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J Rheumatol. 2019 Apr 1. pii: jrheum.180233. doi: 10.3899/jrheum.180233. [Epub ahead of print]

Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

Author information

1
From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA. This study was funded by Arthritis Research UK grant 20380, and special strategic award grant 18676. The funding agency had no role in any of the following: design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. This report includes independent research supported by (or funded by) the NIHR Biomedical Research Unit Funding Scheme. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The Research in Osteoarthritis Manchester group is supported by the Manchester Academic Health Sciences Centre. Prof. D.T. Felson is supported by NIH AR4778. N. Maricar is supported by an NIHR Allied Health Profession Clinical Doctoral Fellowship. N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust. Address correspondence to N. Maricar, NIHR Clinical Doctoral Fellow, Research in Osteoarthritis Manchester (ROAM), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PT, UK. E-mail: nasimah.maricar@manchester.ac.uk, nasimah.maricar@srft.nhs.uk. Accepted for publication March 7, 2019.

Abstract

OBJECTIVE:

To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA.

METHODS:

Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome.

RESULTS:

One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10-1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03-1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04-1.55), anserine tenderness (RR 1.27, 95% CI 1.06-1.52), and a belief that treatment would be effective [RR/unit increase (range 0-10) = 1.05 (1.01-1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66-0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44-0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0-10) = 0.83, 95% CI 0.72-0.97], chronic widespread pain (RR 0.32, 95% CI 0.10-0.98), perceived chronicity of disease [RR/unit increase (range 0-10) = 0.86, 95% CI 0.78-0.94], and a higher depression score [RR/unit increase (range 0-21) = 0.89, 95% CI 0.81-0.99] were less likely to be longer-term responders.

CONCLUSION:

Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits.

PMID:
30936283
DOI:
10.3899/jrheum.180233

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