New research conducted by a team from Tufts University Medical Center casts doubt on the efficacy of long-term, multiple corticosteroid injection therapy for the management of pain from knee osteoarthritis. The study found that repeat injections of intra-articular triamcinolone provided no significant benefit in pain levels compared to placebo over a 2-year evaluation period. Patients who received the corticosteroid therapy also exhibited significantly greater cartilage volume loss, compared to the control group, although the difference was not considered clinically useful. Study coauthor Jeffrey Driban, PhD, commented, "We've known for a while that cortisone injections for knee OA may offer short-term pain relief for a few weeks. What we were testing here is whether getting repeated injections every 3 months would offer prolonged pain relief." The findings were published last month in the Journal of the American Medical Association.
In the study, 140 patients, 75 women and 65 men, were randomized to receive injections of 40 mg/mL triamcinolone or 1 mL of 0.9% sodium chloride. Participants received fMRI scans at baseline, 1 year, and 2 year intervals to assess changes in cartilage volume, together with measurement of pain scores. Although no significant difference in the latter was observed, the mean reduction in index compartment cartilage thickness was significantly greater in the active vs placebo group. The authors state that their findings confirm a role for steroid injection in managing OA pain, but emphasize the need for assessment of individual patient conditions, and encourage the use of other approaches including exercise, dietary modification, and analgesics.
Read a news report about the study conclusions.
The journal abstract may be read here.