Randomised controlled study of postinjection immobilisation after intra-articular glucocorticoid treatment for wrist synovitis

Abstract

Background: Intra-articular glucocorticoid treatment is frequently used in arthritic disorders. Postinjection rest has been shown to improve the outcome of knee injections.

Objective: To investigate whether better treatment results might also be achieved by a similar postinjection regimen for the wrist, which is non-weightbearing.

Methods: 117 patients with rheumatoid arthritis and wrist synovitis were treated with intra-articular glucocorticoid injections. The patients were randomly allocated to 48 hour postinjection immobilisation in elastic wrist orthoses (n=58) or to normal postinjection activity (n=59). The primary end point was relapse of synovitis. In addition, joint circumference, pain, function, range of movement, and grip strength were followed up during six months.

Results: 24 relapses occurred in the orthoses group and 14 in the active group (p=0.056). The secondary measure showed no statistically significant differences between the groups.

Conclusion: The use of elastic wrist orthoses as a postinjection regimen does not improve the outcome of intra-articular glucocorticoid treatment for wrist synovitis. Results achieved in studies on knees should not be generalised to other joints, and postinjection recommendations should differ depending on the joint treated.

Figure 1

Duration of the therapeutic effect after glucocorticoid injection in the wrist with or without immobilisation in elastic wrist orthoses.