Study Questions Corticosteroid Injections For Knee Osteoarthritis

Intra-articular triamcinolone acetonide had no effect on pain and was associated with decreased cartilage volume in patients with knee osteoarthritis, according to the findings of a recent study.

The randomized, placebo-controlled, double-blind trial included 140 patients with knee osteoarthritis (mean age 58 years, 75 of which were women [54%]). Patients were divided evenly and randomly assigned to received either a 40 mg intra-articular injection of triamcinolone acetonide or an intra-articular injection of saline every 3 months for 2 years. Every 3 months, researchers assessed pain levels using the Western Ontario and McMaster Universities Osteoarthritis index, and once a year they assessed changes in cartilage volume using knee magnetic resonance imaging. A total of 119 patients (85%) completed the study.
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Patients who received intra-articular triamcinolone had significantly greater cartilage volume loss (-0.21 mm) compared with patients who received saline (-0.10 mm). Knee pain was similar between participants treated with triamcinolone and participants treated with saline.

In addition, 5 treatment-related adverse events occurred in the triamcinolone group compared with 3 in the saline group. Participants in the triamcinolone group had a small increase in hemoglobin A_1c levels.

“Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain,” the researchers concluded. “These findings do not support this treatment for patients with symptomatic knee osteoarthritis.”

—Melissa Weiss

Reference:

McAlindon TE, LaVallet MP, Harvey WF, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial [published online May 16, 2017]. JAMA. doi:10.1001/jama.2017.5283.