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J M Van Laar - One of the best experts on this subject based on the ideXlab platform.
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Arthroscopic Lavage plus corticosteroids is more effective than joint aspiration plus corticosteroids in patients with arthritis of the knee
Nederlands tijdschrift voor geneeskunde, 2008Co-Authors: M. Van Oosterhout, Jacob K. Sont, Ingeborg M. Bajema, F. C. Breedveld, J M Van LaarAbstract:Objective. To compare the efficacy of Arthroscopic Lavage plus corticosteroids (ALC), Arthroscopic Lavage plus placebo (ALP), and joint aspiration plus corticosteroids (JAC) in patients with arthritis of the knee, and to identify clinical or histological factors that predict outcome. Design. Prospective, randomised. Method. Patients with arthritis of the knee (not due to gout, osteoarthritis or septic arthritis) were randomised to 1 of 3 treatment arms: ALC, ALP or JAC. The primary endpoint was time to recurrence; recurrence was defined as recurrent or persistent symptomatic knee swelling requiring local treatment, and/or non-improvement in knee joint score. Synovial tissue specimens were collected for histological analysis. Results. Of the 78 patients enrolled, 3 did not receive the intended therapy and 3 were lost to follow-up. The median time to recurrence was 9.6 months in the ALC group, 3.0 months in the JAC group and 1.0 month in the ALP group. Compared with ALC, the relative risk of recurrence of arthritis (RR) was 2.2 for JAC (95% CI:1.2-4.2; p = 0.02) and 4.7 for ALP (95%. CI: 2.3-9.4; p < 0.0001). In the ALC group, extensive synovial fibrosis was associated with a higher risk of recurrence (RR 5.7; 95% CI: 1.6-20.5; p < O.OI). Conclusion. Arthroscopic Lavage plus corticosteroids was more effective than Arthroscopic Lavage plus placebo or joint aspiration plus corticosteroids. The absence of synovial fibrosis predicted a beneficial response.
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Comparison of efficacy of Arthroscopic Lavage plus administration of corticosteroids, Arthroscopic Lavage plus administration of placebo, and joint aspiration plus administration of corticosteroids in arthritis of the knee: A randomized controlled tr
Arthritis and rheumatism, 2006Co-Authors: M. Van Oosterhout, Jacob K. Sont, Ingeborg M. Bajema, F. C. Breedveld, J M Van LaarAbstract:Objective To compare the efficacy of Arthroscopic Lavage plus administration of corticosteroids (ALC), Arthroscopic Lavage plus administration of placebo (ALP), and joint aspiration plus administration of corticosteroids (JAC) in knee arthritis, and to evaluate whether clinical or histologic characteristics determine outcome. Methods Patients with knee arthritis (not due to gout, osteoarthritis, or septic arthritis) were randomized over 3 treatment arms: ALC, ALP, and JAC. The primary end point was event-free survival, with events defined as 1) recurrence or persistence of symptomatic knee swelling necessitating local re-treatment, or 2) nonimprovement of the knee joint score. Synovial tissue specimens were collected and analyzed histologically to identify predictive factors of responsiveness. Results A total of 78 patients were enrolled; 3 patients did not receive their allocated therapy and 3 were lost to followup. The median time until recurrence was 9.6 months after ALC, 3.0 months after JAC, and 1.0 month after ALP, corresponding to a relative risk (RR) of arthritis recurrence of 2.2 for JAC (95% confidence interval [95% CI] 1.2–4.2, P = 0.02) and 4.7 for ALP (95% CI 2.3–9.4, P < 0.0001) compared with ALC. A high versus low synovial extent of fibrosis conferred an RR for recurrence of 5.7 (95% CI 1.6–20.5, P < 0.01) after ALC. Conclusion Arthroscopic Lavage plus administration of corticosteroids was more effective than Arthroscopic Lavage plus administration of placebo or joint aspiration plus injection of corticosteroids. The absence of fibrosis was a histologic predictor of a beneficial response.
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Superior effect of Arthroscopic Lavage compared with needle aspiration in the treatment of inflammatory arthritis of the knee
Rheumatology (Oxford England), 2003Co-Authors: M. Van Oosterhout, Jacob K. Sont, J M Van LaarAbstract:Objectives. To compare the duration of symptom relief after Arthroscopic Lavage versus needle aspiration in gonarthritis. Methods. A retrospective chart analysis was performed in 50 patients with non-septic inflammatory arthritis of the knee who underwent Arthroscopic Lavage because of relapsing or persisting arthritis after needle aspiration. The primary outcome measure was the time until symptomatic recurrence of knee synovitis. Results. Needle aspiration was associated with a 3.0 times greater risk of recurrence of arthritis compared with Arthroscopic Lavage within 12 months (P
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superior effect of Arthroscopic Lavage compared with needle aspiration in the treatment of inflammatory arthritis of the knee
Rheumatology, 2003Co-Authors: M. Van Oosterhout, Jacob K. Sont, J M Van LaarAbstract:Objectives. To compare the duration of symptom relief after Arthroscopic Lavage versus needle aspiration in gonarthritis. Methods. A retrospective chart analysis was performed in 50 patients with non-septic inflammatory arthritis of the knee who underwent Arthroscopic Lavage because of relapsing or persisting arthritis after needle aspiration. The primary outcome measure was the time until symptomatic recurrence of knee synovitis. Results. Needle aspiration was associated with a 3.0 times greater risk of recurrence of arthritis compared with Arthroscopic Lavage within 12 months (P<0.001, 95% confidence interval 2.1-4.4). Patients with longer disease duration and who had used more disease-modifying anti-rheumatic drugs (DMARDs) had a significantly lower risk of recurrence of arthritis compared with patients with shorter disease duration and a lower number of previous DMARDs (P=0.04 and 0.02 respectively). Corticosteroids augmented the effect of both interventions. Conclusions. Our results indicate that Arthroscopic Lavage is an effective therapeutic modality in the treatment of inflammatory arthritis of the knee refractory to joint aspiration, especially in patients with longstanding disease.
M. Van Oosterhout - One of the best experts on this subject based on the ideXlab platform.
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Pathological features of rheumatoid synovitis in the context of therapeutic interventions and clinical settings
2008Co-Authors: M. Van OosterhoutAbstract:This thesis discusses several aspects of therapeutic interventions for arthritis of the knee, especially Arthroscopic Lavage. Arthroscopic Lavage is a technique in which the inflamed knee of the patient is rinced with saline. After the procedure corticosteroids can be administered to suppress inflammation. Arthroscopic Lavage was superior in suppressing recurrence of arthritis compared to standard joint injections with corticosteroids. The occurence of fibrosis in the inflamed joint was predictive of an inferior response. During Arthroscopic Lavage synovial tissue samples can be obtained. These biopsies were studied before and after treatment with anti-TNF in longstanding and early (therapy-naieve) Rheumatoid Arthritis (RA)patients. The clinical and synovial effect were comparable between both groups. In the latter part differences in synovial inflamation between RA patients with and without antibodies against cyclic citrullinated peptides (CCP) are discussed in relation to the occurence of joint damage. In anti-CCP positive patients we found more infiltrating lymphocytes leading to progression of joint damage. Also, temporal changes in synovial inflammation differed between anti-CCP positive and anti_CCP negative RA, underlining the fenotypical differences betwen both disease entities.
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Arthroscopic Lavage plus corticosteroids is more effective than joint aspiration plus corticosteroids in patients with arthritis of the knee
Nederlands tijdschrift voor geneeskunde, 2008Co-Authors: M. Van Oosterhout, Jacob K. Sont, Ingeborg M. Bajema, F. C. Breedveld, J M Van LaarAbstract:Objective. To compare the efficacy of Arthroscopic Lavage plus corticosteroids (ALC), Arthroscopic Lavage plus placebo (ALP), and joint aspiration plus corticosteroids (JAC) in patients with arthritis of the knee, and to identify clinical or histological factors that predict outcome. Design. Prospective, randomised. Method. Patients with arthritis of the knee (not due to gout, osteoarthritis or septic arthritis) were randomised to 1 of 3 treatment arms: ALC, ALP or JAC. The primary endpoint was time to recurrence; recurrence was defined as recurrent or persistent symptomatic knee swelling requiring local treatment, and/or non-improvement in knee joint score. Synovial tissue specimens were collected for histological analysis. Results. Of the 78 patients enrolled, 3 did not receive the intended therapy and 3 were lost to follow-up. The median time to recurrence was 9.6 months in the ALC group, 3.0 months in the JAC group and 1.0 month in the ALP group. Compared with ALC, the relative risk of recurrence of arthritis (RR) was 2.2 for JAC (95% CI:1.2-4.2; p = 0.02) and 4.7 for ALP (95%. CI: 2.3-9.4; p < 0.0001). In the ALC group, extensive synovial fibrosis was associated with a higher risk of recurrence (RR 5.7; 95% CI: 1.6-20.5; p < O.OI). Conclusion. Arthroscopic Lavage plus corticosteroids was more effective than Arthroscopic Lavage plus placebo or joint aspiration plus corticosteroids. The absence of synovial fibrosis predicted a beneficial response.
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Comparison of efficacy of Arthroscopic Lavage plus administration of corticosteroids, Arthroscopic Lavage plus administration of placebo, and joint aspiration plus administration of corticosteroids in arthritis of the knee: A randomized controlled tr
Arthritis and rheumatism, 2006Co-Authors: M. Van Oosterhout, Jacob K. Sont, Ingeborg M. Bajema, F. C. Breedveld, J M Van LaarAbstract:Objective To compare the efficacy of Arthroscopic Lavage plus administration of corticosteroids (ALC), Arthroscopic Lavage plus administration of placebo (ALP), and joint aspiration plus administration of corticosteroids (JAC) in knee arthritis, and to evaluate whether clinical or histologic characteristics determine outcome. Methods Patients with knee arthritis (not due to gout, osteoarthritis, or septic arthritis) were randomized over 3 treatment arms: ALC, ALP, and JAC. The primary end point was event-free survival, with events defined as 1) recurrence or persistence of symptomatic knee swelling necessitating local re-treatment, or 2) nonimprovement of the knee joint score. Synovial tissue specimens were collected and analyzed histologically to identify predictive factors of responsiveness. Results A total of 78 patients were enrolled; 3 patients did not receive their allocated therapy and 3 were lost to followup. The median time until recurrence was 9.6 months after ALC, 3.0 months after JAC, and 1.0 month after ALP, corresponding to a relative risk (RR) of arthritis recurrence of 2.2 for JAC (95% confidence interval [95% CI] 1.2–4.2, P = 0.02) and 4.7 for ALP (95% CI 2.3–9.4, P < 0.0001) compared with ALC. A high versus low synovial extent of fibrosis conferred an RR for recurrence of 5.7 (95% CI 1.6–20.5, P < 0.01) after ALC. Conclusion Arthroscopic Lavage plus administration of corticosteroids was more effective than Arthroscopic Lavage plus administration of placebo or joint aspiration plus injection of corticosteroids. The absence of fibrosis was a histologic predictor of a beneficial response.
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Superior effect of Arthroscopic Lavage compared with needle aspiration in the treatment of inflammatory arthritis of the knee
Rheumatology (Oxford England), 2003Co-Authors: M. Van Oosterhout, Jacob K. Sont, J M Van LaarAbstract:Objectives. To compare the duration of symptom relief after Arthroscopic Lavage versus needle aspiration in gonarthritis. Methods. A retrospective chart analysis was performed in 50 patients with non-septic inflammatory arthritis of the knee who underwent Arthroscopic Lavage because of relapsing or persisting arthritis after needle aspiration. The primary outcome measure was the time until symptomatic recurrence of knee synovitis. Results. Needle aspiration was associated with a 3.0 times greater risk of recurrence of arthritis compared with Arthroscopic Lavage within 12 months (P
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superior effect of Arthroscopic Lavage compared with needle aspiration in the treatment of inflammatory arthritis of the knee
Rheumatology, 2003Co-Authors: M. Van Oosterhout, Jacob K. Sont, J M Van LaarAbstract:Objectives. To compare the duration of symptom relief after Arthroscopic Lavage versus needle aspiration in gonarthritis. Methods. A retrospective chart analysis was performed in 50 patients with non-septic inflammatory arthritis of the knee who underwent Arthroscopic Lavage because of relapsing or persisting arthritis after needle aspiration. The primary outcome measure was the time until symptomatic recurrence of knee synovitis. Results. Needle aspiration was associated with a 3.0 times greater risk of recurrence of arthritis compared with Arthroscopic Lavage within 12 months (P<0.001, 95% confidence interval 2.1-4.4). Patients with longer disease duration and who had used more disease-modifying anti-rheumatic drugs (DMARDs) had a significantly lower risk of recurrence of arthritis compared with patients with shorter disease duration and a lower number of previous DMARDs (P=0.04 and 0.02 respectively). Corticosteroids augmented the effect of both interventions. Conclusions. Our results indicate that Arthroscopic Lavage is an effective therapeutic modality in the treatment of inflammatory arthritis of the knee refractory to joint aspiration, especially in patients with longstanding disease.
Sune Larsson - One of the best experts on this subject based on the ideXlab platform.
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Arthroscopic Lavage speeds reduction in effusion in the glenohumeral joint after primary anterior shoulder dislocation: a controlled randomized ultrasound study.
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2000Co-Authors: G. Wintzell, L. Hovelius, L. Wikblad, M. Saebö, Sune LarssonAbstract:Recent studies have shown that Arthroscopic Lavage of the glenohumeral joint within 10 days following a primary anterior dislocation significantly lowers the recurrence rate when compared with a nonoperative regime. We hypothesize that the Lavage reduces distension in the joint and thereby facilitates adaptation and healing of the soft tissue lesion. Using ultrasound, we assessed the hemarthrosis in the glenohumeral joint weekly in 16 consecutive patients after traumatic primary anterior shoulder dislocation. The patients were randomized into two groups for treatment with either Arthroscopic Lavage or a nonoperative regime. Except for the Lavage the two groups followed an identical rehabilitation program. Transversal dorsal ultrasound of the glenohumeral joint was performed, in which the joint effusion was assessed as the distance between the humeral head and the glenoid. Prior to the Lavage the two groups had a similar amount of excessive joint effusion. The effusion declined to a steady state level within 3–7 weeks. The joint effusion decreased more rapidly (33%) in the group treated with Arthroscopic Lavage (P = 0.02) than in the nonoperated group.
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Arthroscopic Lavage reduced the recurrence rate following primary anterior shoulder dislocation A randomised multicentre study with 1-year follow-up
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 1999Co-Authors: G. Wintzell, Y. Haglund-Åkerlind, L. Hovelius, A. Ekelund, B. Sandström, Sune LarssonAbstract:Young individuals have a high recurrence rate following non-operative treatment of traumatic primary anterior shoulder dislocation. The present multicentre study was undertaken to find out whether the results could be improved by using Arthroscopic Lavage as treatment. Sixty patients aged 16–30 years, with traumatic primary anterior shoulder dislocation were randomised into two groups. One group was treated with Arthroscopic Lavage within 10 days, while the other group was treated non-operatively. Rehabilitation was otherwise identical. At 1-year follow-up, 4 of 30 patients (13%) in the Lavage group had had redislocation compared with 13 of 30 (43%) in the group treated non-operatively (P = 0.01).The difference in recurrence rate was more pronounced in younger patients. The functional outcome according to the Rowe shoulder score was better in the Lavage group (P = 0.003), as was the anterior stability according to the apprehension test (P = 0.008). We conclude that Arthroscopic Lavage reduced the recurrence rate and produced a better functional outcome at 1-year follow-up than the non-operative treatment in young individuals.
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Arthroscopic Lavage compared with nonoperative treatment for traumatic primary anterior shoulder dislocation: a 2-year follow-up of a prospective randomized study.
Journal of shoulder and elbow surgery, 1999Co-Authors: G. Wintzell, Y. Haglund-Åkerlind, Jan Nowak, Sune LarssonAbstract:Abstract A prospective randomized study was performed on 30 consecutive patients with traumatic primary anterior shoulder dislocation to compare treatment results of Arthroscopic Lavage with results of conventional nonoperative treatment. The patients were between 18 and 30 years of age and had no history of shoulder problems. At the 2-year followup, 3 (20%) of 15 patients in the Lavage group had a redislocated shoulder compared with 9 (60%) of 15 patients in the nonoperative group (P = .03). Two of the patients in the Lavage group compared with 6 of the patients in the control group had been operated on or were scheduled for stabilizing surgery. Functional outcome according to the Constant and Rowe shoulder scores did not reveal any significant difference (P = .07) between the groups. However, by the Rowe classification 2 of 15 patients in the Lavage group had poor results versus 8 of 15 in the control group, indicating an advantage for the Lavage treatment. The study showed that Arthroscopic Lavage reduced the risk for recurrent dislocation when compared with nonoperative treatment.
Steve J Drew - One of the best experts on this subject based on the ideXlab platform.
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Management of shoulder dislocation--are we doing enough to reduce the risk of recurrence?
Injury, 2002Co-Authors: Anthea R Davy, Steve J DrewAbstract:Young patients with shoulder dislocation are at high risk of recurrence. Traditionally, management has been conservative, but rehabilitative programmes are successful in fewer than 20% of patients. Recent studies suggest that early surgical intervention (Arthroscopic Lavage or stabilisation) can significantly reduce recurrence in young patients with primary traumatic anterior dislocation. This study demonstrated that in our region, 21% of all patients presenting with shoulder dislocation had already suffered recurrence at 1 year; in the 15-22 years age group this figure was 43%. We propose to offer young patients presenting with primary traumatic anterior dislocations Arthroscopic Lavage within 10 days of injury. The extra surgical workload is manageable within our current trauma service arrangements, and we believe that this form of treatment would be acceptable to patients.
Bruce Moseley - One of the best experts on this subject based on the ideXlab platform.
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Arthroscopic Lavage plus corticosteroids was more effective than Arthroscopic Lavage plus placebo or joint aspiration plus corticosteroids for arthritis of the knee
Journal of Bone and Joint Surgery American Volume, 2007Co-Authors: Bruce MoseleyAbstract:Question: In patients with inflammatory arthritis, what is the relative effectiveness of Arthroscopic Lavage plus corticosteroids, Arthroscopic Lavage alone, and joint aspiration plus corticosteroids? Design: Randomized (allocation concealed), partially blinded (outcome assessors), placebo-controlled trial with 9-month follow-up. Setting: A university medical center in The Netherlands. Patients: 78 patients who were ≥18 years of age (mean age 54 y, 55% women) and had arthritis of the knee not due to gout, osteoarthritis, or infection. Exclusion criteria were hemorrhagic disease, oral prednisone >10 mg/day, recent (<6 weeks) change of disease-modifying antirheumatic drugs, recent joint infection, or hypersensitivity to methylprednisolone or local anesthetics. Follow-up was 96%. Intervention: 26 patients were allocated to Arthroscopic Lavage plus corticosteroids, 26 to Arthroscopic Lavage plus placebo, and 26 to joint aspiration plus corticosteroids (methylprednisolone, 80 mg in 2 mL). For all interventions, synovial fluid was maximally aspirated from the suprapatellar pouch, 30 mL of lidocaine 0.5% was injected intra-articularly through the aspiration needle, and the skin and joint capsule was additionally infiltrated with 10 mL of lidocaine 1%. For Arthroscopic Lavage, the skin inferolateral to the patella was also injected with 10 mL of lidocaine 1%. Two trocars were placed into the joint cavity through 2 skin incisions: 1 inferior for the camera and saline solution, and 1 superior for drainage of the irrigation fluid and use of biopsy forceps. 1000 mL of saline solution was flushed through the joint. During Lavage, 15 to 20 synovial biopsy samples were obtained with 2.0-mm forceps. Bupivacaine (30 mg in 6 mL) plus corticosteroids (methylprednisolone, 80 mg in 2 mL) for 1 group and bupivacaine alone ("placebo") for the other was injected through the inferior trocar. For joint aspiration, a single skin incision was made and 1 trocar placed. After synovial biopsy samples (15 to 20) were obtained, a mixture of methylprednisolone (80 mg in 2 mL) and bupivacaine (30 mg in 6 mL) was injected into the joint. Main outcome measures: Event-free survival (time from treatment until local re-treatment because of recurrence or persistence of arthritis of the knee). Main results: The median event-free survival time was 9.6 months after Arthroscopic Lavage plus corticosteroids, 3.0 months after joint aspiration plus corticosteroids, and 1.0 month after Arthroscopic Lavage plus placebo. Patients in the Arthroscopic Lavage plus corticosteroids group had a lower risk of arthritis recurrence than patients in the other 2 groups (Table). Patients in the joint aspiration group had a lower risk of arthritis recurrence than patients in the Arthroscopic Lavage plus placebo group (Table). Conclusion: In patients with inflammatory arthritis of the knee, Arthroscopic Lavage plus corticosteroids was more effective than Arthroscopic Lavage plus placebo or joint aspiration plus corticosteroids.
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Arthroscopic Lavage plus corticosteroids was more effective than Arthroscopic Lavage plus placebo or joint aspiration plus corticosteroids for arthritis of the knee.
The Journal of bone and joint surgery. American volume, 2007Co-Authors: Bruce MoseleyAbstract:Question: In patients with inflammatory arthritis, what is the relative effectiveness of Arthroscopic Lavage plus corticosteroids, Arthroscopic Lavage alone, and joint aspiration plus corticosteroids? Design: Randomized (allocation concealed), partially blinded (outcome assessors), placebo-controlled trial with 9-month follow-up. Setting: A university medical center in The Netherlands. Patients: 78 patients who were ≥18 years of age (mean age 54 y, 55% women) and had arthritis of the knee not due to gout, osteoarthritis, or infection. Exclusion criteria were hemorrhagic disease, oral prednisone >10 mg/day, recent (
