|
|
Can Fam Physician. 2004 February; 50: 241–248. | PMCID: PMC2214544 |
Intra-articular steroid injections for painful knees. Systematic review with meta-analysis. Marshall Godwin and Martin Dawes Department of Family Medicine, Queen's University, Kingston, Ont. OBJECTIVE: Do intra-articular steroid injections relieve the pain of osteoarthritis (OA) of the knee? DATA SOURCES: MEDLINE, Cochrane, and Internet databases were searched for randomized controlled trials. STUDY SELECTION: Five randomized controlled trials involving 312 patients were found. SYNTHESIS: One week after injection, treated patients were less likely to have continuing pain and had significantly lower scores on a visual analogue scale (VAS) for pain. Three to 4 weeks after injection, treated patients still had significantly less pain, but their VAS scores were no longer significantly lower than scores in the control group. Six to 8 weeks after injection, neither pain reduction nor VAS scores were significantly different between groups. CONCLUSION: Intra-articular corticosteroid injection results in clinically and statistically significant reduction in osteoarthritic knee pain 1 week after injection. The beneficial effect could last for 3 to 4 weeks, but is unlikely to continue beyond that. The Full Text of this article is available as a PDF (305K). These references are in PubMed. This may not be the complete list of references from this article. - Ravaud P, Moulinier L, Giraudeau B, Ayral X, Guerin C, Noel E, Thomas P, Fautrel B, Mazieres B, Dougados M. Effects of joint lavage and steroid injection in patients with osteoarthritis of the knee: results of a multicenter, randomized, controlled trial. Arthritis Rheum. 1999 Mar;42(3):475–482. [PubMed]
- Sambrook PN, Champion GD, Browne CD, Cairns D, Cohen ML, Day RO, Graham S, Handel M, Jaworski R, Kempler S, et al. Corticosteroid injection for osteoarthritis of the knee: peripatellar compared to intra-articular route. Clin Exp Rheumatol. 1989 Nov–Dec;7(6):609–613. [PubMed]
- Friedman DM, Moore ME. The efficacy of intraarticular steroids in osteoarthritis: a double-blind study. J Rheumatol. 1980 Nov–Dec;7(6):850–856. [PubMed]
- Creamer P. Intra-articular corticosteroid treatment in osteoarthritis. Curr Opin Rheumatol. 1999 Sep;11(5):417–421. [PubMed]
- Hunter JA, Blyth TH. A risk-benefit assessment of intra-articular corticosteroids in rheumatic disorders. Drug Saf. 1999 Nov;21(5):353–365. [PubMed]
- Wada J, Koshino T, Morii T, Sugimoto K. Natural course of osteoarthritis of the knee treated with or without intraarticular corticosteroid injections. Bull Hosp Jt Dis. 1993 Summer;53(2):45–48. [PubMed]
- Gaffney K, Ledingham J, Perry JD. Intra-articular triamcinolone hexacetonide in knee osteoarthritis: factors influencing the clinical response. Ann Rheum Dis. 1995 May;54(5):379–381. [PubMed]
- Dieppe P, Cushnaghan J, Jasani MK, McCrae F, Watt I. A two-year, placebo-controlled trail of non-steroidal anti-inflammatory therapy in osteoarthritis of the knee joint. Br J Rheumatol. 1993 Jul;32(7):595–600. [PubMed]
- Creamer P, Hunt M, Dieppe P. Pain mechanisms in osteoarthritis of the knee: effect of intraarticular anesthetic. J Rheumatol. 1996 Jun;23(6):1031–1036. [PubMed]
- Valtonen EJ. Clinical comparison of triamcinolonehexacetonide and betamethasone in the treatment of osteoarthrosis of the knee-joint. Scand J Rheumatol Suppl. 1981;41:1–7. [PubMed]
- Jones A, Doherty M. Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response. Ann Rheum Dis. 1996 Nov;55(11):829–832. [PubMed]
- HOLLANDER JL. Intra-articular hydrocortisone in arthritis and allied conditions; a summary of two years' clinical experience. J Bone Joint Surg Am. 1953 Oct;35-A(4):983–990. [PubMed]
- MILLER JH, WHITE J, NORTON TH. The value of intra-articular injections in osteoarthritis of the knee. J Bone Joint Surg Br. 1958 Nov;40-B(4):636–643. [PubMed]
- Pendleton A, Arden N, Dougados M, Doherty M, Bannwarth B, Bijlsma JW, Cluzeau F, Cooper C, Dieppe PA, Günther KP, Hauselmann HJ, Herrero-Beaumont G, Kaklamanis PM, Leeb B, Lequesne M, Lohmander S, Mazieres B, Mola EM, Pavelka K, Serni U, Swoboda B, Verbruggen AA, Weseloh G, Zimmermann-Gorska I. EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2000 Dec;59(12):936–944. [PubMed]
- Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1993 Dec 1;270(21):2598–2601. [PubMed]
- Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA. 1994 Jan 5;271(1):59–63. [PubMed]
- Balch HW, Gibson JM, El-Ghobarey AF, Bain LS, Lynch MP. Repeated corticosteroid injections into knee joints. Rheumatol Rehabil. 1977 Aug;16(3):137–140. [PubMed]
- Raynauld Jean-Pierre, Buckland-Wright Chris, Ward Rupert, Choquette Denis, Haraoui Boulos, Martel-Pelletier Johanne, Uthman Imad, Khy Visithan, Tremblay Jean-Luc, Bertrand Carole, Pelletier Jean-Pierre. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003 Feb;48(2):370–377. [PubMed]
|
See commentary "