Kinematic Analysis of Gait Following Intra-articular Corticosteroid Injection into the Knee Joint with an Acute Exacerbation of Arthritis.

PURPOSE The objective of this study was to examine the effects of intra-articular corticosteroid injection (ICI) on ipsilateral knee flexion/extension, ankle dorsiflexion/plantarflexion (DF/PF), and hip abduction/adduction (abd/add) during stance phase in people with an acute exacerbation of rheumatoid arthritis (RA) of the knee joint. The study also assessed the effects of ICI on spatiotemporal parameters of gait and functional status in this group. METHODS Nine people with an exacerbation of RA of the knee were recruited. Kinematic and spatiotemporal gait parameters were obtained for each participant. Knee-related functional status was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Spatiotemporal gait parameters and joint angles (knee flexion, ankle DF/PF, hip abd/add) of the affected side were compared pre- and post-ICI. RESULTS Data for eight people were available for analysis. Median values for knee flexion and ankle PF increased significantly following ICI. Gait parameters of cadence, velocity, bilateral stride length, bilateral step length, step width, double-support percentage, and step time on the affected side also showed improvement. Pain and knee-related functional status as measured by the KOOS showed improvement. CONCLUSIONS This study demonstrated a beneficial short-term effect of ICI on knee-joint movements, gait parameters, and knee-related functional status in people with acute exacerbation of RA of the knee.

[1]  M P Kadaba,et al.  Measurement of lower extremity kinematics during level walking , 1990, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[2]  I. Arostegui,et al.  Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. , 2008, Archives of internal medicine.

[3]  Gerald V. Smith,et al.  Treadmill training improves fitness reserve in chronic stroke patients. , 2001, Archives of physical medicine and rehabilitation.

[4]  B. Tiplady,et al.  Validity and sensitivity of visual analogue scales in young and older healthy subjects. , 1998, Age and ageing.

[5]  D. Rosenbaum,et al.  Changes of gait patterns and muscle activity after intraarticular treatment of patients with osteoarthritis of the knee: a prospective, randomised, doubleblind study. , 2009, The Knee.

[6]  J. L. Astephen,et al.  Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[7]  F. Salaffi,et al.  Prevalence of musculoskeletal conditions in an Italian population sample : results of a regional community-based study , 2005 .

[8]  P. Giannoudis,et al.  Open patellar fractures: high energy injuries with a poor outcome? , 2008, Injury.

[9]  Kinetic and kinematic characteristics of gait in patients with medial knee arthrosis , 2002 .

[10]  D. Dunlop,et al.  Population impact of arthritis on disability in older adults. , 2006, Arthritis and rheumatism.

[11]  Johan Isacson,et al.  Gait in rheumatoid arthritis: an electrogoniometric investigation. , 1988, Journal of biomechanics.

[12]  J. Natour,et al.  Monoarticular corticosteroid injection versus systemic administration in the treatment of rheumatoid arthritis patients: a randomized double-blind controlled study. , 2009, Clinical and experimental rheumatology.

[13]  J. Natour,et al.  Polyarticular corticosteroid injection versus systemic administration in treatment of rheumatoid arthritis patients: a randomized controlled study. , 2005, The Journal of rheumatology.

[14]  S. Hepguler,et al.  The safety and efficacy of intraarticular hyaluronan with/without corticosteroid in knee osteoarthritis: 1-year, single-blind, randomized study , 2006, Rheumatology International.

[15]  Linda C. Li,et al.  The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study , 2004, Annals of the rheumatic diseases.

[16]  Jonathan F. Borus,et al.  Somatic symptom reporting in women and men , 2001, Journal of General Internal Medicine.

[17]  C. Bach,et al.  Correlation between objective gait parameters and subjective score measurements before and after total knee arthroplasty. , 2008, The Knee.

[18]  M. Egger,et al.  Efficacy and safety of intraarticular hylan or hyaluronic acids for osteoarthritis of the knee: a randomized controlled trial. , 2007, Arthritis and rheumatism.

[19]  Jeffrey M. Hausdorff,et al.  A new measure for quantifying the bilateral coordination of human gait: effects of aging and Parkinson’s disease , 2007, Experimental Brain Research.

[20]  S. Summers.  Evidence-based practice part 2: reliability and validity of selected acute pain instruments. , 2001, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[21]  G. Kobelt,et al.  The burden of rheumatoid arthritis and access to treatment: health burden and costs , 2007, The European Journal of Health Economics.

[22]  L. Klareskog,et al.  Corticosteroids--from an idea to clinical use. , 2004, Best practice & research. Clinical rheumatology.

[23]  M. Morris,et al.  Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait. , 2003, Gait & posture.

[24]  H Yoshioka,et al.  Associations among preoperative MRI features and functional status following arthroscopic partial meniscectomy. , 2006, Osteoarthritis and cartilage.

[25]  H. Bliddal,et al.  A randomized, controlled study of a single intra‐articular injection of etanercept or glucocorticosteroids in patients with rheumatoid arthritis , 2006, Scandinavian journal of rheumatology.

[26]  Y. Pei,et al.  Changes in sagittal ground reaction forces after intra-articular hyaluronate injections for knee osteoarthritis. , 2004, Archives of physical medicine and rehabilitation.

[27]  L. Carmona,et al.  The prevalence of rheumatoid arthritis in the general population of Spain. , 2002, Rheumatology.

[28]  K. Rome,et al.  Evaluation of static and dynamic postural stability in established rheumatoid arthritis: exploratory study. , 2009, Clinical biomechanics.

[29]  P. Wretenberg,et al.  Gait pattern in rheumatoid arthritis. , 2008, Gait & posture.

[30]  E. Roos,et al.  Knee kinematics and kinetics in former soccer players with a 16-year-old ACL injury – the effects of twelve weeks of knee-specific training , 2007, BMC musculoskeletal disorders.

[31]  A. Davis,et al.  A cross-sectional look at patient concerns in the first six weeks following primary total knee arthroplasty , 2007, Health and quality of life outcomes.

[32]  M. Sakauchi,et al.  Kinematic approach to gait analysis in patients with rheumatoid arthritis involving the knee joint. , 2001, Arthritis and rheumatism.

[33]  G S Alarcón,et al.  Epidemiology of rheumatoid arthritis. , 1995, Rheumatic diseases clinics of North America.

[34]  I. Tarkka,et al.  Footprint analysis of gait using a pressure sensor system. , 2004, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[35]  Kara K. Patterson,et al.  Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. , 2010, Gait & posture.

[36]  S. Dai,et al.  Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study. , 2003, The Journal of rheumatology.

[37]  B. Bresnihan,et al.  Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA Study , 2009, Arthritis research & therapy.

[38]  N. Ilowite,et al.  Comparison of the intraarticular effectiveness of triamcinolone hexacetonide and triamcinolone acetonide in treatment of juvenile rheumatoid arthritis. , 2004, The Journal of rheumatology.

[39]  S. Barreto,et al.  Health status indicators among community-dwelling elders with arthritis: the Bambuí health and aging study. , 2006, Journal of Rheumatology.

[40]  K. Webster,et al.  Quantitative gait analysis after medial unicompartmental knee arthroplasty for osteoarthritis. , 2003, The Journal of arthroplasty.

[41]  B. Beynnon,et al.  Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. , 1998, The Journal of orthopaedic and sports physical therapy.

[42]  T. Kvien.  Epidemiology and burden of illness of rheumatoid arthritis , 2012, PharmacoEconomics.

[43]  S. Toksvig-Larsen,et al.  Knee injury and Osteoarthritis Outcome Score (KOOS) – validation and comparison to the WOMAC in total knee replacement , 2003, Health and quality of life outcomes.

[44]  Patrick A Costigan,et al.  Role of knee kinematics and kinetics on performance and disability in people with medial compartment knee osteoarthritis. , 2006, Clinical biomechanics.

[45]  Sheldon R Simon,et al.  Quantification of human motion: gait analysis-benefits and limitations to its application to clinical problems. , 2004, Journal of biomechanics.

[46]  T. Möttönen,et al.  Perceived functional disabilities among rheumatoid arthritis patients , 2010, Rheumatology International.

[47]  J. L. Astephen,et al.  Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels. , 2008, Journal of biomechanics.

[48]  R. D'ambrosia,et al.  Epidemiology of osteoarthritis. , 2005, Orthopedics.

[49]  K. An,et al.  Gait characteristics of patients with knee osteoarthritis. , 2001, Journal of biomechanics.

[50]  S. Õunpuu,et al.  Three-dimensional lower extremity joint kinetics in normal pediatric gait. , 1991, Journal of pediatric orthopedics.

[51]  P. Renström,et al.  Factors affecting outcome after anterior cruciate ligament injury: a prospective study with a six‐year follow‐up , 2008, Scandinavian journal of medicine & science in sports.

[52]  Nicola Hagemeister,et al.  Reliability of a method for analyzing three-dimensional knee kinematics during gait. , 2008, Gait & posture.

[53]  S Hagelberg,et al.  Effect of joint injections in children with juvenile idiopathic arthritis: evaluation by 3D‐gait analysis , 2004, Acta paediatrica.

[54]  M. Wallen,et al.  Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. , 2006, The Cochrane database of systematic reviews.

[55]  J. D. Childs,et al.  Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis. , 2004, Clinical biomechanics.

[56]  Rita M. Kiss,et al.  The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis , 2006, Knee Surgery, Sports Traumatology, Arthroscopy.

[57]  Si-Huei Lee,et al.  Effect of Intra‐articular Injection of Hyaluronic Acid in Rheumatoid Arthritis Patients with Knee Osteoarthritis , 2008, Journal of the Chinese Medical Association : JCMA.

[58]  M. Shrader,et al.  Effects of Knee Pain Relief in Osteoarthritis on Gait and Stair-Stepping , 2004, Clinical orthopaedics and related research.

[59]  T. Turajane,et al.  Outcomes of intra-articular injection of sodium hyaluronate for the treatment of osteoarthritis of the knee. , 2007, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[60]  P. Hannonen,et al.  Monetary value of lost productivity over a five year follow up in early rheumatoid arthritis estimated on the basis of official register data on patients’ sickness absence and gross income: experience from the FIN-RACo trial , 2005, Annals of the rheumatic diseases.