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REFERENCE
[1] Cho L, Rocco M, Colquhoun D, et al. Clinical Profile of Statin Intolerance
in the Phase 3 GAUSS-2 Study. Cardiovasc Drugs Ther 2016;30(3):297–
304.
Disclosure of Interests: Yarden Yavne: None declared, Rivka Sheinin:
None declared, Rita Nogueira: None declared, Nicola Luigi Bragazzi:
None declared, Shmuel Tiosano: None declared, Abdulla Watad: None
declared, Kassem Sharif: None declared, Daniela Amital: None declared,
Hofit Cohen: None declared, Howard Amital Grant/research support from:
Pfizer, AbbVie, Janssen, Grant/research support from: Pfizer, AbbVie,
Janssen, Consultant for: Pfizer, Merck Sharp & Dohme, Consultant for:
Pfizer, Merck Sharp & Dohme, Speakers bureau: Pfizer, Merck Sharp &
Dohme, Janssen, Sanofi, Bristol-Myers Squibb, Abbvie, Neopharm, Speak-
ers bureau: Pfizer, Merck Sharp & Dohme, Janssen, Sanofi, Bristol-Myers
Squibb, Abbvie, Neopharm
DOI: 10.1136/annrheumdis-2019-eular.3349
Back pain, mechanical musculoskeletal problems,
local soft tissue disorders
AB0909 EFFICACY AND SAFETY OF ULTRASOUND GUIDED
ASPIRATION AND INTRA_LESIONAL
CORTICOSTEROIDS INJECTION OF RUPTURED
BAKER’S CYST
Mohammed A. Mortada, Youmna A. Amer. Faculty of Medicine. Zagazig
University, Rheumatology and Rehabilitation, Zagazig, Egypt
Background: Baker’s cyst is the most common mass in the popliteal
fossa and results from fluid distension of the gastrocnemio-semimembra-
nosus bursa. The most common complication of Baker’s cyst is the rup-
ture or dissection of fluid into the adjacent proximal gastrocnemius
muscle belly, which results in a pseudothrombophlebitis syndrome mimick-
ing symptoms of DVT.
Treatment of ruptured Baker cysts ranged from conservative management
to surgical resection.
Ultrasonographic guided aspiration and corticosteroids injection may be an
effective and easy method of management of these cases.
Up to the best of our knowledge, this is the first study to detect the effi-
cacy and safety of ultrasonographic guided aspiration and injections of
ruptured Baker cysts.
Objectives: To evaluate the efficacy and safety of ultrasonographic guided
aspiration and local corticosteroids of ruptured Baker cysts based on fol-
low-up clinical and sonographic results.
Methods: A retrospective study was conducted on 42 patients (12 males
and 30 females, mean age 36 +/- 10 SD years) affected by a ruptured
Baker cysts associated to knee joint disorders in the period between Jan-
uary 2013 to January 2019.The diagnosis was done by clinical presenta-
tion of acute calf pain, swelling, tenderness at the calf muscles and
ultrasonographic evidences of ruptured backer cysts in the form of free
fluid collection in the calf connected to a well defined cyst at the back
of knee.
All cases were treated by ultrasonographic guided aspiration and intra_le-
sional injection of corticosteroids once or twice one week a part. Follow
up were done on a weekly basis until complete resolution of symptoms
then 3 months later. Visual analogue scale (VAS) for calf pain and
Rauschning-Lindgren and Lysholm Knee Scoring Scales were used to
assess pre/post-injection knee functions.
Results: The primary diagnoses to patients presented with ruptured Baker
cyst in this study were as follow: 18 (42.8%) cases with rheumatoid
arthritis, 15 (37.5%) cases with osteoarthritis and 9 (21.4%) cases with
psoriatic arthritis.
Clinical parameters (VAS for calf pain and Rauschning-Lindgren score)
improved significantly in all patients at both post injection evaluation
visits.
Rauschning-Lindgren score was significantly lower after US guided injec-
tions (mean, 0; range, 0-1) than at baseline (mean, 2; range, 1–2);
p< 0.001 (table1).
VAS for calf pain also significantly lower after US guided injections
(mean,0.5; range, 0-1) than at baseline (mean, 9.5; range, 0-10);
p< 0.001.
Ultrasonographic features improved significantly with complete disappear-
ance of free fluid at the calf in 35 (83.3%) cases one week after the
injection.
As regards Baker cyst only 5 (11%) cases showed complete disappear-
ance of the backer cyst and in the majority of cases 37 (88%) there
were persistent Baker cysts.
No side effects were reported in all cases.
Abstract AB0909 Table 1. Clinical results of Baker cyst excision (Rauschning and Lindgren
scale and VAS for calf pain)
Pre injection 1 week later 3 months later
grade 0 0 30 39
Grade 1 0 8 3
Grade 2 6 4 0
Grade3 36 0 0
VAS for calf pain 9.5 1.5 0.5
VAS; visual analogue scale
Conclusion: Ultrasonographic guided aspiration and intra_lesional cortico-
steroids injection is an effective and safe method in management of rup-
tured Baker cysts.
REFERENCE
[1] Nigerian Journal of Orthopaedics and Trauma June 2009: 8 (1): 31-32
Disclosure of Interests: None declared
DOI: 10.1136/annrheumdis-2019-eular.3511
AB0910 EFFECTIVE RESTORING MOTION AND EFFECTIVE
TREATMENT OF MYOFASCIAL AND NEUROPATHIC
LOW BACK PAIN BY TARGATED DRY NEEDLING
USING ULTRASOUND GUIDANCE
Rostyslav Bubnov
1,2
,LevKalika
3
.
1
Zabolotny Institute of Microbiology and
Virology, NAS of Ukraine, Kyiv, Ukraine;
2
Clinical Hospital “Pheophania”of State
Affairs Department, Ultrasound, Kyiv, Ukraine;
3
NYDNRrehab: Chiropractic and
Physical Therapy Clinic NYC, New York, United States of America
Background: Low back pain (LBP) involves both myofascial and neuro-
pathic components of pain. Neuropathic pain is a widespread problem,
require continuous consumption of medications. Muscle spasticity might
evoke nerve compression, dry needling (DN) of myofascial trigger points
(MTrP) under ultrasound (US) guidance is effective method for treatment
myofascial pain [1,2] restoring posture [3] and can be effective for neuro-
pathic pain.
Objectives: The aim was to evaluate efficacy of dry needling under US
guidance for treatment myofascial and neuropathic components of LBP.
Methods: We included 52 patients, 37 females, aged 18-84 years (the
average was 55 years) with clinically diagnosed chronic low back pain
with neuropathic component with clinically diagnosed low back pain over
3 month with neuropathic component and reduced motility in spine, pelvis
and lower extremity. All patients had symptoms over 3 month, underwent
general exam, including MRI, laboratory, neurologic, orthopedic tests. We
conducted precise physical tests and neuromuscular ultrasound using M-
mode and evaluated nerves and motion in intervetrebral spaces, pelvis,
intrinsic foot and leg muscles. We conducted ultrasound survey at the
levels of predicted nerve injury. Patients received DN of MTrP under US
guidance according to approach by R.Bubnov [1,2], considering nerve
entrapment area. Visual analogue scale (VAS, 0-10) and Leeds Assess-
ment of Neuropathic Symptoms and Signs (LANSS) scores were meas-
ured before, immediately after, 24 hours, and 7 days after intervention.
Results: After 7 days, VAS scores showed pain improvement from 7.4 to
2.2; LANSS scores improved from 16 to 4. In diabetic and postherpetic
neuropathy cases we obtained similar results as in rest of patients (p <
0.05). US demonstrated improvement nerve structure, increasing motility,
contractility (muscle contracted/rested thickness) on M-mode during func-
tional tests and walking in all levels. Improvement of neuropathy signs as
decrease of fascicles diameter from 2 to 0.9 mm measured on US in
sciatic nerve, both in tibial, peroneal portions, data correlated with self-
assessment pain decrease (r > 0.8). Preferably MTrP were identification
in supinator muscle (wrist pain); rotator muscles (infraspinatus, supraspina-
tus, subscapular and teres minor muscles); scalene muscles; obliquus
capitis muscles, and also in fascial tissue.
Conclusion: Dry needling under US guidance guidance effectively reduce
myofascial pain, ameliorate symptoms of neuropathy and local muscle
hypomotility in low back pain. Further research needed for development
US patterns and study causation in chain spasticity-contractility- motion-
neuropathic pain.
Scientific Abstracts 1921
on December 7, 2019 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/annrheumdis-2019-eular.5533 on 27 June 2019. Downloaded from
REFERENCES
[1] Bubnov RV: The use of trigger point “dry”needling under ultrasound guid-
ance for the treatment of myofascial pain (technological innovation and lit-
erature review). Lik Sprava 2010, 5-6:56-64.
[2] Bubnov RV: Evidence-based pain management: is the concept of integra-
tive medicine applicable? EPMA J 2012, 3(1):13.
[3] Bubnov R, Kalika L, Babenko L. AB1199 Dynamic ultrasound for multilevel
evaluation of motion and posture in lower extremity and spine. Annals of
the Rheumatic Diseases 2018;77:1699. http://dx.doi.org/10.1136/annr-
heumdis-2018-eular.3949
Disclosure of Interests: None declared
DOI: 10.1136/annrheumdis-2019-eular.5533
AB0911 REFRACTORY LOW BACK PAIN AND LUMBAR CT-
GUIDED STEROID INFILTRATION. STUDY OF 582
PROCEDURES FROM THE SAME CENTER
I. Calvo
1
,O. Ibarguengoitia
1
, D Montero
1
,L Vega
1
, L María
1
, M E. Ruiz
1
ITorre
1
,
OFernandez
1
,JM.Blanco
1
, A R. Inchaurbe
1
, Clara Pérez
1
,Eduardo Cuende
1
,
F. Diez
2
,C.Morandeira
2
, Iñigo Gorostiza
3
,E Galindez
1
.
1
Basurto University
Hospital, Rheumatology, Bilbao, Spain;
2
Basurto University Hospital,
Radiodiagnostic, Bilbao, Spain;
3
Basurto University Hospital, Research Unit,
Bilbao, Spain
Background: Mechanical low back pain which is refractory to analgesic
and rehabilitative treatment is an important cause of disability. The pri-
mary objective of corticosteroid (CS) lumbar infiltratation is to accelerate
the recovery process and to avoid surgery. However, its use is not with-
out controversy.
Objectives: To review the indications, efficacy and complications of lum-
bar computed tomography (CT)-guided CS infiltration.
Methods: Retrospective study (January 2012 - April 2018) of lumbar CT-
guided CS infiltrations performed in a single center. The epidemiological
variables, underlying pathologies, approach of injection, used CS (dexame-
thasone during the whole period and triamcinolone until February 2015),
efficacy after 1 and after 3 months and complications were registered. In
addition, a comparative study of the efficacy according to indication, type
of CS and approach of injection was performed.
Frequencies and percentages were used in qualitative variables, mean
±SD in quantitative and for the comparison between groups Chi2 test or
Fisher test was used in categorical variables and Student T test or U of
Mann-Whitney in quantitative. Statistical analysis was performed with IBM
SPSS v.23.
Results: 582 procedures were performed in 445 patients (1 infiltration in
445 patients, 2 in 106, 3 in 23, 4 in 7 and 5 in 1). The mean age±SD
was 58.6±14.8 years with a male/female ratio of 224/221. Traumatology
was the service with highest demand (88.8%) followed by rheumatology
(4.8%). The indications were disc herniation (43.1%), lumbar spinal steno-
sis(36.4%), postoperative fibrosis (14.8%), spondyloarthrosis (2.7%) and
other [listhesis, synovial cyst and facet joint syndrome] (2.8%). Posterior
epidural access was performed in 27.1% of the procedures, foraminal in
17.9% and lateral recess in 55%. The used CS were dexamethasone
(66.3%) and triamcinolone (33.7%). In 86% of patients the oral analgesic
treatment had been ineffective.
Improvement was observed in 68% of patients at the first month (table)
regardless of the indication, approach of injection and CS used and in
63.2% at 3 months.
Only 124 patients (21.3%) required surgery due to the persistence of
pain, mostly within the first year after infiltration (66.9%).
Clinical efficacy showed no statistically significant differences regarding to
the indication of the procedure. On the other hand, we observed a signif-
icantly higher improvement of the pain through the foraminal and lateral
recess than through the epidural at 3 months (p= 0.002). Regarding the
CS used, the improvement was significantly greater with triamcinolone
compared to dexamethasone in the first and third months (p= <0.001).
Concerning safety, there were 16 cases (2.7%) of local complications (5
punctures of the thecal sac, 4 extravasations of the contrast and 7 tran-
sient pain in lower extremities) and 5 (0.9%) systemic complications (3
allergic reactions and 2 syncope due to low blood pressure), without clin-
ical relevance and they were not associated with the indication, approach
of injection and CS used.
Conclusion: In our series disc herniation, lumbar stenosis and postopera-
tive fibrosis were the most common indications. Improvement was
observed in 68% and in 63.2% of the patients in the first and third
months respectively.
Figure 1
Only 21% required surgery. Triamcinolone (although its use is currently
discouraged because it is a particulate CS), foraminal infiltration and lat-
eral recess proved to be more effective for pain control.
In this study, lumbar CT-guided CS infiltration in patients with refractory
low back pain is an accessible, minimally invasive, safe and effective
procedure in long term.
Disclosure of Interests: None declared
DOI: 10.1136/annrheumdis-2019-eular.1990
AB0912 EXTRACORPOREAL SHOCKWAVE VERSUS
MUSCULOSKELETAL MESOTHERAPY FOR ACHILLES
TENDINOPATHY IN ATHLETES
Reem Elmallah
1
, Enas Elattar
2
.
1
faculty of medicine Ain Shams University,
Assistant Professor of Physical Medicine, Rheumatology and Rehabilitation, cairo,
Egypt;
2
Faculty of Medicine. Ain Shams University, Assistant Professor of Physical
Medicine, Rheumatology and Rehabilitation, cairo, Egypt
Background: Achilles tendinopathy (AT) is considered as one of the com-
mon tendon pathologies, which occurs mainly in athletes. Different conser-
vative treatment options have been introduced and used for symptoms
relief of At but with short-term effect.1 Extracorporeal shockwave treat-
ment (ESWT) provides longer effects and could be used in cases fail to
respond to conservative treatments.2 Mesotherapy is widely practiced in
sports medicine as multiple injections, often of anti-inflammatory medica-
tions into the subcutaneous fat overlying a region of musculoskeletal
pain. The effect appears unclear but may be due to localized tissue
uptake of anti-inflammatory medication which may provide symptomatic
relief especially in insertional Achilles tendinopathy 3
Objectives: In this study, we aimed to evaluate the effect of extracorpor-
eal shockwave treatment
(ESWT)and mesotherapy on chronic Achilles tendinopathy in athletes
Methods: 40 patients with chronic AT were diagnosed clinically & using
high resolution ultrasound (US) according to the Eular guide lines and
randomly allocated in two groups, first receive ESWT, other group under-
went mesotherapy (MT) one session once a week for 4 weeks to the 2
groups. Pain, ankle-hindfoot scale of the American Orthopedic Foot and
Ankle Society (AOFAS) 4 & US were recorded at baseline, 4 and 12
weeks after intervention
Results: Both groups improved during the treatment and follow-up period.
The mean VAS score decreased from 7.55 to 3 in the ESWT group and
from 7.70 to 4.30 in MT group. There was no significant difference in
terms of AOFAS and VAS scores between both groups at 4 weeks fol-
low up while Mean AOFAS & VAS scores were significantly different
between ESWT and MT groups at 12 weeks of follow-up (P = 0.013) (P
= 0.47). US assessment significantly improved after 12 weeks in ESWT
group as regards tendon thickness, calcifications(figure1,2) and doppler
signal.
Conclusion: ESWT showed improvement of pain and inflammation of AT
than MT injections which was documented by the decreased VAS,
increased AOFAS scores as well as US improved findings shortly after
the treatment as well as on late follow up.
REFERENCES
[1] Diehl P, Gollwitzer H, Schauwecker J, Tischer T, Gerdesmeyer L. Conser-
vative treatment of chronic tendinopathies. Orthopade. 2014;43:183–93.
[2] Moayednia A, Haghdani S, Khosrawi S, Yousefi E, Vahdatpour B. Long-
term effect of extracorporeal shock wave therapy on the treatment of
chronic pelvic pain syndrome due to non bacterial prostatitis. J Res Med
Sci. 2014;19:293–6
[3] Paoloni J. Current Strategy in the Treatment of Achilles Tendinopathy. In:
Čretnik Andrej., editor. Achilles’tendon. InTech Rijeka; Croatia: 2012
1922 Scientific Abstracts
on December 7, 2019 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/annrheumdis-2019-eular.5533 on 27 June 2019. Downloaded from
