Effect of Intramuscular vs Intra-articular Glucocorticoid Injection on Pain Among Adults With Knee Osteoarthritis

Abstract

IMPORTANCE Intra-articular (IA) glucocorticoid injection is widely used in patients with knee osteoarthritis (OA), but the safety of this technique is in question among physicians. Intramuscular (IM) glucocorticoid injection could be an alternative approach. OBJECTIVE To investigate whether an IM glucocorticoid injection is noninferior to an IA glucocorticoid injection in reducing knee pain for patients with knee OA in primary care. DESIGN, SETTING, AND PARTICIPANTSThe KIS trial, a multicenter, open-label, randomized clinical noninferiority trial including patients with symptomatic knee OA, was conducted in 80 primary care general practices in the southwest of the Netherlands. The study was conducted from March 1, 2018, to July 28, 2020. INTERVENTIONS Patients were randomly allocated to receive an injection of triamcinolone acetonide, 40 mg, either IM in the ipsilateral ventrogluteal region or IA in the knee joint. All patients were followed up for 24 weeks. MAIN OUTCOMES AND MEASURESThe pain score at 4 weeks measured with Knee Injury and Osteoarthritis Outcome Score (range, 0-100; 0 indicates extreme pain), with a noninferiority margin of −7 (IM minus IA). A per-protocol analysis was prespecified as the primary analysis.RESULTS A total of 145 patients (94 women [65%]; mean [SD] age, 67 [10] years) were included; of these, 138 patients (IM, 72; IA, 66) were included in the per-protocol analysis. Clinically relevant improvements in knee pain were reached up to 12 weeks after the injection in both groups. At 4 weeks, the estimated mean difference in the Knee Injury and Osteoarthritis Outcome Score between the 2 groups was −3.4 (95% CI, −10.1 to 3.3). Noninferiority could not be declared because the lower limit exceeded the noninferiority margin. Intramuscular injection was noninferior to IA injection at 8

Clin‐STAR corner: 2021 update in musculoskeletal pain in older adults with a focus on osteoarthritis‐related pain

“…IM injection did not reach noninferiority compared to IA injection at 4‐weeks, but did at 8 and 24‐weeks. Importantly, KOOS scores were improved at all timepoints in both intervention groups 9 …”

“…To be eligible, retained studies needed to: (1) be published in English; (2) employ an RCT design; and (3) include older adults (mean age ≥65 years) with a MSK pain condition. We evaluated the articles using two chief criteria, that is, the intervention's (1) scalability and (2) likely impact in the care of older adults 3–9 . Studies involving younger subjects (age <65 years) were included if the intervention evaluated was considered relevant to older adults.…”

“…We evaluated the articles using two chief criteria, that is, the intervention's (1) scalability and (2) likely impact in the care of older adults. [3][4][5][6][7][8][9] Studies involving younger subjects (age <65 years) were included if the intervention evaluated was considered relevant to older adults. Studies were excluded if they focused on non-MSK pain conditions (e.g., cancer pain).…”

Recognising and managing osteoarthritis flares in primary care

“…Recently examined pharmacological therapies for flares that are not yet used widely in clinical practice include oral prednisolone, intramuscular glucocorticoids and hyaluronan injections 373839. These interventions require further research.…”

An open-label, multicenter, randomized, parallel, single-dose, comparative bioavailability study of two triamcinolone hexacetonide injectable suspensions in patients with knee osteoarthritis

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Osteoarthritis is the second most common rheumatologic disorder, and its prevalence ranges from 22% to 39% in India. 1,2 Knee osteoarthritis is the most common type of osteoarthritis in India. Disability-adjusted life year due to osteoarthritis has increased from 0.79 million (95% uncertainty interval [UI]: 0.40-1.55) to 2.12 million (95% UI:1.07-4.23).

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