: 10.1371/journal.pone.0019634.
Downloads
Published
How to Cite
Issue
Section
