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Study: Intra-articular triamcinolone not effective for symptomatic knee osteoarthritis
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Intra-articular triamcinolone acetonide injections were no more effective than placebo saline injections for the reduction of pain in patients with knee osteoarthritis, according to recently published data. In addition, steroid injections lead to greater cartilage loss in these patients.
“The hypothesis that intra-articular corticosteroids might reduce the rate of cartilage loss and other structural manifestations of osteoarthritis was based on recognition of the role of inflammation in its pathogenesis, and reduced structural progression observed in vivo,” Timothy E. McAlindon, DM, MPH, from Tufts Medical Center, and colleagues wrote. “Suppression of inflammation could attenuate catabolic effects of inflammation and reduce articular damage. However, these results showed greater progression of knee cartilage volume loss and no sustained effect on intra-articular inflammation as indicated by persistence of effusion. As a proof-of-concept study, the results raise questions about the role of inflammation in osteoarthritis progression.”
Between 2011 and 2015, investigators performed a 2-year double-blinded randomized controlled trial of intra-articular triamcinolone acetonide administered at 40 mg/mL every 3 months compared with saline for 140 patients with symptomatic knee osteoarthritis and evidence of synovitis on ultrasound. For the 10 visits during the 24-month study period, patients were advised to discontinue concomitant analgesics 2 days prior to each assessment and to only take acetaminophen if needed. At months 0, 12 and 24, patients underwent MRI.
Compared with placebo, the steroid group had a greater cartilage loss rate (–0.21 mm vs. –0.10 mm) and a greater cartilage damage index (–133.66 µm3 vs. –72.41 µm3). There were no significant differences in progression of cartilage denudation, bone marrow lesion, effusion volume, trabecular morphology or bone mineral density of the subchondral tibia and hip. Investigators found no significant differences for semi-quantitative cartilage abnormalities between the groups. However, they noted superficial fibrillation was more common in the saline group (34% vs. 13%). In addition, there was a difference in knee pain between steroid and placebo groups (–1.2 units vs. –1.9 units), but this was not significant.
For safety, there were more adverse events in the saline group (182 vs. 131); however, there was no significant difference in serious adverse events.
At the final visit, 45% of patients correctly guessed their treatment assignment.
“These findings do not support this treatment for patients with symptomatic knee osteoarthritis,” the researchers wrote. – by Will A. Offit
Disclosures: The researchers report no relevant financial disclosures.
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