Article
Nerve block of the proximal interphalangeal joints (PIPs) in Rheumatoid arthritis (RA) patients: a prospective pilot study
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Authors
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Ahmed Elsaman
- Universität Sohag
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Ahmed Hamed
- Faculty Of Education - Minia University
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Ahmed Radwan
- Universität Sohag
| Published: | September 9, 2020 |
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Outline
Text
Introduction: RA is among the commonest inflammatory arthritis influencing the hand with devastating impact on function and activities of daily living. Multiple remedies have just been setup for such a disease, but still achieving sustained remission is unattainable or challenging goal. Local therapy is getting more feasibility with fewer systemic side effects. Approximately 42% of RA patients could get sustained remission at a certain point of time during their disease progress. This can be ascribed to either inefficacy, side effects, poor compliance or the high cost of the present medications. An Intact nerve supply is needed to keep up the inflammatory cascade in RA. RA patients with hemiplegia have less arthritis on the hemiplegic side.
Methods: We included 83 rheumatoid arthritis patients (either early or established) diagnosed after ACR EULAR criteria 2010 with bilateral hand arthritis aged 18 or above. Nerve block to the neural bundle of the 2nd and 3rd PIP was done to one hand (the dominant in half of the participants and the non-dominant in the remaining). The other hand was used as a control and was injected with saline. Half ml of Bupivacaine hydrochloride .5% (Marcaine, Pfizer) was injected through a 27G needle at the level of the volar proximal digital crease of the 2nd and 3rd PIP on each side. PIPs of the 2nd and 3rd fingers in both hands were examined by EULAR OMERACT scoring system at 0, 2 weeks and 2 months intervals. VAS for each hand was also done at the same intervals. There was no certain conditions for medications and all the patients were using sDMARDS (10). The study was performed in two centers in upper Egypt (Sohag university, Minia university).
Results: There was a significant difference between both groups regarding pain and US and pain scores. Improvement was more significant in the 2nd than in the 3rd PIP in the active group. This effect was manifest in 0 and 2 weeks interval. At 2 months interval the difference was less manifest, yet still significant. This improvement was more in the non-dominant hand. Early patients achieved better results than established with non-significant difference (Table 1 [Tab. 1]).
Conclusion: Nerve block is a new promising therapy for RA. It is able to control pain and disease activity in the finger joints. In spite of its relatively short-term effect, it could limit steroid use and escalating systemic treatment plans. Further research is required to develop long term nerve block techniques and inclusion of greater number of joints.
Disclosures: none
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