Efficacy and Treatment Response of Intra-Articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis

Elizabeth G. Matzkin, MD; Emily J. Curry, BA; Qingwu Kong, MD; Miranda J. Rogers, MD; Michael Henry, MD; Eric L. Smith, MD

Disclosures

J Am Acad Orthop Surg. 2017;25(10):703-714. 

In This Article

Abstract and Introduction

Abstract

Introduction: Intra-articular corticosteroid injections are often used for short-term pain relief in patients with knee osteoarthritis (OA). This study investigates the efficacy of intra-articular corticosteroid injections in patients with symptomatic knee OA and factors that affect treatment response.

Methods: This prospective, multicentered cohort study had 100 participants with radiographic evidence of knee OA enrolled. Participants received one corticosteroid injection into the affected knee and were evaluated before the injection (baseline) and at 3 weeks, 6 weeks, 3 months, and 6 months after the injection.

Results: Participants' Visual Numeric Scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores improved at all time points except for the Visual Numeric Scale score at 6 months, compared with baseline scores (P < 0.001). Participants with Kellgren-Lawrence grade 1 or 2 OA saw clinical improvement in the WOMAC scores at all time points, compared with the baseline score (P < 0.01). Compared with all other subgroups, obese patients with Kellgren-Lawrence grade 3 or 4 OA had significantly worse WOMAC scores at baseline, 6 weeks, and 3 months (P < 0.01 and P < 0.01, respectively).

Discussion: Our findings validate previously established guidelines for nonsurgical management of knee OA and suggest that intra-articular corticosteroid injections may be an acceptable short-term management option in patients unwilling or unable to undergo surgical treatment. Obesity and OA severity affect the efficacy of intra-articular corticosteroid injections.

Conclusion: Patients receiving intra-articular corticosteroid injections had improved pain and function. Clinicians should expect less improvement in patients with obesity and/or advanced arthritis. Clinical benefits of intra-articular injections in these patients are less predictable.

Introduction

Osteoarthritis (OA) is a common chronic disease, affecting nearly 52.5 million people or 22.7% of the population in the United States.[1] It is one of the most common causes of pain and disability among the elderly.[2] Knee OA is the most prevalent form of OA, with symptoms occurring in 13% of women and 10% of men aged >60 years.[3,4] Nonsurgical treatments include activity modification, bracing, physical therapy, intra-articular injections, and oral anti-inflammatory medications. Intra-articular injections can include hyaluronic acid, platelet-rich plasma, stem cells, and corticosteroids. The American Academy of Orthopaedic Surgeons (AAOS) 2013 clinical practice guideline strongly recommended against the use of hyaluronic acid injections and did not recommend for or against growth factor or platelet-rich plasma injections in patients with symptomatic knee OA.[5]

Intra-articular corticosteroid injections have been widely used for short-term pain relief since the 1950s.[6] Their use is indicated by the American College of Rheumatology for short-term pain relief that interferes with daily life.[6–10] Few side effects have been reported.[7–10] However, the AAOS found only four placebo comparison studies evaluating pain relief beyond 4 weeks that met the rigorous study selection criteria of the AAOS 2013 clinical practice guideline.[5,11–14] Thus, evidence regarding the use of intra-articular corticosteroids for the management of symptomatic knee OA was determined to be inconclusive.[5] Furthermore, no conclusions could be made about the duration of pain relief or functional improvement. Prior studies have found that the beneficial effects of intra-articular corticosteroid injections can last anywhere from 2 to 24 weeks.[12,15] The purpose of this study was to investigate the efficacy of intra-articular corticosteroid injections in the management of symptomatic knee OA and to identify factors that affect treatment response.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....