|
Tenderness/pain
|
Eich et al, [35]
|
Knee: 0% after 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Weak evidence for IACIs decreasing pain in the knee as 2 studies show a reduction of pain
|
Weak evidence for IACIs decreasing pain in lower leg joints overall as 3 studies show a reduction of pain
|
|
Huppertz et al, [38]
|
Knee: 33.3% after 7 weeks (no significance value given)
|
Not Specified
| | |
|
Laurell et al, [24]
|
Ankle: Pain regression/partial improvement = 92.5% (no specific data included, only percentages) after 4 weeks
|
Local subcutaneous atrophy in 3 patients at 4 injection sites
|
Inconclusive due to lack of studies
| |
|
(No significance value given)
|
|
Swelling
|
Eich et al, [35]
|
Knee: 27.3% after 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
| |
Weak evidence for IACIs decreasing swelling in lower leg joints overall as 2 studies show a reduction in swelling
|
|
Huppertz et al, [38]
|
Knee: 0% after 7 weeks (no significance value given)
|
Not Specified
| | |
|
Synovitis
|
Papadopoulou et al., [40]
|
Number of joints in remission vs.
|
0.9% of injected joints suffered from skin hypopigmentation or subcutaneous atrophy.
|
Weak evidence for IACIs decreasing synovitis in the knee, ankle and STJ as 2 studies for each joint showed a reduction of synovitis.
|
Weak evidence for IACIs decreasing synovitis in lower leg joints overall as 3 studies show reduction of synovitis
|
|
Number of joints with synovitis flare: Knee = 79.2% vs. 20.8% (p < 0.001); Ankle = 54.8% vs. 45.2% (p = 0.14) STJ = 65.5% vs. 34.5% (p < 0.0001); MTPJ = 85.7% vs. 14.2% (p = 0.008); IPJ = 90.0% vs. 10.0% (p = 0.0003).
|
|
“A few” patients developed flushing or redness of the cheeks 24-48 hrs post-injection.
|
|
Inconclusive evidence for MTPJ and IPJ due to lack of studies
|
|
Overall mean relapse time 0.5 yrs (IQR 0.3-1.3 yrs) vs. mean remission time 0.9 yrs (IQR 0.6-1.9 yrs).
|
|
Ravelli et al., [41]
|
Knee: continued resolution at 6 months = 69%
|
One patient suffered from subcutaneous atrophy at the injection site.
| | |
|
Reoccurrence/relapse = 31%
|
|
(no significance value given)
|
|
Remedios et al., [42]
|
Clinical synovitis vs. MRI pannus:
|
Not Specified.
| | |
|
Tibiotalar: 84.6% vs. 84.6%; STJ: 23.1% (definite) vs. 46.2% (no significance value given)
|
|
Mean duration of effect (guided vs. unguided) (weeks): 38.3 vs. 13.9 (no significance value given)
|
|
Effusion
|
Huppertz et al, [38]
|
Knee: 13.3% after 7 weeks (no significance value given)
|
Not Specified
| |
Inconclusive due to lack of studies
|
|
Hyperthermia
|
Eich et al, [35]
|
Knee: 18.2% after 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
| |
Inconclusive due to lack of studies
|
|
Sustained clinical response
|
Al-Wahadneh, [31]
|
Knee: 30/30 = 100% maintained resolution at 3 months (no significance value given)
|
1/24 (4%): short-lived pain and erythema, 2/24 (8%): subcutaneous atrophy resolved dramatically after one year, 2/24 (8%): asymptomatic periarticular calcification.
|
Weak evidence for IACIs decreasing clinical signs and symptoms in the knee, ankle and STJ as 11, 4 and 2 studies respectively showed sustained clinical response.
|
Weak evidence for IACIs decreasing clinical signs and symptoms in lower leg joints overall as 21 studies show sustained clinical response
|
|
Inconclusive evidence for midfoot due to lack of studies
|
|
Allen et al, [35]
|
Knee: 18/48 = 37.5% relapse at 6 months (no significance value given)
|
Subcutaneous fat atrophy at injection site in one patient.
| | |
|
Beukelman et al, [26]
|
Knee: 1.4 yrs of resolution before relapse (SD ± 1.0)
|
53%: subcutaneous atrophy or hypopigmentation at injection site.
| | |
|
STJ: 1.2 yrs of resolution before relapse (TH + TA) (SD ± 0.9)
|
|
Earley et al, [33]
|
Knee: Excellent/Good Outcome: 92.8% vs.
|
2/23 had areas of subcutaneous atrophy at injection site.
| | |
|
Poor/Re-injected: 7.2% at 3 months (No significance value given)
|
|
Eberhard et al, [34]
|
Knee Median Relapse (months)
|
Not Specified.
| | |
|
TH: 11.1 +/- 0.81
|
|
TA: 7.95 +/- 0.95
|
|
(p = 0.0072)
|
|
Hertzberger-ten Cate et al, [36]
|
Knee: resolution maintained in 70% of knees for >6 months (No significance value given)
|
2/21 patients suffered a small atrophic lesion at the injection site.
| | |
|
1/21 patient suffered a red and painful knee the day following injection (resolved by local ice application).
|
|
Sustained clinical response (cont’d)
|
Honkanen et al, [37]
|
Knee: overall probability of sustained clinical response was higher for TH then MP after 6-8 weeks (p > 0.0005)
|
Not Specified.
| | |
|
Laurell et al, [24]
|
Ankle pain Regression/Partial Improvement = 92.5% (no specific data included, only percentages) after 4 weeks (No significance value given)
|
Local subcutaneous atrophy in 3 patients at 4 injection sites.
| | |
|
Lepore et al, [39]
|
Knee: mean remission time = 13.9 months (range = 0-54 months) (no significance value given)
|
10% (3 patients) subcutaneous lipolysis with spontaneous regression.
| | |
|
Marti et al, [19]
|
Mean duration of remission until flare in months (range): knee = 8.0 (0-27); ankle = 4.5 (0-13); STJ = 3.5 (0-11); midfoot = 1 (0-3) (no significance value given)
|
Systemic effects of glucocorticoids in 7 patients (one flushed cheeks, three increased appetite, three mood changes).
| | |
|
Mean follow-up time of joints with ongoing remission in months (range):knee = 27.2 (1-69); ankle = 18.2 (1-39); STJ = 13; midfoot = n/a (no significance value given)
|
Local side effects in 12 patients (14 skin atrophies combined with hypopigmentation).
|
|
Remedios et al., [42]
|
Clinical synovitis vs. MRI pannus:
|
Not Specified.
| | |
|
Tibiotalar: 84.6% vs. 84.6%; STJ: 23.1% (definite) vs. 46.2% (no significance value given)
|
|
Mean duration of effect (guided vs. unguided) (weeks): 38.3 vs. 13.9 (no significance value given)
|
|
Sustained clinical response (cont’d)
|
Sornay-Soares et al., [44]
|
Knee: continued resolution in 76.9% knees at 6 months
|
No adverse effects were recorded.
| | |
|
(no significance value given)
|
|
Zulian et al., [46]
|
Knee and Ankle: continued resolution at 6 months
|
2 patients in each group developed skin atrophy at the injection site.
| | |
|
TH: 81.4%
|
2 patients experienced reversible apnoea (<20secs duration) during the induction phase of sedation.
|
|
TA: 53.3%
|
|
(p = 0.001)
|
|
Joint ROM
|
Balogh et al., [30]
|
Knee: BM = 0 degree difference vs. TH = 13 degrees difference at 42 days (no significance value given)
|
Mild skin atrophy in 1/23 who was injected with TH
|
Weak evidence for IACIs increasing ROM in the knee as 3 studies show improvement
|
Weak evidence for IACIs increasing ROM in lower leg joints overall as 5 studies show improvement
|
|
Eich et al, [35]
|
Knee: 66.7% improvement after 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
| | |
|
Huppertz et al, [38]
|
Knee: 92.9% improvement after 7 weeks (no significance value given)
|
Not Specified
| | |
|
Laurell et al, [24]
|
Ankle: 95% improvement after 4 weeks
|
Local subcutaneous atrophy in 3 patients at 4 injection sites
|
Inconclusive due to lack of studies
| |
|
(No significance value given)
|
|
Cahill et al., [25]
|
STJ: 89.5% returned to normal ROM within 13 weeks (no significance value given). Mean duration of improvement = 1.2 SD ±0.9 yrs.
|
Subcutaneous atrophy or hypopigmentation in 53%
|
Inconclusive due to lack of studies
| |
|
Leg length discrepancy
|
Eich et al, [35]
|
Improvement after 1 month: 100% (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
| |
Weak evidence for IACIs decreasing LLD as 3 studies show reduction
|
|
Sherry et al., [43]
|
Mean difference in leg length for early intervention vs. control:
|
Not Specified
| | |
|
0% (±0) vs. 1.0% (±1.4) (p = 0.005)
|
|
over mean follow up of 4 months (SD ± 11 months)
|
| |
Verma et al., [45]
|
Mean Lower Leg Difference (cm): ↓ 0.22 at 6 and 12 weeks (no significance value given).
|
No adverse effects were recorded.
| | |
|
Circumference
|
Balogh et al., [30]
|
Mean Knee Joint Circumference (cm):
|
Mild skin atrophy in 1/23 who was injected with TH
| |
Inconclusive due to lack of studies
|
|
BM = 1.0
|
|
TH = -1.7 after 1, 3, 7 and 42 days (no significance values given).
|
|
Imaging
| | | | |
Weak evidence for IACIs decreasing imaging findings in lower leg joints overall as 3 studies show improvement
|
|
MR imaging
| | | | |
Weak evidence for IACIs decreasing MRI detectable clinical signs and symptoms as 3 studies show detectable improvement
|
|
Effusion
|
Eich et al., [35]
|
Knee: 36.4% detected by MRI at 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Weak evidence for IACIs decreasing MRI detectable effusion as 2 studies show detectable improvement.
| |
|
Huppertz et al, [38]
|
Knee and Ankle: 40.0% at 7 and 13 weeks (no significance value given)
|
Not Specified.
| | |
|
Pannus
|
Eich et al., [35]
|
Knee: 63.6% detected by MRI at 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Weak evidence for IACIs decreasing MRI detectable pannus as 3 studies show detectable improvement.
| |
|
Huppertz et al, [38]
|
Knee and Ankle: 10.0% at 7 and 13 weeks (no significance value given)
|
Not Specified.
| | |
|
Remedios et al., [42]
|
Clinical synovitis vs. MRI pannus:
|
Not Specified.
| | |
|
Tibiotalar: 84.6% vs. 84.6%; STJ: 23.1% (definite) vs. 46.2% (no significance value given)
|
|
Mean duration of effect (guided vs. unguided) (weeks): 38.3 vs. 13.9 (no significance value given)
|
|
Popliteal cyst
|
Eich et al., [35]
|
Knee: 33.3% detectable at 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Inconclusive due to lack of studies
| |
|
Destruction of articular cartilage/bone
|
Eich et al., [35]
|
Missing outcome data at 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Inconclusive due to lack of studies
| |
|
Destruction of meniscus
|
Eich et al., [35]
|
100% (no ligament destruction reported) at 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Inconclusive due to lack of studies
| |
|
Bone marrow oedema
|
Eich et al., [35]
|
None reported at 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Inconclusive due to lack of studies
| |
|
Avascular necrosis
|
Eich et al., [35]
|
None reported at 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Inconclusive due to lack of studies
| |
|
Uptake of contrast medium
|
Huppertz et al, [38]
|
Knee and Ankle: 20.0% detectable at 7 and 13 weeks (no significance value given)
|
Not Specified.
|
Inconclusive due to lack of studies
| |
|
US imaging
| | | | |
Weak evidence for IACIs decreasing US detectable clinical signs and symptoms as 2 studies show detectable improvement
|
|
Joint effusion and/or pannus
|
Eich et al., [35]
|
Knee: 100% detectable after 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Inconclusive due to lack of studies
| |
|
Popliteal cyst
|
Eich et al., [35]
|
Knee: 0% detectable after 1 week and 1 month (no significance value given)
|
One patient experienced focal cutaneous atrophy and a possible ruptured popliteal cyst
|
Inconclusive due to lack of studies
| |
|
Synovial hypertrophy
|
Laurell et al., [24]
|
Talocrural joint = 87% regression vs. 13% no effect
|
Local subcutaneous atrophy in 3 patients at 4 injection sites.
|
Inconclusive due to lack of studies
| |
|
Posterior-STJ = 95% regression vs. 5% no effect
|
|
Midfoot joints = 91% regression vs. 9% no effect (no significance value given).
|
|
Mean synovial thickness: statistically significant difference at 4 weeks (p < 0.001)
|
|
Synovial hyperaemia
|
Laurell et al., [24]
|
Talocrural Joint = 86% normalisation vs. 14% no normalisation
|
Local subcutaneous atrophy in 3 patients at 4 injection sites.
|
Inconclusive due to lack of studies
| |
|
Posterior-STJ = 95% normalisation vs. 5% no normalisation
|
| | |
Midfoot Joints = 80% normalisation vs. 20% no normalisation (no significance value given) after 4 weeks.
| | | |
