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

Egyptian Rheumatology and Rehabilitation volume 40, pages 198–202 (2013)Cite this article

Abstract

Objectives

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.

Results

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).

Conclusion

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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Authors and Affiliations

  1. Department of Clinical Neurophysiology & Pain Rehabiliation Unit, Foundation Salvatore Maugeri’ IRCCS, Montescano, Italy

    Alaa A. Labeeb PhD & Roberto Casale

  2. Department of Rheumatology, Physical Medicine and Rehabilitation and department of Radiology, Menoufia University, 17 eisha street, Almay - Shibin Alkom El-Menoufia Governorate, Menoufia, Egypt

    Alaa A. Labeeb PhD, Samar G. Soliman & Waleed A. Mosa

Authors
  1. Alaa A. Labeeb PhD
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  2. Roberto Casale
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  3. Samar G. Soliman
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  4. Waleed A. Mosa
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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). https://doi.org/10.4103/1110-161X.123807

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  • DOI: https://doi.org/10.4103/1110-161X.123807

Keywords

  • intra-articular
  • methotrexate
  • pulsed ultrasound