Projecto «Terapêutica por Infiltração Local com Corticosteróides nas Doenças Reumáticas Periarticulares na USF Marginal» - Da ideia à acção

Introduction: Rheumatic diseases cause a significant economic and social burden in Portugal. They comprise 16-23% of consultations in primary health care. Corticosteroid injections are considered important agents in the treatment of joint and periarticular diseases. Many consider that these injections may be done by the family doctor with adequate training. Objective: To provide the option of treatment with local infiltration of corticosteroids in periarticular rheumatic diseases to the patients of Marginal Family Health Unit (MFHU) in S. Joao do Estoril (Portugal). Methods: The project included a literature review (an evidence-based review of effectiveness of corticosteroids injections in various periarticular rheumatic diseases, a narrative review of technical aspects, contraindications, side effects, patient information and monitoring of results), 50 hours of training in the Technical Department of the Hospital Egas Moniz (Lisbon, Portugal) under the guidance of Dr. Bravo Pimentao for the acquisition of skills in executing techniques, and presentation, discussion and implementation of the project in MFHU. Results: The project was presented to the professional team of MFHU in January 2011. The process of internal referral was defined and a small multidisciplinary team was formed. By October 31, 2011, 74 injections were performed. The project was well accepted by the professionals at MFHU. The patients’ perception of clinical improvement was positive. There are few contraindications to injection. No significant adverse effects were reported in most studies found in the literature review. Serious adverse events were rare. Discussion/Conclusion: Local injection with corticosteroids was found to be a simple safe, and cost-effective therapeutic option in all conditions suggested. This project has advantages for the patient, the family doctor, the primary health care team, the National Health Service, and society. Another outcome was improved coordination between primary and secondary care.