Intra-articular corticosteroids unlikely to benefit osteoarthritis patients
1. In this double blind, randomized controlled trial, intra-articular triamcinolone injections did not prevent cartilage degeneration compared to saline injection controls.
2. Triamcinolone injections did not improve patients’ pain from osteoarthritis compared to controls.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Osteoarthritis is a leading cause of disability in the United States. The condition leads to significant medical costs, due in part to a high rate of knee arthroplasty. As the pathogenesis of osteoarthritis is largely considered to be inflammatory, reducing inflammation at the joint may slow disease progression and improve symptoms. In this double-blind, randomized controlled trial, patients with osteoarthritis were given either intra-articular injections of triamcinolone or saline every 3 months for two years. Surprisingly, assessments showed moderate but significant reductions in cartilage thickness for the triamcinolone-treated group compared to saline-treated controls, though other measures such as cartilage denudation, marrow lesion, effusion volume, or changes in trabecular morphology were not significantly different. There was no decrease in knee pain or other patient-reported symptoms. Though some significant differences between groups in adverse events were reported, the number that was due to the treatment itself were likely to be similar. As such this trial does not support the use of intra-articular steroids as a treatment for osteoarthritis.
Click to read the study, published in JAMA
Relevant Reading: Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: A randomized, double-blind, placebo-controlled trial
In-Depth [randomized controlled trial]: In total, 140 patients with osteoarthritis were split evenly into triamcinolone and saline groups. Intra-articular injections of either compound were given every 3 months for 2 years. About 85% of patients in each group completed the study and had complete records with radiographs, ultrasonography, x-ray absorptiometry, and MRI used for quantitative assessments of joint health. Triamcinolone caused a decrease in cartilage thickness (-0.11 mm; CI95 -0.20 to -0.03 mm) and an increase in the secondary cartilage damage index (-61.25 μm3; CI95 -121.78 to -0.72 μm3). There were no significant differences between groups for cartilage denudation, bone marrow lesions, effusion volume, or changes in trabecular morphology (p > 0.05). There was no change in the subchondral tibia or hip and in bone mineral densities between groups. While there were more adverse effects in the saline treated group (p = 0.02), there were 3 treatment related effects in the saline group compared to 5 treatment related effects in the triamcinolone group, suggesting that adverse effect differences were likely due to chance. There was no difference in serious adverse effects.
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