Healthcare costs among patients with macular oedema associated with non-infectious uveitis: a US commercial payer’s perspective

ObjectiveTo describe patient characteristics and healthcare costs associated with uveitic macular oedema (UME) in US clinical practices from a commercial payer’s perspective.Methods and analysisThe IBM MarketScan Commercial Subset (1 October 2015–31 March 2020) was used to identify patients with non-infectious uveitis (NIU), with or without UME. Patients with UME at any time were further classified into subgroups of patients who received a UME diagnosis during the study period and those who received a UME diagnosis and local steroid injection (LSI) during the study period. Demographic and clinical characteristics, NIU-related treatments and healthcare costs were described for each cohort and subgroup during the most recent 12 months of continuous health plan enrolment. Healthcare costs were also described by vision status among all patients with NIU.ResultsA total of 36 322 patients with NIU were identified, of whom 3 301 (9.1%) had UME and 33 021 (90.9%) had no UME. Patients with UME more frequently received NIU-related treatment compared with those without UME (64.6% vs 45.0%), particularly LSI treatment (12.5% vs 0.7%). Mean total all-cause healthcare costs per-patient-per-year (PPPY) were higher among patients with UME ($19 851) than patients without UME ($16 188) and were especially high among those with bilateral UME ($24 162). Further, vision loss was more commonly observed in those with UME versus those without UME (5.7% vs 2.2%) and a trend of increasing healthcare costs with increasing vision loss was observed.ConclusionNIU is associated with substantial clinical and economic burden, particularly when UME is present.

A better functional outcome with platelet rich plasma compared with local steroid injection in tennis elbow

Lateral epicondylitis commonly referred to as 'tennis elbow,' is mainly observed in the 3rd and 4th decade of life in around 2% -3% of the population. Treatment modalities for lateral epicondylitis include analgesics, immobilization, tennis elbow brace, local steroid infiltration, and ultrasound therapy. Recent studies have explored the effectiveness of platelet-rich plasma (PRP) injections in lateral epicondylitis. We used the block randomization technique. Two groups were prepared with 30 patients in each group. One group of patients received PRP and the other received local steroid injection. Patients were evaluated at the time of procedure and immediately after the procedure, at six weeks, three months, and six months, using the visual analog score and Liverpool's elbow score. At the end of 6 months, follow-up patients in the PRP injection group show good clinical and functional compare to the steroid group of patients. PRP and local corticosteroid injection provide symptomatic relief in the treatment of lateral epicondylitis. PRP infiltration gives better results in pain relief and functional activities with statically significant values when compared with corticosteroid injections.

ROLE OF LOCAL CORTICOSTEROID INJECTION VS THERAPEUTIC ULTRASOUND REGARDING IMPROVEMENT IN PAIN FREE GRIP STRENGTH OF TENNIS ELBOW PATIENTS

Background: Tennis elbow or Lateral epicondylitis is now a days a well known condition with mixed etiopathogenesis of inammation and microtear resulting in decreased hand grip strength. Among the various treatment options, therapeutic ultrasound and local steroid injection are commonly used in managing these patients, but comparative effectiveness of these two treatment procedures are often debated. To compare the efcacy of local cortic Aim of Study: osteroid injection versus therapeutic ultrasound in terms of improvement in painfree grip strength(PFGS) of affected upper limb. This i Method: nterventional study was conducted on 56 patients of both sexes within the age group of 18-60 years with unilateral Tennis elbow. They were randomly divided in two groups of same number(28 in each group)- Group-1: managed with local injection of steroid (methylprednisolone-10mg, single dose) with 2% of 0.5 ml lignocaine and Group-2 : managed with Therapeutic Ultrasound. Improvement of PFGS was assessed by hand held Dynamometer. Data collected at 0 week (Visit-1 or Pre-initiation), 3weeks (Visit-2 ), 6 weeks (Visit-3), 12 weeks (Visit-4). For PFGS score, in both Group-1 and Group-2, there Result: was signicant increase in subsequent visits (p<0.05). The mean PFGS score of Group-1 was signicantly higher than that of Group-2 in visit2(p<0.01), but in visit-3(p>0.05) & visit-4(p>0.05) there was no statistically signicant difference noted. Local Steroid injection & Conclusion: therapeutic ultrasound both are effective in improving PFGS. Though Local steroid injection is more effective in initial period, but in subsequent followups, the difference was statistically insignicant.

COMPARISON OF CORTICOSTEROID INJECTION WITH THERAPEUTIC ULTRASOUND FOR PAIN MANAGEMENT IN LATERAL EPICONDYLITIS

Background: Lateral epicondylitis is the most common presentation of lateral elbow pain and quite disabling entity in Musculoskeletal rehabilitation. Among the various treatment options, therapeutic ultrasound and local steroid injection are commonly used for managing pain in these patients, but comparative effectiveness of these two treatment procedures are often debated. Aim of Study: To evaluate the efcacy of local corticosteroid injection versus therapeutic ultrasound regarding pain reduction in patients with Lateral epicondylitis. Method:This interventional study was conducted on 56 patients of both sexes within the age group of 18-60 years with unilateral Lateral epicondylitis. They were randomly divided in two groups of same number(28 in each group)- Group-1: managed with local injection of steroid (methylprednisolone-10mg, single dose) with 2% of 0.5 ml lignocaine and Group-2 : managed with Therapeutic Ultrasound. Improvement of pain was assessed in 0-10 visual st analogue scale(VAS). Data collected at 0 week (Visit-1 or Pre-initiation), 3weeks (Visit-2 or 1 Follow up), 6 weeks (Visit-3), 12 weeks (Visit-4). Result: For VAS(pain) score, in both Group-1 and Group-2, there was signicant decrease in subsequent visits (p<0.05). The mean VAS(pain) score of Group-1 was signicantly lower than that of Group-2 in visit -2(p<0.01), visit-3(p<0.01) & visit-4(p<0.05) indicating better outcome in Group-1. Conclusion: Both Local Steroid injection (methylprednisolone) & therapeutic ultrasound are effective in pain management of lateral epicondylitis but Local steroid injection is more effective mostly in early follow up period.

Evaluation of Local Corticosteroids Injection in Treatment of Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome is the most common type of peripheral nerve entrapment; it affects females more than males; it may be idiopathic or secondary to other disorders especially diabetes mellitus. Carpal tunnel syndrome mostly affects manual workers and may be bilateral or unilateral and mainly affects the dominant hand. Carpal tunnel syndrome has characteristic symptoms and signs including paresthesia and pain along median nerve distribution, these symptoms are usually accompanied by positive provocative tests. Electrodiagnostic studies remain the cornerstone in the diagnosis of CTS. Carpal tunnel syndrome can be treated conservatively by activities of daily living instructions, splints, medical treatments as neurotropic drugs and NSAIDs and local steroid injection. Also, it can be treated by surgical decompression in severe cases. Aims: The aim of this study was to evaluate local steroid injection in the treatment of CTS. Twenty-one patients with mild and moderate CTS were included in this study. Patients and Methods: This was a prospective study included 21 patients with symptoms and signs of mild to moderate CTS attending the outpatient clinic of orthopedic Department, Tanta University Hospitals in the period between February 2019- January 2020. 1 ml Triamcinolone was used with 2 ml lidocaine. Patient’ hand was rested on towel roll flexed about 30 to 45 degrees and injection was done according to landmarks. Night splint was described for 3 days after injection. Results: In regards to clinical assessment; there was a significant clinical improvement after injection and follow-up period as compared to before injection. In regards to electrophysiological assessment; there was a significant improvement in NCS after injection. Conclusion: Local steroid injection is an effective treatment and recommended as a therapeutic tool in the management of idiopathic mild to moderate CTS.

Dislocations of the second and third metatarsophalangeal joints after local steroid injection in patients with refractory metatarsalgia: A case report

Local steroid injections are frequently administered to patients with refractory metatarsalgia. No reports have described dislocation of the second and third metatarsophalangeal joints after local steroid injections. A 46-year-old woman had suffered from metatarsalgia and received multiple local steroid injections for over 2 years. The second and third metatarsophalangeal joints revealed dorsal dislocations on the lateral radiograph. Therefore, collateral ligament reconstruction of the metatarsophalangeal joints was performed. Intraoperative findings suggested that the rupture of the plantar plate may have caused dorsal dislocation of both joints. Thus, unnecessary multiple steroid injections around the lesser metatarsophalangeal joint should be avoided.