Therapeutic Review of Methylprednisolone Acetate Intra‐Articular Injection in the Management of Osteoarthritis of the Knee – Part 1: Clinical Effectiveness

Abstract

Intra-articular (IA) corticosteroid injections are a common approach in the management of osteoarthritis (OA) of the knee. The effectiveness of injections and particular injection products is often discussed and debated in clinical arenas. The following therapeutic review examines the evidence for intra-articular methylprednisolone acetate (MPA) injections in the management of OA knee. A review of research evidence, published guidelines and clinical literature was undertaken following an electronic database and relevant literature search. The review found that there is limited evidence which indicates that a single dose intra-articular MPA injection can provide short to medium term benefits for pain, with less evidence for beneficial effects on function or stiffness. There is heterogeneity across studies and until recently, most studies had only short to medium term follow-up periods, thus limiting the evidence available on longer term benefit. There was also evidence indicating equivalent overall efficacy of MPA to that of other corticosteroid products. Most guideline recommendations concerning IA injections for OA knee have drawn on evidence from pooled data for several corticosteroid products. The review also found there was limited reporting of the incidence of adverse events in most studies. Overall, MPA shows efficacy for symptom relief in OA knee. At an individual management level, evidence for a limited duration of effect needs consideration in injections decisions. Furthermore, consensus across clinical guidelines suggests that the management of OA knee should be individualized to a person's clinical history, degree of disability, risk factors, quality of life and personal preferences, whereby injecting involves a shared decision and forms part of a multimodal approach. Copyright © 2016 John Wiley& Sons Ltd.

Addition of corticosteroids to local anaesthetics for chronic non-cancer pain injections: a systematic review and meta-analysis of randomised controlled trials

“…161 It is possible that factors outside of this review (such as sub-acute pain), 162 or other patient-level factors not yet recognised could indicate success with steroids. 150,151,163 Adverse events and acceptable risks Our review did not find significant differences, most likely as a result of methodological considerations and study limitations. As such, RCTs are not ideal to capture adverse effects related to therapy, 164 and most adverse effects are under-reported.…”

Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis

“…The pathological process includes inflammation and structural changes of knee joints. [ 17 ] Thus, it may result in pain and deformity. Conservative treatment, including physical therapy, intra-articular injections and oral medications, is the first choice for the treatment of knee osteoarthritis with mild to moderate.…”

Efficacy of intraarticular steroid injection in knee osteoarthritis using knee society score and visual analog score

“…The use of intraarticular corticosteroids has immediate analgesic effects however long term outcomes show no great improvement in functional outcomes. 7,8 This is believed to be due to the fact that the period of analgesia permits increased mobility and therefore causes increase articular cartilage damage due to weight bearing on an unhealthy knee joint. 9 In our study we used Injection Methylprednisolone (80 mg) 2 ml for injection into the lateral tibiofemoral compartment without local anesthesia.…”