Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis.

OBJECTIVE: We conducted an open observational study to assess the short and longterm effect of single local glucocorticosteroid injection for trochanteric bursitis. METHODS: 75 patient diagnosed with trochanteric bursitis based on clinical criteria were injected; 20, 32, and 22 patients each received 6, 12, and 24 mg betamethasone, respectively, mixed with 4 cm3 of 1% lidocaine. A standardized baseline questionnaire was administered to assess the severity and functional limitation due to trochanteric pain, including the visual analog scale for pain. Patients were followed at Weeks 1, 6, and 26 to determine their response to treatment. RESULTS: 77.1, 68.8, 61.3% of responding patients reported improvement in pain at Week 1, 6, and 26, respectively. Patients receiving higher doses of betamethasone were more likely to experience pain relief (p < 0.0123). CONCLUSION: Corticosteroid and lidocaine injection for trochanteric bursitis is an effective therapy with prolonged benefit.

Pilot study of antithymocyte globulin in systemic sclerosis.

OBJECTIVE: Between June 1, 1992 and August 31, 1994 we conducted an open pilot study of antithymocyte globulin (ATGAM; Upjohn, Kalamazoo, MI) in 10 patients with early systemic sclerosis (SSc) to assess whether this agent might prevent the progression of cutaneous and pulmonary involvement in this disease. METHODS: Adult patients with early SSc (< 3 years) and evidence of progressive skin and pulmonary disease were enrolled. All patients were hospitalized and received a single course of intravenous ATGAM, at a dosage of 10 mg/kg over 4 hours, on 5 consecutive days. Patients were followed up at weeks 1, 2, 3, and 4, and months 2, 4, 6, and 12. Patients were considered to be improved if the Rodnan skin score decreased > or = 25%, to be worse if the skin score increased > or = 25%, and to be not improved if the skin score was within 25% of baseline. For pulmonary involvement, patients were considered to be improved if either the diffusing capacity for carbon monoxide or the forced vital capacity was increased > or = 10%, worse if decreased by > or = 10%, and stable if within 10% of baseline. RESULTS: Most patients tolerated the treatment well, although 1 patient developed an allergic reaction necessitating discontinuation of treatment, 1 developed a serum sickness reaction after completion of therapy, and 1 developed a central venous access-related axillary vein thrombosis. Two patients died of SSc-related complications during the followup period. At 12 months, only 2 patients showed improvement in both skin and pulmonary function measures, whereas 5 patients were worse and 3 were stable. CONCLUSION: At the dosage administered in this study, ATGAM appears ineffective in improving the skin and pulmonary features of SSc.

Trochanteric bursitis (greater trochanter pain syndrome).

Trochanteric bursitis, a common regional pain syndrome, is characterized by chronic, intermittent aching pain over the lateral aspect of the hip. The incidence of trochanteric bursitis peaks between the fourth and sixth decades of life, but cases have been reported in all age-groups. The diagnosis may be elusive, especially if symptoms are atypical. This condition can be associated with pain and limitation of function. Treatment includes physical therapy measures, analgesics, and local glucocorticoid injection. In this article, we review the pathogenesis, common initial symptoms, diagnostic approach, and treatment options for trochanteric bursitis.