Effectiveness of intramuscular gluteal glucocorticoid injection versus intra-articular glucocorticoid injection in knee osteoarthritis: design of a multicenter randomized, 24 weeks comparative parallel-group trial

Abstract

Background: The knee is symptomatically the most frequent affected joint in osteoarthritis and, in the Netherlands and other Western countries, is mainly managed by general practitioners (GPs). An intra-articular glucocorticoid injection is recommended in (inter) national guidelines for patients with knee osteoarthritis as an option for a flare of knee pain and/or for those who are not responding well to pain medication. An innovative approach that could replace the intra-articular injection is an intramuscular gluteal glucocorticoid injection. An intramuscular injection is easier to perform than an intra-articular injection with lesser risk of severe local adverse reactions. We hypothesize that intramuscular gluteal glucocorticoid injection is non-inferior in reducing knee pain compared to intra-articular glucocorticoid injection, with potentially a longer lasting effect than intra-articular injection. Methods/design: The study will be a pragmatic randomized controlled non-inferiority trial with two parallel groups. A total of 140 patients aged 45 years and older with knee osteoarthritis who contacted their general practitioner and have persistent knee pain (score ≥ 3 on 0-10 numerical rating scale; 0 = no knee pain) will be included. Patients will be randomly allocated (1:1) to an injection of 40 mg triamcinolone acetonide intra-articular in the knee joint or intramuscular in the ipsilateral ventrogluteal area. The effect of treatment will be evaluated by questionnaires at 2, 4, 8, 12, and 24 weeks after injection. The primary outcome is patients' reported severity of knee pain measured with the pain subscale of the Knee injury and Osteoarthritis Outcome Score 4 weeks after injection. Statistical analysis will be based on both the per-protocol and the intention-to-treat principle.(Continued on next page)

Exosomes Derived from M2 Macrophages Exert a Therapeutic Effect via Inhibition of the PI3K/AKT/mTOR Pathway in Rats with Knee Osteoarthritic

“…Due to changes in people's dietary structure and increasing social aging, the incidence of osteoarthritis is increasing year by year [ 2 ]. Epidemiological investigations show that the incidence of osteoarthritis is about 40.2% [ 3 ]. At present, the most common treatment methods for osteoarthritis include physical therapy, drug therapy, surgical treatment, and traditional Chinese medicine treatment [ 4 ].…”

The Efficacy of Intra-Articular Versus Extra-Articular Corticosteroid Injections in the Thumb Carpometacarpal Joint

“…The systemic effects of corticosteroid injections and their impacts on osteoarthritic joint disease are presently being studied in clinical trials. 20,21 Wang et al, 22 in their 2021 multicenter randomized controlled trial, found that gluteal glucocorticoid injections are not inferior to intraarticular knee injections for reducing knee pain in osteoarthritis at 8 and 24 weeks. While the exact mechanism has not yet been defined, evidence for the effects of systemic corticosteroid use on joint osteoarthritis is emerging.…”

Self-Assessment of Competence and Referral Behavior for Musculoskeletal Injections among Dutch General Practitioners

“…Furthermore, the clinical effectiveness of intramuscular injections has already been shown for hip osteoarthritis [ 29 ] and the effectiveness of an intra-articular injection versus intramuscular injection in patients with rotator cuff disease showed no significant differences between the methods of administration [ 30 ]. Recently, a randomized controlled trial on the non-inferiority of an intramuscular injection in comparison with an intra-articular injection in patients with knee osteoarthritis finished data collection [ 31 ].…”