Efficacy of Triamcinolone Hexacetonide versus Methylprednisolone Acetate Intraarticular Injections in Knee Osteoarthritis: A Randomized, Double-blinded, 24-week Study

Lomonte, Andrea Barranjard Vannucci; Morais, Marina Gonçalves Veras de; Carvalho, Lina Oliveira de; Zerbini, Cristiano Augusto de Freitas

doi:10.3899/jrheum.150297

Cited by 52 publications

(35 citation statements)

References 26 publications

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“…However, there were no differences between both corticosteroids. 62 Increased recognition of the role of synovitis in the pathogenesis of human OA makes one wonder how the stage and degree of synovitis may impact treatment results. One of the biggest contrasts when discussing IA corticosteroid use in horses compared with the human knee is the stage of synovitis usually being treated (generally acute in the horse and more mixed with considerable chronic synovitis in the human knee).…”

Section: Factors That Might Affect a Response To Intra-articular Cortmentioning

confidence: 99%

Intra-articular Corticosteroids for Knee Pain—What Have We Learned from the Equine Athlete and Current Best Practice

McIlwraith

Lattermann

2018

J Knee Surg

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The use of intra-articular corticosteroids for traumatic arthritis and osteoarthritis (OA) is common in the horse. The beneficial and deleterious effects of the principal corticosteroids used betamethasone esters (Celestone [Soluspan], methylprednisolone acetate [Depo Medrol], and triamcinolone acetonide [TA] [Vetalog or Kenalog]) have been defined for the horse. While TA has both disease-modifying as well as symptom-modifying effects, methyl prednisolone acetate has deleterious effects on the articular cartilage. Studies in traumatically injured joints show the same rationale (suppression of deleterious mediators associated with inflammation) and positive results from the use of TA in both equine and human patients. Studies in the experimental equine OA model allow for more in-depth knowledge of disease-modifying effects. Recent insights allow us to understand posttraumatic OA as an early consequence of joint injury that may require a more aggressive and proactive treatment approach than commonly applied to date.

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Section: Factors That Might Affect a Response To Intra-articular Cortmentioning

confidence: 99%

Intra-articular Corticosteroids for Knee Pain—What Have We Learned from the Equine Athlete and Current Best Practice

McIlwraith

Lattermann

2018

J Knee Surg

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“…The use of intra-articular corticosteroid injections as an adjuvant therapy in the treatment of inflammatory arthritis 54,55 and knee and hip osteoarthritis [56][57][58][59] is well established, and it may help preserve the integrity of the joint. 60 Intra-articular corticosteroid injections generally provide short-term pain relief and functional improvement, 61,62 although there is great variability in the duration and magnitude of the clinical response. In a longitudinal cohort study, an intra-articular corticosteroid injection guided by computed tomography provided significant clinical improvement at 6 months in active sacroiliitis in patients with spondylarthropathy.…”

Section: Use Of Corticosteroids In Musculoskeletal Disorders Articulamentioning

confidence: 99%

Injectable Corticosteroids: Take Precautions and Use Caution

Freire

Bureau

2016

Semin Musculoskelet Radiol

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Corticosteroids are routinely injected into soft tissues, tendon sheaths, bursae, and joints. These anti-inflammatory agents have different potency and solubility, and solubility is inversely correlated with the duration of action. Corticosteroids carry a low risk of complications but commonly cause systemic and local adverse effects. The use of intra-articular corticosteroid injections in the treatment of inflammatory arthritis and osteoarthritis is well established. Evidence also supports the use of injectable corticosteroids in the treatment of inflammatory tenosynovitis and bursitis associated with rheumatic diseases, trigger finger and de Quervain disease, and carpal tunnel syndrome. The role of corticosteroid injections in the management of rotator cuff disease remains unclear. Strong scientific evidence indicates that corticosteroid injections for lateral epicondylosis worsen the long-term outcomes of patients. This review article discusses the considerations related to the use of corticosteroid injections in the management of nonspinal musculoskeletal conditions.

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“…The manufacturer-recommended dose for knee injections (large joint) is 40-80 mg (Summary of Product Characteristics -Depo-Medrone ® , 2014; Summary of Product Characteristics -Depo-Medrol ® , 2014). Studies on the effectiveness of MPA injections have shown clinical benefit with doses of 40 mg (Jones and Doherty, 1996;Lomonte et al, 2015;Yavuz et al, 2012) and 60 mg (Wagner et al, 2015). In studies on triamcinolone acetonide (TA), a higher dose (80 mg) showed no additional benefit compared with 40 mg (Popma et al, 2015).…”

Section: Dosementioning

confidence: 99%

Therapeutic Review of Methylprednisolone Acetate Intra‐Articular Injection in the Management of Osteoarthritis of the Knee – Part 2: Clinical and Procedural Considerations

McCrum

2016

Musculoskeletal Care

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The use of an intra-articular methylprednisolone acetate (MPA) injection has been shown to have benefits for symptoms of knee osteoarthritis (OA). However, considerations beyond drug efficacy can influence the appropriateness, clinical effectiveness and potential harm of an injection. A review of research evidence and published literature on clinical and procedural factors influencing the effectiveness and safety of a knee injection has been undertaken. Factors include dose, frequency, contraindications, precautions, drug interactions, side-effects, and procedural and patient-related considerations. An evaluation of evidence indicated that a 40 mg dose provides clinical benefit. No strong predictors of response were evident, with the exception of pain severity. Additional benefit for outcomes from higher doses, local anaesthetic, ultrasound guidance or particular anatomical approaches is yet to be demonstrated. Evidence for dose- and duration-related detrimental effects suggests judicious use and frequency. The evaluation showed that there are a number of contraindications and precautions arising from the drug pharmacology, concurrent medications, comorbidities and adverse events which need consideration and monitoring. There was limited safety evidence concerning anticoagulation. The review found that specialist guidance and limited evidence suggests that injection safety concerning warfarin may be enhanced by ensuring that the international normalized ratio level is within therapeutic range. However, the risk-benefit evaluation concerning non vitamin K antagonist oral anticoagulants remains challenging. Although there is published guidance, a lack of clinical studies, safety evidence and reversibility advocates caution. Overall, the review indicates that injection decisions and procedures need an individualized approach and supporting evidence is limited in many areas. Evaluation and discussion of benefits and risks, peri-procedural and post-injection management, and tailoring to the context and individuals' preferences are important in optimizing the benefits and safety of a knee injection.

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Efficacy of Triamcinolone Hexacetonide versus Methylprednisolone Acetate Intraarticular Injections in Knee Osteoarthritis: A Randomized, Double-blinded, 24-week Study

Abstract: Both IA therapies are equally effective, and improvement in pain and function can be sustained for up to 24 weeks. Controlled-trials.com identifier: ISRCTN15077843.

Cited by 52 publications

References 26 publications

Intra-articular Corticosteroids for Knee Pain—What Have We Learned from the Equine Athlete and Current Best Practice

Intra-articular Corticosteroids for Knee Pain—What Have We Learned from the Equine Athlete and Current Best Practice

Injectable Corticosteroids: Take Precautions and Use Caution

Therapeutic Review of Methylprednisolone Acetate Intra‐Articular Injection in the Management of Osteoarthritis of the Knee – Part 2: Clinical and Procedural Considerations

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