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Inflammation not predictive of glucocorticoid response in patients with osteoarthritis
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No ultrasound or other characteristic of inflammation was shown to be predictive of response to intra-articular glucocorticoid injections in knee osteoarthritis, according to research from the Netherlands.
Between November 2010 and May 2011, 62 patients who met the American College of Rheumatology criteria for knee osteoarthritis (OA) were included in the study. Eligible patients had pain on a numeric rating system (NRS) of (0 = no pain, 10 = the worst pain) greater than 4. Patients were excluded when other rheumatic or orthopedic conditions were present, orthopedic procedures were planned in the following 3 months, or other comorbidities or cognitive issues were present that would be prohibitive to completing the study. Enrollees were 58% female with an average BMI of 30.2 and NRS score of 6.6.
Each patient was treated with an intra-articular injection of 40 mg of triamcinolone acetonide in addition to standard multimodal treatment. Synovial fluid was not aspirated, and no local anesthetic was used. Ultrasonography was conducted with each patient and analyzed using protocols comprised of effusion, synovial hypertrophy, meniscal protrusion, infrapatellar bursitis, Baker’s cyst and cartilage thickness, with follow-up planned at 4 weeks.
Responders were defined as those with a pain NRS score of less than 4. Statistical analysis was used to compare responders to nonresponders based on age, gender, BMI, knee swelling at baseline, NRS score and other characteristics.
After 4 weeks, 42% of patients achieved a NRS score of 4 or less. Through regression analyses, the researchers found patients who had used analgesics at baseline were less likely to achieve a good response compared with those who had not.
Aside from infrapatellar bursitis, no patient, disease or ultrasound characteristic of inflammation was shown to be a clinically meaningful predictor of response to treatment with triamcinolone acetonide, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.
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