Intra-Articular Corticosteroids Show No Benefit in Knee Osteoarthritis — Physician’s First Watch

Medical News |
May 17, 2017

Intra-Articular Corticosteroids Show No Benefit in Knee Osteoarthritis

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Intra-articular triamcinolone does not help relieve knee pain in adults with osteoarthritis — and might even lead to harm — according to a placebo-controlled trial in JAMA.

Some 140 adults with symptomatic knee osteoarthritis and ultrasound evidence of synovitis were randomized to receive intra-articular injections of either the corticosteroid triamcinolone (40 mg) or saline every 12 weeks for 2 years. At the end of the study, magnetic resonance imaging showed significantly greater knee cartilage volume loss with triamcinolone than with placebo, with no difference in knee pain between the groups.

The authors note, "It is likely that the difference in cartilage loss rates between groups was due to an adverse effect of intra-articular corticosteroids on cartilage rather than a benefit from intra-articular saline." They conclude, "These findings do not support [triamcinolone] for patients with symptomatic knee osteoarthritis."

Reader Comments (8)

A.L.

The previous comments astonish me. Bashing on a study because it doesn't support your biases isn't helping the medical field to grow. This study doesn't indicate that CSI doesn't reduce pain. Both groups have seen a reduction in pain both CSI didn't outperform saline. So why do both intervention work? Is it too hard to believe that CSI is mostly an overpriced placebo? How many patients do not get any effect from it after a few injections?! Anyways, there is enough evidence against the structural model of pain. Read any imaging study of asymptomatic patients, you will find a lot of painless structural changes. Time to evolve guys.

Daniel Ash, MD Resident, Internal Medicine, Chicago, IL

The investigators measured pain only at each 3mo visit, by which point the effect of the preceding CSI would presumably have worn off. They mention this issue in their discussion, but it is unclear why they did not take steps to mitigate it. As is, the study does not adequately assess the efficacy of CSI in treatment of knee pain due to OA.

B,S, Physician, Neurology, NMH

SAMPLE POPULATION TOO SMALL.

Y Khan Physician, Rheumatology, South Africa

Corticosteroid injections definitely do work. Disagree with study.

David S Smith, MD Physician, Family Medicine/General Practice

Prior studies of steroid injection have also shown no benefit and perhaps harm. I think we need to consider the perhaps short term benefit from the long term harm. We need to use patience

John Wood Physician, Orthopedics

It could be that the progression of articulate wear is due to the pain relief obtained from the I/A injection of steroid which then allows patient to continue activity levels leading to further wear. This only treats the symptoms not the disease process which will continue especially medical compartment wear

Abdullah, MD,FRCPC Physician, Emergency Medicine

Most of patients who received steroid injections, thier pain was relieved .

B Patrick Harpole MD Physician, Family Medicine/General Practice, Private practice > 40 years

Study probably sponsored by big pharma. Knee injections with triamcinolone work. If they didn't the patient wouldn't request another treatment. They delay surgery and relieve symptoms.
Whoever did study is not a clinician.
Why not do retrospective study? Interview patients who have received steroid injection.

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