Intra-articular corticosteroid injection for osteoarthritis

Abstract

Efficacy Intra-articular corticosteroid injection is quick and simple to carry out and in RCTs it has a large effect size (ES) of 1.27 at 7 days postinjection for pain relief against placebo for knee OA [101]. It produces relatively rapid relief of severe pain within a few hours or days. Although this benefit is relatively short lasting, in RCTs (1–4 weeks), individual patients may derive benefit for 2–3 months or longer. When used with other treatments, this relatively large ES is likely to improve confidence in, and adherence to, other treatments including core nonpharmacological interventions. For these reasons, the UK regulatory body, NICE, recommends intraarticular corticosteroid injection as a useful adjunct to core treatment for the relief of moderate-to-severe pain in OA patients [101]. Many guidelines suggest that patients having a ‘flare’, or those with a joint effusion, may particularly benefit from a steroid injection, which seems logical for a drug with a potent anti-inflammatory effect. However, there is little objective evidence that the presence of clinically assessed joint inflammation is a predictor of clinical outcome, although the presence of an effusion may improve the accuracy of injection, which itself is a predictor of response [8,16]. Although not all patients respond, it is a rewarding procedure for the vast majority who do. It may even work well for patients with advanced radiographic change. Some patients receive three-monthly injections as an integral part of their management plan, providing excellent supplemental symptom relief [19]. In addition, the predictable benefit can be used to an advantage for special events, Intra-articular corticosteroid injection Intra-articular injection of corticosteroid is an effective, safe and rewarding procedure. Osteoarthritis (OA) is a condition that only affects joints so it seems logical to target therapy directly to the joint and thus, bypass the potential side effects of systemic administration. Following the first report of the use of intraarticular corticosteroid in 1951 by Hollander et al. [1], the procedure has become popular with both clinicians and patients [2]. Injection of long-acting insoluble corticosteroids into the knee produces rapid improvement in symptoms and can be repeated with predictable benefit in suitable patients [3–8].