Phonophoresis for Enthesitis-Related Pain: Real-World Outcomes from a Retrospective Single-Center Study

Objectives To evaluate the efficacy, safety, and delivery of phonophoresis with fluocinonide 0.05% gel in patients with enthesitis-related pain who were referred to the Centre of Arthritis Excellence (CArE), Newmarket, Ontario. We hypothesized that this treatment approach would be effective in reducing pain and could serve as a non-invasive adjunct to standard enthesitis management. Methods This retrospective single-center study included patients treated with phonophoresis using fluocinonide 0.05% gel between November 2023 and May 2025. Patients were offered 6 sessions over 2–3 weeks, with some receiving adjunctive dry needling or corticosteroid injections before treatment. Data extracted from the QHR Accuro EMR included demographics, rheumatic and musculoskeletal diagnoses, treatment details, inflammatory markers (when available), Visual Analog Scale (VAS) pain scores, patient-reported outcomes, physical assessments, and adverse effects related to phonophoresis. A clinically meaningful improvement was defined as a ≥2-point reduction in VAS from baseline to the final session. [1] Subgroup analyses compared outcomes by anatomical site, adjunctive therapy use, and overall course duration. Results A total of 32 treatment courses were administered to 27 patients (mean ± SD age 59 ± 13 years; 81% female). Thirteen (48.1%) were receiving disease-modifying antirheumatic drugs (DMARDs), and 2 (7.4%) were on biologics at the time of treatment. Across 47 anatomical sites with paired VAS data, the mean VAS reduction (ΔVAS) was 3.18 ± 2.71, with 70.2% achieving clinically meaningful improvement. The Achilles tendon was the most frequently treated site (n = 24), with 62.5% of these sites achieving meaningful improvement, followed by the plantar fascia (n = 9, 66.7%) and peroneal tendon (n = 5, 100%) (Table 1). Sites treated with phonophoresis plus adjunctive dry needling (n = 19) demonstrated higher response rates compared to sites treated with phonophoresis alone (89.5% vs 58.6%) and greater pain reduction (ΔVAS = 3.71 ± 2.37 vs 2.81 ± 2.90). Four patients received corticosteroid injections prior to phonophoresis (3 intramuscular and 1 site-specific), with a mean ΔVAS of 3.75 following phonophoresis and 75% showing clinically meaningful improvement. Most patients completed ≥ 6 sessions within approximately 4–5 weeks. Phonophoresis was well tolerated, with only one mild, self-limiting adverse event reported. Table 1. Primary outcomes of phonophoresis by anatomical site Conclusion Phonophoresis was associated with clinically meaningful pain reduction across most anatomical sites, with adjunctive dry needling further enhancing outcomes. This non-invasive, well-tolerated treatment modality could serve as a useful adjunct for localized enthesitis-related pain, especially in patients unable to receive corticosteroid injections or for whom standard therapies are not ideal. References [1.] Farrar JT. Pain 2000;88:287-94.