Monoarticular corticosteroid injection versus systemic administration in the treatment of rheumatoid arthritis patients: a randomized double-blind controlled study (original) (raw)
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Clinical Rheumatology, 2014
This review concluded that there was insufficient evidence on the comparative efficacy of different corticosteroid injections. A few trials favoured triamcinolone hexacetonide over the other corticosteroids. These conclusions reflect the evidence presented and appear to be reliable. Authors' objectives To determine the comparative efficacy of corticosteroid injections for intra-articular or periarticular soft tissue injections. Searching MEDLINE, Cochrane Database of Systematic Reviews, DARE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched in October or November 2013, for articles in English. Search terms and a search strategy were reported. Citation tracking and manual searches of bibliographies of relevant publications were conducted. Study selection Double-blind randomised controlled trials (RCTs) comparing corticosteroid injections, administered to peripheral joints or periarticular soft tissues, were eligible for inclusion. Trials had to include adults or children diagnosed with inflammatory arthritis, osteoarthritis, or a periarticular regional pain syndrome. Trials of spinal injections were excluded. The included trials were published between 1979 and 2009. The most commonly evaluated corticosteroids were methylprednisolone acetate, triamcinolone, and betamethasone. Most injections were administered to the knees or shoulders. Patient characteristics and outcome measures varied across the trials. Two reviewers independently selected trials for inclusion. Any discrepancies were resolved by consensus. Assessment of study quality Two reviewers independently assessed trial quality by assigning yes or no ratings for: specific inclusion and exclusion criteria; valid patient randomisation; blinding of patients; blinding of injectors; blinding of assessors; and power analysis. The thresholds used to define the quality of the trials were not reported. Data extraction The outcomes were extracted independently by two reviewers. None of the outcomes were specified before study selection and data extraction. Methods of synthesis The data were synthesised in a narrative. Results of the review Seven RCTs were included, with 306 patients (range 23 to 85). All seven RCTs were rated as high quality. One did not report blinding of assessors, and one did not report a power analysis. Two trials did not report blinding of the injector. Follow-up ranged from two weeks to 24 months. Compared with methylprednisolone or prednisolone-t-butyl acetate, for rheumatoid arthritis of the knee, triamcinolone hexacetonide demonstrated statistically significantly faster pain relief at day seven (one RCT; 30 patients). A similar result was shown when triamcinolone hexacetonide for knee osteoarthritis was compared with methylprednisolone at week three (one RCT; 57 patients). Another trial (24 patients) demonstrated significantly faster pain relief with methylprednisolone for rotator cuff tendonitis, compared with triamcinolone acetonide, at two weeks. All three trials
Arthritis Care & Research, 1994
Objective. To determine which intraarticular steroids are used by rheumatologists and whether this use and associated practice vary with time and place of training. Method. American College of Rheumatology members were mailed questionnaires that focused on steroid use in the adult knee. Results. The steroids favored by the respondents were methylprednisolone acetate [MPA), preferred most by those trained in the eastern U.S.; triamcinolone hexacetonide [TH), preferred by those trained in the Midwest and Southwest; and triamcinolone acetonide FA), preferred by those trained in the West. Only TH was chosen primarily because of efficacy. Regardless of concentration, respondents used 1 ml of steroid. Most (especially those recently trained) combined steroid with local anesthetic. Post-injection instructions varied: 29% did not restrict weight-bearing; 8% recommended limited weight-bearing for 1 week or more. Conclusion. MPA, TH, and TA were favored. Associated techniques varied, based in part on where and when training took place. Research is needed to provide a more rational basis for clinical practice.
Intra-articular corticosteroid injections were used decades to treat symptomatic arthritis of the knee and are still widely utilized. A steroid infusion is supposed to relieve pain by lowering inflammation within the arthritic knee. There is still significant variation between physicians in the strategy employed to execute the treatment, such as place of injection, the drugs administered, and level of bareness. Steroid infusions are most effective in alleviating arthritic painful symptoms in the short to midterm. The effectiveness of intra-articular conservative treatment, though, differs according to the available research. The freshest medical practice recommendation from US Academy of Orthopedic Doctors does not provide definitive guidelines for intra-articular corticosteroid injections for symptomatic knee osteoarthritis. Whenever utilizing those injections in medical care, providers must be alert of potential risks in addition possible problems. Keywords: Intra-Articular Corticosteroid Infusions, Orthopedic Therapist, Knee Osteoarthritis.
Intra-articular corticosteroid for knee osteoarthritis
Cochrane Database of Systematic Reviews, 2015
Background Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intraarticular corticosteroids, there is an ongoing debate about their benefits and safety. This is an update of a Cochrane review first published in 2005. Objectives To determine the benefits and harms of intra-articular corticosteroids compared with sham or no intervention in people with knee osteoarthritis in terms of pain, physical function, quality of life, and safety. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE (from inception to 3 February 2015), checked trial registers, conference proceedings, reference lists, and contacted authors. Selection criteria We included randomised or quasi-randomised controlled trials that compared intra-articular corticosteroids with sham injection or no treatment in people with knee osteoarthritis. We applied no language restrictions. Data collection and analysis We calculated standardised mean differences (SMDs) and 95% confidence intervals (CI) for pain, function, quality of life, joint space narrowing, and risk ratios (RRs) for safety outcomes. We combined trials using an inverse-variance random-effects meta-analysis. Main results We identified 27 trials (13 new studies) with 1767 participants in this update. We graded the quality of the evidence as 'low' for all outcomes because treatment effect estimates were inconsistent with great variation across trials, pooled estimates were imprecise and did not rule out relevant or irrelevant clinical effects, and because most trials had a high or unclear risk of bias. Intra-articular corticosteroids appeared to be more beneficial in pain reduction than control interventions (SMD-0.40, 95% CI-0.58 to-0.22), which corresponds to a difference in pain scores of 1.0 cm on a 10-cm visual analogue scale between corticosteroids and sham injection and translates 1 Intra-articular corticosteroid for knee osteoarthritis (Review)
Joint Bone Spine, 2010
Objective: To develop recommendations about the use of glucocorticoids in patients with established rheumatoid arthritis (RA) managed in everyday practice, using the evidence-based approach and expert opinion. Methods: A three-step procedure was used: a scientific committee used a Delphi procedure to select five questions, which formed the basis for developing the recommendations; a systematic literature review was conducted by searching the Medline and Embase databases and the abstracts of meetings held by the Société Franç aise de Rhumatologie (SFR), American College of Rheumatology (ACR), and European League Against Rheumatism (EULAR); and recommendations were developed and validated by a panel of experts based on the data from the literature review and on their experience. For each recommendation, the level of evidence and extent of agreement among experts were determined. Results: The five questions pertained to the use of glucocorticoids in RA patients: role for intravenous glucocorticoid bolus therapy, role for intraarticular injections, and practical modalities of glucocorticoid administration and discontinuation. From the literature search, 93 articles were selected based on their titles and abstracts. Of these, 50 were selected for the literature review. Eight recommendations about the use of glucocorticoid therapy in everyday practice in patients with established RA were validated by a vote among all participating experts: bolus glucocorticoid therapy should be reserved for highly selected situations; triamcinolone hexacetonide is the preferred glucocorticoid for intraarticular therapy, and the joint should be rested for about 24 h after the injection; for oral glucocorticoid therapy, agents with a short half-life taken once daily should be preferred; and when discontinuing glucocorticoid therapy, the patient and usual physician should be informed of the risk of adrenal insufficiency.
Pakistan Journal of Medical and Health Sciences, 2022
Objectives: To compare the frequency of disease progression in patients with osteoarthritis of knee treated with versus without intra-articular injection of corticosteroids. Design: The present study was a randomized single-blind controlled trial. Study Settings: The current study was conducted at Department of Orthopedic Surgery at Sir Ganga Ram Hospital Lahore over 1 year from May 2020 to April 2021. Study Procedure: The present study was conducted over 186 patients of both genders aged between 40-70 years presenting in outpatient department of orthopedic surgery with osteoarthritis of knee joint. The sampled patients were randomly allotted into two treatment arms. Patients from Group-A received intraarticular injection of steroids in addition to conservative management while those in Group-B were taken as controls and were managed conservatively without intraarticular injection of steroids. Outcome variable was frequency of disease progression over KL grading which was noted and compared between the groups. An informed on paper consent was obtained from every participant. Results: The mean age of the patients was 52.5±8.7 years. There was a female predominance with a male to female ratio of 1:1.7. The mean BMI of these patients was 28.3±3.6 Kg/m 2 and 60 (32.3%) patients were obese. 103 (55.4%) patients had grade 2 while 83 (44.6%) patients had grade 3 osteoarthritis. Disease progression was noted in 30 (16.1%) patients after 6 months follow-up. The frequency of disease progression was significantly higher in patients receiving intra-articular injection of corticosteroids as compared to controls (26.9% vs. 5.4%; p-value<0.001). When stratified, comparable difference was observed across various subgroups of patients based on patient's age, gender, BMI and baseline Kellgren-Lawrence Grade. Conclusion: In the present study intraarticular injection of steroids was found to be associated with articular cartilage damage evident from increased frequency of disease progression following intraarticular injection as compared to controls which advocates that intraarticular injection of steroids should be avoided in the management of osteoarthritis and should be reserved only for patients with advanced disease and who are already planned for joint replacement.
Reumatologia/Rheumatology
In knee osteoarthritis (KOA), synovial inflammation is linked with pain, swelling and structural abnormalities. Intra-articular corticosteroids (IACS) have been considered for pain relief in subjects who are non-responders to standard therapy. However, the results vary across different studies. This review aims to determine efficacy of IACS in KOA by review of the existing data. In several randomized controlled trials (RCTs), meta-analyses and uncontrolled studies a single IACS resulted in pain relief from 1 to a few weeks. In a few studies repeated IACS every three months provided a longer duration of pain relief and functional improvement in a proportion of patients. Baseline synovitis was predictor of treatment response in some but not all studies. Based upon the existing data, IACS provides a short-term pain relief in a proportion of patients. Given, anti-inflammatory properties of IACS, it is likely to be more effective in subgroups of KOA who display inflammatory phenotype.
The efficacy, accuracy and complications of corticosteroid injections of the knee joint
Knee Surgery, Sports Traumatology, Arthroscopy, 2011
Corticosteroid joint injections are perceived as being an effective treatment for symptomatic knee osteoarthritis, with a very low risk of complications. We present a case of a 71-year-old obese female who presented to her general practitioner (GP) with worsening left knee pain and radiographic changes consistent with osteoarthritis. She was administered a corticosteroid joint injection which gave minimal relief, and over the next few days resulted in worsening severe pain, erythema and swelling. She returned to the GP who commenced oral antibiotics and referred her to casualty. A large knee abscess was diagnosed and intravenous antibiotics were commenced.