Intra-articular Injections for Management of Knee Osteoarthritis

Abstract

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.

Use of hyaluronic acid associated with triamcinolone acetonide or ozone gas in the treatment of induced osteoarthritis in rabbits

“…Several types of corticosteroids and hyaluronic acid have been used in rabbits’ studies 12 , 20 , 23 , 24 . The corticosteroid incorporated into the product was triamcinolone, that is one of the corticosteroids of intra-articular injection used in human patients 1 , 7 , 25 . In a systematic review, triamcinolone appeared to be more effective than methylprednisolone and betamethasone, but with pain relief for only one week, which suggested the need for other treatment modalities for chronic pain 26 .…”

“…In a systematic review, triamcinolone appeared to be more effective than methylprednisolone and betamethasone, but with pain relief for only one week, which suggested the need for other treatment modalities for chronic pain 26 . Furthermore, the use for prolonged periods and at high doses can promote side effects, such as damage to the cartilage and knee bursa, causing worsening of osteoarthritis and, consequently, more pain 3 , 7 . Therefore, further studies with different proportions between corticosteroids and hyaluronic acid must be carried out.…”

“…The treatments include surgical procedures or conservative approaches, such as reduction of modifiable risk factors, intra-articular therapies, physical modalities, as well as systemic pharmacological treatments 3 , 6 . Among substances used intra-articularly for the osteoarthritis treatment, corticosteroids, hyaluronic acid or combinations, and blood-derived products may be cited 1 , 7 .…”

Potential effect of hyaluronic acid and triamcinolone acetate, alone or combined, on chondrogenic differentiation of mesenchymal stem cells

“…The triamcinolone acetate, triamcinolone hexacetonide and methylprednisolone acetate are long-acting corticosteroid preparations frequently used intra-articular in human patients (Silvinato and Bernardo, 2017). The efficacy of one corticosteroid over the other remains controversial (Golding et al, 2017).…”