We are unable to recommend for or against the use of intraarticular (IA) corticosteroids for patients with symptomatic osteoarthritis of the knee.
Our search found only four placebo comparison studies that met criteria and evaluated pain relief for a minimum treatment period of four weeks.102-105 One study found IA corticosteroids to be superior to placebo on WOMAC total subscale scores at four weeks.102 However, another study found IA corticosteroid injections inferior to hyaluronic acid injections106 and a third study found IA corticosteroids inferior to needle lavage (tidal irrigation).107Since the evidence in the guideline did not support the use of hyaluronic acid or needle lavage, the work group interpreted the evidence to be inconclusive as to the benefit of IA corticosteroids.
- (102) Chao J, Wu C, Sun B et al. Inflammatory characteristics on ultrasound predict poorer longterm response to intraarticular corticosteroid injections in knee osteoarthritis. J Rheumatol 2010;37(3):650-655. PM:20080918
- (103) Gaffney K, Ledingham J, Perry JD. Intra-articular triamcinolone hexacetonide in knee osteoarthritis: factors influencing the clinical response. Ann Rheum Dis 1995;54(5):379-381. PM:7794044
- (104) Raynauld JP, Buckland-Wright C, Ward R et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2003;48(2):370-377. PM:12571845
- (105) Jones A, Doherty M. Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response. Ann Rheum Dis 1996;55(11):829-832. PM:8976640
- (106) Caborn D, Rush J, Lanzer W, Parenti D, Murray C. A randomized, single-blind comparison of the efficacy and tolerability of hylan G-F 20 and triamcinolone hexacetonide in patients with osteoarthritis of the knee. J Rheumatol 2004;31(2):333-343. PM:14760806
- (107) Arden NK, Reading IC, Jordan KM et al. A randomised controlled trial of tidal irrigation vs corticosteroid injection in knee osteoarthritis: the KIVIS Study. Osteoarthritis Cartilage 2008;16(6):733-739. PM:18077189