Evaluation of the Benefit of Corticosteroid Injection Before Exercise Therapy in Patients With Osteoarthritis of the Knee

Mi Jin Kim, Mercer University College of Pharmacy 2015

The centers for Disease Control and Prevention (CDC) reports that nearly half of American adults may develop knee osteoarthritis (OA) by the age 85.1 Current guidelines suggest that exercise is a first-line non-pharmacologic intervention that is highly recommended for OA of the knee.2 Intra-articular corticosteroid injection is a possible pharmacological option for managing knee OA per the American College of Rheumatology.3 A recently published study assessed the clinical efficacy of intra-articular corticosteroid injection given before an exercise program in patients with OA of the knee.

Title: Evaluation of the benefit of corticosteroid injection before exercise therapy in patients with osteoarthritis of the knee
Design Randomized, blinded, placebo-controlled clinical trial; 100 patients
Objective

(Primary)

To assess the clinical benefits of an intra-articular corticosteroid injection given before exercise therapy in patients with osteoarthritis (OA) of the knee
Study Groups Corticosteroid group (n= 50) vs. placebo group (n= 50)
Methods Patients randomly received corticosteroid or placebo in a 1:1 ratio. The corticosteroid group received a 1 mL intra-articular injection of methylprednisolone acetate, 40 mg while the placebo group received a 1 mL injection of isotonic saline. Both injections were mixed with 4 mL of lidocaine hydrochloride (10 mg/ mL).
Duration From October 1, 2012 to April 2, 2014
Primary outcome measure Change in the pain subscale of the knee injury and osteoarthritis outcome score (KOOS) questionnaire at week 14
Baseline Characteristics Corticosteroid group: age 61.3, female 56%, BMI 29, KOOS score 53.3

Placebo group: age 65.5, female 66%, BMI 28.9, KOOS score 55.2

Results The mean changes in the KOOS pain subscale score at week 14 were 13.6 and 14.8 points in the corticosteroid and placebo groups, respectively. (95% confidence interval [CI] -3.8 to 6.2; p= 0.64)
Adverse Events Common Adverse Effects: Not reported
Serious Adverse Events: Not reported
Percentage that Discontinued due to Adverse Events: None reported
Study Author Conclusions No additional benefit results from adding an intra-articular injection of 40 mg of corticosteroid before exercise in patients with painful OA of the knee.

This study was the first trial to evaluate if the combined treatment of intra-articular corticosteroid and exercise leads to important OA outcomes. The results of this study did not support the superiority of intra-articular injection of corticosteroid compared with saline before an exercise intervention. However, the low dose of corticosteroid was used in this trial and a higher dose may give rise to different results.

References:

  1. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm. Accessed April 2, 2015.
  2. Mcalindon TE, Bannuru RR, Sullivan MC, et al. Response to Letter to the Editor entitled “Comments on ‘OARSI guidelines for the non-surgical management of knee osteoarthritis'”. Osteoarthr Cartil. 2014;22(6):890-1.
  3. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012; 64(4): 465-74.
  4. Henriksen M, Christensen R, Klokker L, et al. Evaluation of the Benefit of Corticosteroid Injection Before Exercise Therapy in Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial. JAMA Intern Med. 2015. doi:10.1001/jamainternmed.2015. 0461.
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