Background:Rheumatoid arthritis is a common type of autoimmune arthritis characterized by chronic inflammation. Cervical spine is often affected specially in long lasting diseaseObjectives:Evaluate efficacy of Third occipital nerve Radiofrequency under fluoroscopic guidance to treat refractory cervicogenic headache in RA patients.Methods:The current study was revised and approved from the local ethical committee of Faculty of Medicine; Assiut University, then registered in the clinical trials under the number ofNCT03852355. Inclusion criteria included, Patients who fulfilled the American College of Rheumatology (ACR) (2010) criteria for RA and suffering from upper neck pain and/or headache due to bilateral 3rd occipital nerve involvement, excluding other local cervical spine pathologies was confirmed by MRI and previously failed conservative treatment for at least three months prior to enrollment. Sixty adult patients were randomly assigned to one of the two studied groups Group 1 (RF, n = 30), received bilateral Third occipital nerve Radiofrequency under fluoroscopic guidance or Group 2 (control group, n = 30), received oral prednisolone 10 mg/day. The two groups were then followed-up with neck disability index (NDI), nocturnal neck pain VAS score and headache score every two weeks for three months. Sleep disturbance, sleep disability index were reassessed six months post intervention. Post interventional assessment was done by pain physician who were kept blind to the grouping process.Results:Neck disability index (1ry outcome), Nocturnal pain VAS, and severity of headache showed significant differences during the whole post-interventional study period. The patients in RF group demonstrated significant improvement of pain in comparison to baseline value over the whole six months with p-value < 0.001 as regard to the fore-mentioned three parameters. On the other aspect, the control group patients showed significant improvement in comparison to its baseline value after the 2nd, 12th and 24th weeks only as follows: (0.001,0.003, 0.003 for the NDI) (p values of 0.02,0.01, 0.01 for the nocturnal pain VAS), (0.001 0.009, 0.005 for the headache VAS severity.Conclusion:Radiofrequency of 3rd occipital nerve is effective in treatment of refractory cervicogenic headache in RA.Disclosure of Interests: :None declared
Modified percutaneous radiologic gastrostomy technique without endoscopic or nasogastric access
