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Therapeutic pulsed ultrasound with or without intra-articular methotrexate in the management of rheumatoid arthritis



The aim of the study was to evaluate the role of combined therapeutic pulsed ultrasound with intra-articular methotrexate as against pulsed ultrasound treatment program alone in the management of chronic synovitis in rheumatoid arthritis patients.

Patients and methods

A total of 38 patients were enrolled in the study. All patients were above 18 years of age with inadequate clinical response in the form of persistent monoarthritis. Of them, 24 completed the study. Patients were divided into two equal treatment groups: The first group (12 patients) received three consecutive intra-articular methotrexate injections and daily therapeutic pulsed ultrasound sessions, whereas the second group (12 patients) received daily therapeutic low-intensity pulsed ultrasound sessions. All patients were subjected to clinical, laboratory, and ultrasound evaluation before and after treatment.


Patients were subjected to an ultrasound evaluation before and after treatment to detect synovial thickness, hot spots, erosions and effusion, with highly statistically significant difference observed in the number of swollen joints, tender joint count, visual analogue scale scores and synovial thickness at the wrist (P<0.01) in the group of patients who received ultrasound and methotrexate. In addition, there was a statistically significant difference with respect to hot spots, number of erosions and joint space narrowing (P<0.05).


The combination of pulsed ultrasound therapy with repeated intra-articular methotrexate can give us better results in the form of decreased effusion, tenderness, inflammation and synovial membrane thickness, all of which translate into significant recovery of function and reduction in pain in rheumatoid patients with resistant monoarthritis or oligoarthritis, with the least number of side effects and without the need of adding another disease-modifying agent and/or resorting to surgical synovectomy.


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Correspondence to Alaa A. Labeeb PhD.

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Labeeb, A.A., Casale, R., Soliman, S.G. et al. Therapeutic pulsed ultrasound with or without intra-articular methotrexate in the management of rheumatoid arthritis. Egypt Rheumatol Rehabil 40, 198–202 (2013).

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