Background: There is uncertainty as to whether supplemental oral
nonsteroidal anti-inflammatory medication improves the effectiveness of
steroid injections in the treatment of de Quervain disease. We tested the
hypothesis that there are no significant differences in the success rates when
this condition is treated with triamcinolone injection with or without
supplemental oral nimesulide.
Methods: In a randomized, double-blind trial, 160 patients with de
Quervain disease received an injection of 10 mg of triamcinolone acetonide and
either 200 mg of oral nimesulide for seven days (eighty patients) or placebo
tablets for seven days (eighty patients). An independent, blinded evaluator
assessed the primary outcomes (tenderness, pain, and the result on the
Finkelstein test) at three weeks after injection. Adverse reactions were
assessed, and probabilities of recurrence for both groups were compared.
Factors possibly predictive of disease recurrence were also assessed.
Results: The success rate after one injection was 67% in the
nimesulide group and 68% in the placebo group. The overall success rates after
single or multiple injections with a mean follow-up of 13.6 months were 95%
for both groups. No significant differences were noted with respect to the
success rates (p = 0.69) or pain scores after treatment (p = 0.11). The most
common adverse reactions to triamcinolone injection and nimesulide were pain
after injection and dyspepsia, respectively. The symptoms of de Quervain
disease recurred in 33% of the patients in the nimesulide group and in 37% of
those in the placebo group. The median time of recurrence was at the fifth
month in the nimesulide group and at the fourth month in the placebo group.
The recurrence of symptoms was significantly (p = 0.01) related to the
presence of crepitation (relative risk, 2.13; 95% confidence interval, 1.19 to
Conclusions: Supplemental oral administration of the nonsteroidal
anti-inflammatory drug nimesulide does not improve the effectiveness of a
single injection of triamcinolone acetonide in the treatment of de Quervain
disease. Patients with crepitation in the first dorsal compartment during
thumb extension or abduction are at increased risk for recurrence of this
Level of Evidence: Therapeutic study, Level I-1b
(randomized controlled trial [no significant difference but narrow confidence