Comparison of Intra-articular corticosteroids with and without intra articular local anesthesia in patients with chronic inflammatory arthritis: a randomised control trail with paired-design.

Joint Injections of corticosteroid are routinely practised in patients with inflammatory arthritis like rheumatoid arthritis and spondyloarthritis. Routinely inflamed joints like shoulders, kinees, ankles and elbows are done. These lead to rapid relef. However, just after giving the injection it takes times for the corticosteroid to act, and sometimes it may also cause an increase in joint pain for a few days due to steroid crystals leading to inflammation. Addition of lignocaine, which is a local anaesthetic agent to the corticosteroid being injected into the joint is practised at some centers. The logic of this addition is its ability to lead to rapid improvement (within minutes) and also the prevention of joint flares. However, this has not been investigated by a trail

We propose to compare whether the addition of the local anaesthetic agent mixed to the corticosteroid before giving the joint injection will benefit the short and medium term improvement which the patient feels with this intervention and whether there is any difference in the remission rates over a longer term of 3-months. We plan a paired-design, that is we will include only those patients whose paired joints have to be injected and then inject one of these joints with corticosteroid alone and one with addition oflignocaine to the corticosteroid. This paired design will standardise the pain felt by each patient and lead to a better and easier comparison of which arm is doing better.