Intra-Articular Steroids Relieve Pain of Knee Osteoarthritis

Authors: Lomonte AB et al. J Rheumatol 2015 Sep.

Triamcinolone and methylprednisolone worked equally well in a double-blind trial.

Symptomatic knee osteoarthritis (OA) occurs in as many as 6% of adults older than 30, and the prevalence of OA rises with increasing age. Treatment of patients with symptomatic knee OA includes physical therapy, analgesics (including nonsteroidal anti-inflammatory drugs, acetaminophen, and narcotics), topical agents, hyaluronate products, and intra-articular steroids. Few data guide the choice between the two most common intra-articular steroid preparations — triamcinolone hexacetonide and methylprednisolone acetate. In one comparative study, triamcinolone was more effective at week 3, whereas methylprednisolone was superior at week 8 (Clin Rheumatol 2004; 23:116).

In this randomized, double-blind Brazilian study, researchers compared intra-articular administration of triamcinolone or methylprednisolone in 100 outpatients with radiographic findings of OA and pain scores of >40 mm on a visual-analog scale (VAS; range, 0–100 mm). Injections (40 mg in 2 mL) were performed by a rheumatologist who was blinded to treatment group. In the entire cohort, VAS scores decreased from 80 mm at baseline to 50 mm at week 4. This improvement was largely sustained during the 24-week follow-up. No difference between groups was noted in VAS scores at 4, 12, or 24 weeks.

COMMENT

This study demonstrates that the two types of intra-articular steroids are equally useful; although no placebo comparator was included, other trials that included placebo controls have demonstrated at least short-term pain reduction (Cochrane Database Syst Rev 2006; 2:CD005328). This finding mirrors practice: Most clinicians’ steroid of choice is the one supplied by their practice. This study also demonstrates that, although the effect of these agents is equivalent, the magnitude of the effect is disappointing.