Corticosteroid injection into the osteoarthritic knee: drug selection, dose, and injection frequency

Douglas, R J W

doi:10.1111/j.1742-1241.2012.02963.x

Cited by 54 publications

(42 citation statements)

References 41 publications

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“…Corticosteroids also attenuate the effects of IL-1, decrease leukotriene and prostaglandin release, and inhibit metalloproteases and immunoglobulin synthesis [13]. The specific corticosteroids used vary by the physician’s preference, but generally include triamcinolone, betamethasone, and methylprednisolone [1]. …”

Section: Resultsmentioning

confidence: 99%

“…Handler and Wright first described radiographic evidence of destruction of the knee joint and cartilage after several corticosteroid injections [1]. The incidence of joint infection following corticosteroid administration is rare, but may be as high as one in three thousand patients, with an associated mortality rate of approximately 11%.…”

Section: Resultsmentioning

confidence: 99%

“…More specifically, OA of the knee involves the largest synovial joint in humans [1]. Knee OA is especially prevalent in middle-aged and elderly patients.…”

Section: Introductionmentioning

confidence: 99%

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Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine

Richards

Maxwell

Weng

et al. 2016

The Physician and Sportsmedicine

142

117

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Objectives Knee osteoarthritis (OA)1 is a debilitating condition that may ultimately require total knee arthroplasty (TKA)2. Non-operative treatments are bracing, oral analgesics, physical therapy, and intra-articular knee injection (IAKI)3. The objective of this paper is to provide a systematic literature review regarding intra-articular treatment of knee OA and insight into promising new products of regenerative medicine that may eventually have a substantial effect on treatment. Methods A literature search was executed using Medline, Cochrane, and Embase with keywords ”knee osteoarthritis” and “injection.” Specifically, articles discussing intra-articular knee injection using corticosteroids, hyaluronic acid, analgesics, local anesthetics, and newer products of regenerative medicine, such as platelet-rich plasma (PRP)4 and mesenchymal stem cells (MSC)5, were analyzed. Results Forty-five publications were scrutinized. Of these, eleven were level 1, three were level 2, twelve were level 3, two were level 4, and seventeen were level 5. Papers included animal models. Local anesthetics have potential side effects and may only be effective for four hours. Morphine and ketorolac may provide significant pain relief for 24 hours. Corticosteroids may give patients weeks to one months of effective analgesia, but complications may occur, such as systemic hyperglycemia, septic arthritis, and joint degradation. Hyaluronic acid is a natural component of synovial fluid, but efficacy with respect to analgesia is controversial. Platelet-rich plasma formulations, autologous conditioned serum, autologous protein solution, and mesenchymal stem cell injections contain anti-inflammatory molecules and have been proposed to attenuate joint destruction or potentially remodel the joint. Conclusions Currently, knee OA treatment does not address the progressively inflammatory environment of the joint. More investigation is needed regarding products of regenerative medicine, but they may ultimately have profound implications in the way knee OA is managed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine

Richards

Maxwell

Weng

et al. 2016

The Physician and Sportsmedicine

142

117

View full text Add to dashboard Cite

show abstract

“…The clinician has a variety of options available regarding choice of corticosteroids with hydrocortisone, triamcinolone, methylprednisolone and betamethasone being among the most frequently used in practice [12]. There is a lack of conclusive evidence to suggest the efficacy of one corticosteroid over the other, however a systemic review by Hepper et al did demonstrate a trend suggesting that triamcinolone leads to a greater reduction in pain scores in comparison to other preparations [15].…”

Section: Corticosteroidsmentioning

confidence: 99%

“…Corticosteroids have a broad range of antiin lammatory properties; however, it is well documented that oral or intravenous doses have a wide range of systemic side-effects such as osteoporosis, weight gain, an increased susceptibility to infections and the development of hypertension and diabetes mellitus [11]. To alleviate this problem, clinicians irst began delivering intraarticular corticosteroids (IACS) in the 1950s and their use has been increasing in conservative management of knee OA ever since [12].…”

Section: Corticosteroidsmentioning

confidence: 99%

Intra-articular Injections for Management of Knee Osteoarthritis

Golding¹,

Brock²,

Whiting³

et al. 2017

J Arthritis

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Knee pain is an increasingly common presentation to general practitioners worldwide which is thought to be related to the obesity epidemic, an ageing population and increasingly sedentary lifestyles in more developed nations. Degenerative osteoarthritis (OA) accounts for the majority of presentations in older age groups and this has traditionally been treated with analgesia, lifestyle modifications and adjuncts such as physiotherapy, braces and insoles. All these therapies aim to delay the need of total knee replacement (TKR), which is often the end-point for severe knee OA. However, TKR is associated with poor levels of patient satisfaction, low functional outcomes and has recently been shown to have low levels of cost-effectiveness except in patients with severe disabling OA. Increasingly doctors are turning to intra-articular injections which can provide temporary pain relief such as corticosteroids, hyaluronic acid and platelet rich plasma. This article aims to review the current options for intraarticular injections, comment on their efficacy and suggest areas for future development.

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Intra-articular corticosteroid for knee osteoarthritis

Jüni

Hari

Rutjes

et al. 2015

Cochrane Database of Systematic Reviews

322

302

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Background Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intraarticular corticosteroids, there is an ongoing debate about their benefits and safety. This is an update of a Cochrane review first published in 2005. Objectives To determine the benefits and harms of intra-articular corticosteroids compared with sham or no intervention in people with knee osteoarthritis in terms of pain, physical function, quality of life, and safety. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE (from inception to 3 February 2015), checked trial registers, conference proceedings, reference lists, and contacted authors. Selection criteria We included randomised or quasi-randomised controlled trials that compared intra-articular corticosteroids with sham injection or no treatment in people with knee osteoarthritis. We applied no language restrictions. Data collection and analysis We calculated standardised mean differences (SMDs) and 95% confidence intervals (CI) for pain, function, quality of life, joint space narrowing, and risk ratios (RRs) for safety outcomes. We combined trials using an inverse-variance random-effects meta-analysis. Main results We identified 27 trials (13 new studies) with 1767 participants in this update. We graded the quality of the evidence as 'low' for all outcomes because treatment effect estimates were inconsistent with great variation across trials, pooled estimates were imprecise and did not rule out relevant or irrelevant clinical effects, and because most trials had a high or unclear risk of bias. Intra-articular corticosteroids appeared to be more beneficial in pain reduction than control interventions (SMD-0.40, 95% CI-0.58 to-0.22), which corresponds to a difference in pain scores of 1.0 cm on a 10-cm visual analogue scale between corticosteroids and sham injection and translates 1 Intra-articular corticosteroid for knee osteoarthritis (Review)

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Corticosteroid injection into the osteoarthritic knee: drug selection, dose, and injection frequency

Cited by 54 publications

References 41 publications

Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine

Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine

Intra-articular Injections for Management of Knee Osteoarthritis

Intra-articular corticosteroid for knee osteoarthritis

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