BMJ  2004;328:E305 (12 June), doi:10.1136/bmj.328.7453.E305

BMJ USA: Letter

RAPID RESPONSES FROM BMJ.COM

Following are edited excerpts from the Rapid Responses generated by this article, all of which can be read in their entirety at http://bmj.bmjjournals.com/cgi/content/full/328/7444/869#responses.-Editor

Having used methylprednisolone and lidocaine (80 mg) for more than 15 years for osteoarthritis of the knee that did not respond to conservative treatment, I have found that a significant proportion of patients have had pain relief lasting up to five years. Anecdotal as it may seem, elderly patients, especially those who do not wish to have surgery, are very grateful for the pain relief.

I have also had a few very elderly patients [to whom I have given injections], so that they could fly [overseas to visit] family in the US and Canada. The steroids enabled them to cope with the mechanical stress on the joints as a result of the traveling and extra walking they had to do while on holiday.

Norwich, UK

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I have used this procedure since 1961, and the reduction of pain and improvement in function is enhanced if any effusion is aspirated at the same time. Aspiration also aids diagnosis.

It is a simple procedure that can be done easily in a general practitioner's office as long as a 19 gauge, 1 1/2 inch needle is used, because osteoarthritis fluid is viscous and will not flow through a smaller one. I use 80 mg of methylprednisolone together with some lidocaine. Improvement lasts from a few months to a few years.

Details of technique: Draw up 5 mL of 1% lidocaine in a 10 mL syringe. Using a 19 gauge needle, infiltrate the lidocaine from the skin to the joint cavity. The best approach is beneath the lateral border of the patella. Aspirate any effusion completely. Clear viscous fluid indicates osteoarthritis. Cloudy non-viscous fluid indicates an inflammatory effusion, and a sample should be sent for microscopy and culture. If fluid is clear or absent, with the 19 gauge needle still in situ inject 80 mg of methylprednisolone into the joint space.

Bristol, UK

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Intra Articular Steroid Therapy.

chidambaran ganapathy
bmj.com, 11 Jun 2004 [Full text]