Marius H, Christensen R, Klokker L, et al.
JAMA Intern Med. Published online March 30, 2015. doi:10.1001/jamainternmed.2015.0461
This randomized, blinded, placebo-controlled clinical trial evaluated the benefit of intra-articular corticosteroid injection (1 ml of methylprednisolone acetate 40 mg/ml dissolved in 4 ml of lidocaine) vs placebo injection (1 ml of isotonic saline in 4 ml of lidocaine) given before exercise therapy in 100 patients with radiographic confirmation of clinical OA of the knee, clinical signs of localized inflammation in the knee, and knee pain during walking (>4/10 pain). Two weeks after injection, all participants started a 12 week supervised exercise program. Outcomes were measured at baseline, week 2 (exercise start), week 14 (exercise stop), and week 26. Primary outcome was change in Pain subscale of Knee Injury and Osteoarthritis Outcome Score (KOOS) at week 14. Secondary outcome included the remaining KOOS subscales and objective measures of physical function and inflammation. Result showed no statistically significant difference between the 2 groups in primary or secondary outcomes at any time points.
Comment: Knee OA is a frequent cause of pain and disability with one of the standard treatment being IA steroid injection. This study showed no clinical benefit of 40 mg methylprednisolone acetate compared to placebo of saline with lidocaine when combined with exercise. This study poses the question or doubt about the standard of care and presumed benefit of steroid injection for knee OA.
Icon credit: Carl Holderness