Abstract
To assess patient perspective and professional practice of intraarticular therapies (IATs) across Europe, an expert international multidisciplinary panel designed two open web-based surveys: one targeting people who had experienced at least two IATs (44 items); and one targeting health care providers (HCPs) (160 items). Surveys were disseminated via patient and professional associations and social media. A descriptive analysis was performed. The surveys were answered by 200 patients and 186 HCPs from 26 countries, showing that IAT is routinely performed by rheumatologists (97%) and orthopaedic surgeons (89%), with specific training being compulsory in a few countries. The most frequent indications for IAT are arthritis (76%), osteoarthritis (74%), crystal arthritis (71%) and bursitis (70%); the most frequently injected joints are knee (78%) and shoulder (70%); and the most used compounds are glucocorticoids. The majority of HCPs report informing patients about side-effects (73%), benefits (72%), and the nature of the procedure (72%), which coincides with 27% of patients reporting that they had not been informed about benefits or potential complications of IATs; 73% of patients had not been asked whether they wanted an anaesthetic. Few HCPs (10%) obtain written consent (56% get oral consent, being mandatory for 32%), a procedure deemed necessary by 41% of the patients. 50% of patients reported a clear benefit of IAT and 20% experienced complications including pain, impaired mobility, rashes, or swelling. In summary, the practice of IAT is variable across Europe, and although patients perceive it as relatively safe and usually effective procedure, some gaps were identified.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The surveys and material are available upon reasonable request to the corresponding author.
Code availability
The surveys were launched in the platform SurveyMonkey© and the analysis were run in Stata©. The statistical code is available upon request to the corresponding author.
References
Canoso J, Naredo E (2011) Aspiration and injection of joints and periaticular tissue intralesional therapy. Rheumatology, 5, 5th edn. Mosby Elsevier, Philadelphia, pp 617–627
Maricar N, Parkes MJ, Callaghan MJ, Felson DT et al (2013) Where and how to inject the knee–a systematic review. Semin Arthritis Rheum 43(2):195–203. https://doi.org/10.1016/j.semarthrit.2013.04.010
Bowden DJ, Byrne CA, Alkhayat A, Eustace SJ et al (2017) Injectable viscoelastic supplements: a review for radiologists. AJR Am J Roentgenol 209(4):883–888. https://doi.org/10.2214/AJR.17.17847
Fischer M, Modder G (2002) Radionuclide therapy of inflammatory joint diseases. Nucl Med Commun 23(9):829–831. https://doi.org/10.1097/00006231-200209000-00003
Hetland ML, Ostergaard M, Ejbjerg B, Jacobsen S et al (2012) Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP. IgM-RF and CRP Ann Rheum Dis 71(6):851–856. https://doi.org/10.1136/annrheumdis-2011-200632
Jevsevar D, Donnelly P, Brown GA, Cummins DS (2015) Viscosupplementation for osteoarthritis of the knee: a systematic review of the evidence. J Bone Joint Surg Am 97(24):2047–2060. https://doi.org/10.2106/JBJS.N.00743
Ornetti P, Nourissat G, Berenbaum F, Sellam J et al (2016) Does platelet-rich plasma have a role in the treatment of osteoarthritis? Joint Bone Spine 83(1):31–36. https://doi.org/10.1016/j.jbspin.2015.05.002
D’Agostino MA, Schmidt WA (2013) Ultrasound-guided injections in rheumatology: actual knowledge on efficacy and procedures. Best Pract Res Clin Rheumatol 27(2):283–294. https://doi.org/10.1016/j.berh.2013.04.001
Naredo E, Cabero F, Beneyto P, Cruz A et al (2004) A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol 31(2):308–314
Uson J, Rodriguez-Garcia SC, Castellanos-Moreira R, O’Neill TW et al (2021) EULAR recommendations for intra-articular therapies. Ann Rheum Dis 80(10):1299–1305. https://doi.org/10.1136/annrheumdis-2021-220266
Gormley GJ, Corrigan M, Steele WK, Stevenson M et al (2003) Joint and soft tissue injections in the community: questionnaire survey of general practitioners’ experiences and attitudes. Ann Rheum Dis 62(1):61–64. https://doi.org/10.1136/ard.62.1.61
Liddell WG, Carmichael CR, McHugh NJ (2005) Joint and soft tissue injections: a survey of general practitioners. Rheumatology (Oxford) 44(8):1043–1046. https://doi.org/10.1093/rheumatology/keh683
Ekhtiari S, Horner NS, Simunovic N, Ayeni OR (2020) The precision survey: preferences of physicians regarding ultrasound-guided intra-articular injections. Clin J Sport Med 30(4):372–377. https://doi.org/10.1097/JSM.0000000000000612
Alunno A, Najm A, Sivera F, Haines C et al (2020) Assessment of competences in rheumatology training: results of a systematic literature review to inform EULAR points to consider. RMD Open. https://doi.org/10.1136/rmdopen-2020-001330
Bandinelli F, Bijlsma JW, Ramiro MS, Pia E et al (2011) Rheumatology education in Europe: results of a survey of young rheumatologists. Clin Exp Rheumatol 29(5):843–845
Beyer C, Ramiro S, Sivera F, Mandl P et al (2016) Educational needs and preferences of young European clinicians and physician researchers working in the field of rheumatology. RMD Open 2(2):e000240. https://doi.org/10.1136/rmdopen-2015-000240
Najm A, Alunno A, Sivera F, Ramiro S et al (2020) Strategies for the assessment of competences during rheumatology training across Europe: results of a qualitative study. RMD Open. https://doi.org/10.1136/rmdopen-2020-001183
Sivera F, Alunno A, Najm A, Avcin T et al (2021) 2019 EULAR points to consider for the assessment of competences in rheumatology specialty training. Ann Rheum Dis 80(1):65–70. https://doi.org/10.1136/annrheumdis-2020-218015
Sivera F, Ramiro S, Cikes N, Cutolo M et al (2016) Rheumatology training experience across Europe: analysis of core competences. Arthritis Res Ther 18(1):213. https://doi.org/10.1186/s13075-016-1114-y
Sivera F, Ramiro S, Cikes N, Dougados M et al (2015) Differences and similarities in rheumatology specialty training programmes across European countries. Ann Rheum Dis 74(6):1183–1187. https://doi.org/10.1136/annrheumdis-2014-206791
Rodriguez-Garcia SC, Castellanos-Moreira R, Uson J, Naredo E et al (2021) Efficacy and safety of intra-articular therapies in rheumatic and musculoskeletal diseases: an overview of systematic reviews. RMD Open. https://doi.org/10.1136/rmdopen-2021-001658
Rodriguez-Garcia S, Castellanos-Moreira R, Uson-Jaeger J, Naredo E et al. (2019) Quantifying the Placebo Effect After Intra-Articular Injections: Implications for Trials and Practice. Arthritis Rheumatol 71 (suppl 10 (2019 ACR/ARP Annual Meeting)):1878.
Acknowledgements
The authors are indebted to the associations that forwarded the surveys to their members and to those who retweeted or posted the links in social media. We also want to acknowledge the help of Alzbeta Gohmann at the EULAR house for translating the patient survey into Czech, Ilhab Diri for checking the German translation, and Concha Cantalapiedra for uploading all surveys to SurveyMonkey©.
Funding
This specific survey was not funded, but the recommendations they support were supported by EULAR grant CL 109. SCR-G was funded by the Spanish Rheumatology Foundation (Grants for physician-researchers 2018–2021).
Author information
Authors and Affiliations
Contributions
JdlT and IP designed the first draft of the surveys with the help of JU and LC, which was reviewed by all other authors. The surveys were analysed by LC. JdlT, IP, LC, JU, and EN drafted the manuscript. All other authors contributed to the corrections and discussion.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare no conflicts of interest in relation to the topic under study.
Ethical approval
The study was exempt from ethics committee review, in accordance with national criteria, as it was not considered clinical research.
Consent to participate
The answer to the surveys was volunteer and consent was implicit in the answer. The first page explained the aims and contents, including the will to contribute.
Consent for publication
There was no specific consent for publication by survey participants. All authors gave consent for publication.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
de la Torre-Aboki, J., Uson, J., Pitsillidou, I. et al. Intra-articular therapies: patient preferences and professional practices in European countries. Rheumatol Int 42, 869–878 (2022). https://doi.org/10.1007/s00296-021-05045-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-021-05045-5