Intra-articular steroid injections not supported for knee OA
medwireNews: Results of a randomized trial suggest no clinical benefits of triamcinolone injections for patients with symptomatic knee osteoarthritis (OA).
As reported in JAMA, 70 participants given intra-articular triamcinolone acetonide 40 mg every 12 weeks for 2 years experienced significantly greater decreases in index compartment cartilage thickness as measured by magnetic resonance imaging (MRI) than the 70 patients given intra-articular saline, with corresponding reductions of 0.21 and 0.10 mm.
The cartilage damage index score also worsened by a mean 133.66 mm3 among patients in the triamcinolone group versus 72.41 mm3 among those in the saline group, a significant difference.
However, the team found no significant difference in knee pain severity over the course of the study between the two groups; mean scores on the Western Ontario and McMaster Universities pain subscale decreased by 1.2 units from a baseline of 7.5 in the triamcinolone group, compared with 1.9 units from a baseline of 8.2 in the saline group.
The overall rate of adverse events (AEs) was lower in the triamcinolone than the saline group, with 52 and 63 participants experiencing side effects, respectively. But a higher number of AEs was considered related to treatment among those receiving triamcinolone, at five (four injection site pain and one facial flushing) and three (two injection site pain and one cellulitis), respectively.
“These findings do not support this treatment for patients with symptomatic knee osteoarthritis,” say Timothy McAlindon (Tufts Medical Center, Boston, Massachusetts, USA) and study co-authors.”
The researchers observe that although direct MRI measurements showed a greater degree of cartilage loss among patients receiving triamcinolone compared with saline, “cartilage loss was not associated with worsening of symptom outcomes.”
However, they note that previous studies have demonstrated an association between cartilage loss and higher rates of arthroplasty, “raising the possibility of potential for longer-term adverse consequences on the health of the joint.”
Therefore, they recommend that “[c]artilage structure should be evaluated in any future clinical studies of similar therapeutics.”
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