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Intramuscular glucocorticoid injection versus placebo injection in hip osteoarthritis: a 12-week blinded randomised controlled trial
  1. Desirée M J Dorleijn1,
  2. Pim A J Luijsterburg1,
  3. Max Reijman2,
  4. Margreet Kloppenburg3,
  5. Jan A N Verhaar2,
  6. Patrick J E Bindels1,
  7. Pieter Koen Bos2,
  8. Sita M A Bierma-Zeinstra1,2
  1. 1Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3Department of Rheumatology, Leiden University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Desirée M J Dorleijn, Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam 3000 CA, The Netherlands; d.dorleijn{at}erasmusmc.nl

Abstract

Objectives Guidelines recommend intra-articular glucocorticoid injection in patients with painful hip osteoarthritis. However, intra-articular hip injection is an invasive procedure. The efficacy of systemic glucocorticoid treatment for pain reduction in hip osteoarthritis is unknown. This randomised, double-blind, trial assessed effectiveness in hip pain reduction of an intramuscular glucocorticoid injection compared with a placebo injection in patients with hip osteoarthritis.

Methods Patients with painful hip osteoarthritis were randomised to either 40 mg triamcinolone acetate or placebo with an intramuscular injection into the gluteus muscle. The primary outcomes were severity of hip pain at rest, during walking (0–10) and WOMAC pain at 2-week postinjection. We used linear mixed models for repeated measurements at 2, 4, 6 and 12 weeks for the intention-to-treat data analysis.

Results Of the 107 patients randomised, 106 could be analysed (52 in the glucocorticoid group, 54 in the placebo group). At 2-week follow-up, compared with placebo injection, the intramuscular glucocorticoid injection showed a significant and clinically relevant difference in hip pain reduction at rest (difference −1.3, 95% CI −2.3 to −0.3). This effect persisted for the entire 12-week follow-up. For hip pain during walking, the effect was present at 4-week, 6-week and 12-week follow-ups, and for WOMAC pain the effect was present at 6-week and 12-week follow-up.

Conclusions An intramuscular glucocorticoid injection showed effectiveness in patients with hip osteoarthritis on one of the three primary outcomes at 2-week postinjection. All primary outcomes showed effectiveness from 4 to 6 weeks, up to a 12-week follow-up.

Trial registration number NTR2966.

  • osteoarthritis
  • treatment
  • corticosteroids

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Footnotes

  • Handling editor Josef S Smolen

  • Contributors DMJD: trial coordination, data-acquisition, data-analysis and data interpretation, writing article. PAJL: study design, participation in trial coordination, data interpretation and extensive review of article. MR, MK, JANV and PJEB: study design and review of article. PKB: study design, radiological assessment, data interpretation and review of article. SMAB-Z: conceived the study, study design, data interpretation and extensive review of article. All authors read and approved the final manuscript.

  • Funding Financial support was received from the Dutch Arthritis Foundation and the NutsOhra Fund.

  • Disclaimer There was no role of both funding sources.

  • Competing interests MK reports grants from Abbvie, grants from Levicept, grants from GlaxoSmithKline, grants from Arthritis Rheumatology, grants from APPROACH consortium, grants from Foreum, grants from TI-Pharma, grants from Pfizer; outside the submitted work. SMAB-Z reports grants from Dutch Arthritis Foundation, grants from Nuts Ohra, during the conduct of the study. Pending grants from Dutch Arthritis Foundation, at the Netherlands Organization for Health research and development, and EU Horizon 2020, outside the submitted work. Grants received from the Dutch Arthritis Foundation, Netherlands organization for Health research and development, Nuts-Ohra, and EU Fp7, outside the submitted work.

  • Patient consent Obtained.

  • Ethics approval Medical Ethics Committee of the Erasmus University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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