Intra-articular corticosteroid injections (IACI) are effective treatments for pain in knee osteoarthritis (KOA) but treatment response varies. There is uncertainty as to whether structural factors such as accurate placement of IACI affect outcome. We examined this question in a pragmatic observational study, using ultrasound (US) to verify accuracy of IACI.
105 subjects with KOA (mean age 63.1 years, 59% female) routinely referred for IACI underwent assessment of demographic factors, x-ray and US of the knee before aspiration and IACI (based on clinical landmarks) with 40 mg triamcinolone acetonide with lignocaine plus a small amount of atmospheric air by an independent physician. US demonstration of intra-articular mobile air, i.e. a positive air arthrosonogram, was used to determine accurate placement of injection. Both patients and injecting physicians were blind to the US findings. Pain at baseline, three and nine weeks post injection was assessed using the 500 mm WOMAC pain subscale and response defined as ≥ 40% reduction in pain from baseline. Inter-observer reliability of air-arthrosonogram assessment was good: κ 0.79 (three raters).
Sixty-three subjects (60.6%) were responders at three weeks and 43 (45.7%) at nine weeks. Seventy-four subjects (70.5%) had a positive arthrosonogram. A positive air arthrosonogram did not associate with a higher rate of response to treatment (p 0.389 at three weeks, p 0.365 at nine weeks). There was no difference in US effusion depth, power Doppler signal or radiographic grade between responders and non-responders to the injection, but female gender associated with response at 3 weeks and previous injection with non-response at 9 weeks.
Accurate intra-articular injection of corticosteroid results did not result in superior outcome in terms of pain compared to inaccurate injection in symptomatic knee OA.
Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JWJ, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to 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. 2003;62(12):1145–55. CrossRefPubMedPubMedCentral
National Institute for Health and Care Excellence. Osteoarthrtis: care and management in adults. CG177th ed. London: National Institute for Health and Care Excellence; 2014.
Bellamy N, Campbell J, Welch V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;19(2), CD005328.
Smith MD, Wetherall M, Darby T, Esterman A, Slavotinek J, Roberts-Thomson P, et al. A randomized placebo-controlled trial of arthroscopic lavage versus lavage plus intra-articular corticosteroids in the management of symptomatic osteoarthritis of the knee. Rheumatology. 2003;42(12):1477–85. CrossRefPubMed
Jones A, Regan M, Ledingham J, Pattrick M, Manhire A, Doherty M. Importance of placement of intra-articular steroid injections. Br Med J. 1993;307(6915):1329–30. CrossRef
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC - A health-status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40. PubMed
Burnett S, Hart D, Cooper C, Spector TD. A radiographic atlas of osteoarthritis. London: Springer; 1994.
Tubach F, Ravaud P, Baron G. Evaluation of clinically relevant changes in patient reported outcome measures in patients with knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheumeumatic Dis. 2005;64(1):29–33. CrossRef
Cunnington J, Marshall N, Hide G, Bracewell C, Isaacs J, Platt P, et al. A Randomized, Double-Blind, Controlled Study of Ultrasound-Guided Corticosteroid Injection Into the Joint of Patients With Inflammatory Arthritis. Arthritis Rheum. 2010;62(7):1862–9. PubMed
Leopold SS, Redd BB, Warme WJ, Wehrle PA, Pettis PD, Shott S. Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee - A prospective, randomized trial. J Bone Joint Surg Am Vol. 2003;85A(7):1197–203. CrossRef
Bevers K, Zweers MC, Vriezekolk JE, Bijlsma JWJ, den Broeder AA. Are ultrasonographic signs of inflammation predictors for response to intra-articular glucocorticoids in knee osteoarthritis? Clin Exp Rheumatol. 2014;32(6):930–4. PubMed
- Accuracy of injection and short-term pain relief following intra-articular corticosteroid injection in knee osteoarthritis – an observational study
T. W. O’Neill
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
e.Med Kampagnen-Visual, Mail Icon II