Treatment of arthritis by intra-articular injection.

In a previous paper (1948) a clinic for the treatment of osteoarthritis was described and certain conclusions were drawn. The technique used was that described by Waugh (1939). The value of this method of intra-articular injection was considered proven but the value of acid solutions not proven. It was felt that the success was due to varying combinations of three factors. Firstly, the injection oflocal anaesthetic allowed a pain-free period during which " auto-manipulation " was carried out. Secondly, the liquid injected into the (usually) dryjoint cavity acted as a lubricant and presumably " spread" the hyaluronic acid which tends to persist even in the degenerate joint (Kellgren, 1961). Thirdly, the bringing together of fellow sufferers at a clinic where relief was given coupled with the advice as to active movements and exercises to be carried out as homework, produced a progressive atmosphere far more helpful than in some physiotherapy departments where so often the patient feels the treatment is being done for him and requires no active effort from him. One cannot exclude the effect of such group therapy and must accept it gratefully as a constant adjunct to the physical benefit achieved by the injection treatment alone.