Intraarticular corticosteroid injections in the management of osteoarthritis knee

  • Shahid Hussain DHSK
  • Asif Qayoom
  • Manzoor Ahmad DHSK
Keywords: Intra-articular injection; Corticosteroid, Knee Osteoarthritis

Abstract

Objective:- The aim of the study was to assess therapeutic efficacy, adverse events and patient satisfaction of intraarticular (IA) corticosteroid injections for knee osteoarthritis (OA).

Methods:- Ninety-Six (96) patients with OA of the knee participated in the present study. The inclusion criteria included (1) Resting visual analog scale pain >50 mm (2) Radiographic evidence for osteoarthritis (as per Kellgren-Lawrence scale) plus;  age ≥50yrs, morning stiffness ≤ 30 min and crepitus on the motion. Baseline Western Ontario and MacMaster University Osteoarthritis Index (WOMAC) and visual analogue score (VAS) were documented. Patients received intra-articular injections of triamcinolone acetonide 40 mg in the affected knee. The patients were reviewed at 1 week, 4 weeks and 8 weeks post-injection with final analysis at 3 months. Use of over the counter analgesia in the form of acetaminophen was allowed for concomitant analgesia.

 Results:- Ninety-six patients (male =45, female=51) with   mean age of  50±5 years (range 45-55); duration of symptoms 5.7 ± 0.5 years and mean body mass index (BMI) 29.4kg/m2 were available at final follow-up. The VAS scores at baseline were:- at rest=71 and after 30 meter walk=80 and improved to 35 and 40, respectively. Improvement in pain and disability based on the WOMAC scores were significant. The overall efficacy “Knee Society Score” was judged as excellent in 56.25%, satisfactory in 21.87%, fair in 18.75%, and poor in 3.12%. The beneficial effects stayed until 4-6 weeks.

Conclusion:- Intra-articular steroid injections for knee OA is safe and effective. The symptomatic relief is prompt, particularly in the presence of inflammation (Effusion/synovitis). Proper patient selection and aseptic precautions yield satisfactory results. The need for concomitant analgesia is reduced. 

Author Biography

Shahid Hussain, DHSK

MS

References

1. Dieppe P: Osteoarthritis. Acta Orthop Scand Suppl 1998;281:2-5
2. Bonnet C, Walsh D. Osteoarthritis, angiogenesis and inflammation. Rheumatology 2005;44:7-16
3. Murphy L, Schwartz TA, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207–13
4. David H. Neustadt. Intra-articular injections for osteoarthritis. Cleveland Clinic Journal of MEdicine Volume 73 • Number 10 October 2006
5. Fleming BC, et al. Ligament injury, Reconstruction and Osteoarthritis. Current Opinion in Orthopedics. 2005;16(5):354-362
6. Thorn, quoted by Hollander JL, et al. Hydrocortisone injected into arthritic joints. J Am Med Assoc. 1951;147:1629-1635.
7. Hollander JL. Osteoarthritis: perspectives on treatment. Postgrad Med 1980; 68:161–164, 167–168.
8. Raynauld JP, Buckland-Wright C, Ward R, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2003; 48:370–377
9. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum 2000;43:1905–15.
10. Kim RH, Springer BD, Douglas DA. Knee reconstruction and replacement. In: Flynn F, ed. Orthopaedic Knowledge Update. Rosemont, IL: American Academyof Orthopaedic Surgeons; 2011:469-475.
11. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957;16:494–501.
12. Bellamy N. WOMAC osteoarthritis index users guide. Queensland, Australia: University of Queensland; 2000. p 1-43.
13. Linkert, Rensis (1932). "A Technique for the Measurement of Attitudes". Archives of Psychology 140: 1–55.
14. Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol. 2006;20(1):3-25.
15. Revell PA, Mayston V, Lalor P, Mapp P. The synovial membrane in osteoarthritis: a histological study including the characterization of the cellular infiltrate present in inflammatory osteoarthritis using monoclonal antibodies. Ann Rheum Dis 1988;47:300–7.
16. Fries JF. The epidemiology of NSAID gastropathy: the ARAMIS experience. J Clin Rheumatol. 1998;4(5 suppl):s11-s16.
17. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;19(2):CD005321.
18. Blyth T, Hunter JA, Stirling A. Pain relief in the rheumatoid knee after steroid injection: a single-blind comparison of hydrocortisone succinate, and triamcinolone acetonide or hexacetonide. Br J Rheumatol 1994;33:461–3.
19. Williams JM, Brandt KD. Triamcinolone hexacetonide protects against fibrillation and osteophyte formation following chemically induced articular cartilage damage. Arthritis Rheum 1985;28: 1267–74.
20. Pelletier J-P, Di Battista JA, Raynauld J-P, Wilhelm S, Martel- Pelletier J. The in vivo effects of intraarticular corticosteroid injections on cartilage lesions, stromelysin, interleukin-1 and oncogene protein synthesis in experimental osteoarthritis. Lab Invest 1995;72:578–86.
21. Cederlof S, Jonson G. Intraarticular prednisolone injection for osteoarthritis of the knee: a double blind test with placebo. Acta Chir Scand 1966;132:532–7.
22. Friedman DM, Moore ME. The efficacy of intraarticular steroids in osteoarthritis: a double-blind study. J Rheumatol 1980;7:850–6.

23. Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. .J Am Acad Orthop Surg. 2017 Oct;25(10):703-714.

24. Papacrhistou G, et al. The effect of intraarticular hydrocortisone injection on the articular cartilage of rabbits. Acta Orthop Scand Suppl. 1997;275:132-134.
25. Altman RD, Fries JF, Bloch DA, Carstens J, Cooke TD, Genant H, et al. Radiographic assessment of progression in osteoarthritis. Arthritis Rheum 1987;30:1214–25.
26. Brandt KD, Fife RS, Braunstein EM, Katz B. Radiographic grading of the severity of knee osteoarthritis: relation of the Kellgren and Lawrence grade to a grade based on joint space narrowing, and correlation with arthroscopic evidence of articular cartilage degeneration. Arthritis Rheum 1991;34:1381–6.
27. Valtonen EJ. Clinical comparison of triamcinolonehexacetonide and betamethasone in the treatment of osteoarthrosis of the knee-joint. Scand J Rheumatol Suppl 1981;41:1–7.
28. Juergen Steinmeyer, Fritjof Bock, Johannes Stöve; Pharmacological treatment of knee osteoarthritis: Special considerations of the new German guideline. Orthop Rev (Pavia). 2018 Dec 6; 10(4): 7782
29. Jüni P, Hari R, Rutjes A, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev 2015; (10):CD005328.
Published
2019-05-27
How to Cite
1.
Hussain S, Qayoom A, Ahmad M. Intraarticular corticosteroid injections in the management of osteoarthritis knee. jms [Internet]. 2019May27 [cited 2019Jul.19];22(1):43-8. Available from: http://jmsskims.org/index.php/jms/article/view/371
Section
Original Articles