Injections in the treatment of osteoarthritis

doi:10.1053/berh.2001.0177

Best Practice & Research Clinical Rheumatology

Volume 15, Issue 4, October 2001, Pages 609-626

https://doi.org/10.1053/berh.2001.0177 Get rights and content

Abstract

Injections, especially of corticosteroids but also of hyaluronan, are widely used in the treatment of osteoarthritis. The various joints – knee, hip, hand – affected by OA are accessible to these local treatments. This chapter concentrates on the evidence for efficacy of these treatments and attempts to delimit their respective indications and optimal doses. The side-effects of corticosteroid injections are reviewed, and the potential interest in post-injection rest is discussed. Finally, the potential structure-modifying effect of hyaluronan is investigated.

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In this study, we aimed to assess the analgesic efficacy of a thermoresponsive polymeric dexamethasone (Dex) prodrug (ProGel-Dex) in a mouse model of osteoarthritis (OA). At 12 weeks post model establishment, the OA mice received a single intra-articular (IA) injection of ProGel-Dex, dose-equivalent Dex, or Saline. Comparing to Saline and Dex controls, ProGel-Dex provided complete and sustained pain relief for >15 weeks according to incapacitance tests. In vivo optical imaging confirmed the continuous presence of ProGel-Dex in joints for 15 weeks post-injection. According to micro-CT analysis, ProGel-Dex treated mice had significantly lower subchondral bone thickness and medial meniscus bone volume than Dex and Saline controls. Except for a transient delay of body weight increase and slightly lower endpoint liver and spleen weights, no other adverse effect was observed after ProGel-Dex treatment. These findings support ProGel-Dex's potential as a potent and safe analgesic candidate for management of OA pain.
In situ gelling system for sustained intraarticular delivery of bupivacaine and ketorolac in sheep
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Citation Excerpt :
Of note, dose-normalized AUC calculations revealed comparable AUC values among various groups, suggesting a complete release of BH and KT from both dosage forms. Extending the residence time has been a challenge in the IA drug delivery, attributed to the highly porous nature of the synovial membrane [21,22]. As shown in Table 4, the concentration of BH in the synovial fluids in the gel groups at 72 h was 11.5-fold that of the drug solution groups, denoting that the developed gel formulations successfully extended the residence time of BH inside the joint cavity for more than three days.
Suboptimal control of postoperative pain following knee arthroplasty can slow recovery and reduce patient satisfaction. Intraarticular (IA) administration of bupivacaine and ketorolac offers efficient pain control and minimizes opioid consumption. However, the clinical benefits of this approach are short lived due to rapid clearance of drugs from the joint cavity. Here, we describe a poloxamer based thermoresponsive in situ gelling system for the sustained IA delivery of bupivacaine hydrochloride (BH) and ketorolac tromethamine (KT) following knee surgery in an ovine model. Drug loaded formulations were prepared using poloxamer 407, poloxamer 188 and sodium chloride. In vitro characterization was conducted, followed by in vivo evaluation of sustained drug release and safety in an ovine model of knee joint surgery. Rheological studies revealed a Newtonian-like flow of the developed formulation at room temperature, confirming its injectability, followed by a transition to a viscous gel as temperature approached body temperature. The developed formulation successfully sustained the in vivo release of BH for 72 h and KT for 48 h, as determined by circulating drug levels, compared to 24 and 8 h for marketed drug solutions. The concentrations of BH and KT in the synovial fluids at 72 h were 11.5 and 1.8 times that of marketed products, suggesting a significant increase in the IA residence time. The developed formulation induced a comparable inflammatory response compared to the marketed drug solutions, however a significantly higher chondrotoxicity was observed following administration of the gel formulations. Poloxamers based in situ gelling systems are promising delivery platforms for the sustained and localised IA delivery of BH and KT, with potential clinical benefits in managing the postoperative pain following knee arthroplasty.
Intra-articular triamcinolone hexacetonide injections in hands osteoarthritis ‒ A double-blinded randomized controlled trial with a one year follow-up
2022, Clinics
to evaluate the effectiveness of triamcinolone Hexacetonide (TH) Intra-Articular Injection (IAI) in hand Interphalangeal Joints (IP) of Osteoarthritis (OA) patients to improve pain and joint swelling; improve function, goniometry, and grasping force, and assess IAI influence on radiographic evolution over 1-year.
A randomized, double-blind study. 60 patients who underwent IAI at the most symptomatic IP joint were randomly assigned to receive TH+Lidocaine (LD) (TH/LD group) or just LD (LD group). Patients were assessed blindly for 1-year, at baseline and 1, 4, 8, 12, and 48 weeks. The following variables were assessed: articular pain and swelling, AUSCAN and COCHIN functional questionnaires, grip and pinch strength, goniometry, perception of improvement, acetaminophen consumption, and simple radiography. Repeated-measures ANOVA test was used to analyze the intervention response.
Sixty patients completed the follow-up. There were nine missed assessments. 97% were women; mean age of 61-years (SD = 8.2), and approximately 5-years of disease (SD = 3.6). Half of the patients present radiographic classification Kellgren and Lawrence (KL) grades I and II, and the other half grades III and IV. The two groups evolved similarly at 48-weeks. TH/LD group had a better evaluation in joint swelling and acetaminophen consumption (p = 0.04 and p < 0.001, respectively) at 48-weeks. Radiographically there was no statistical difference between groups (KL, p = 0.564; erosive OA, p = 0.999; worsening, p = 0.573).
The IAI IP hands OA is effective for the improvement of joint swelling and decrease of analgesic consumption and does not influence the radiographic evolution of the injected joint.
Comparative analysis of intra-articular injection of steroid and/or sodium hyaluronate in adhesive capsulitis: prospective, double-blind, randomized, placebo-controlled study
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Few studies have reported the effects of simultaneous injections of corticosteroid (CS) and hyaluronic acid (HA) on adhesive capsulitis (AC) of the shoulder. This study investigated the synergistic effects of simultaneous intra-articular injections of CS and compared them to those of CS or HA alone.
Sixty patients with AC were enrolled in this randomized, placebo-controlled trial. The participants were divided into 4 groups: saline, CS, HA, and CS with HA groups. The primary outcome measure was changes in the Shoulder Pain and Disability Index (SPADI) scores at one month. The secondary outcome measures included changes in pain, range of motion, muscle strength, and additional shoulder functional scores at 1 day, 1 week, and 1, 3, and 6 months after injection.
After 1 month, changes of the SPADI scores were significantly higher in the CS with HA group (−58.4%) than those in the saline (−7.7%) and HA (−14.4%) groups. The score changed more in the CS with HA group than that in the CS group (−43.7%), but there was no significant difference. In the changes in pain, the CS with HA group showed significantly better and faster effects than the saline and HA groups. In the changes of range of motion, functional scores, the CS with HA group showed better results than the saline and HA groups.
In the treatment of AC, the simultaneous injection of CS and HA was more effective in improving SPADI scores at one month after injection than a single injection of CS or HA.
Evaluation of alginate hydrogel encapsulated mesenchymal stem cell migration in horses
2019, Research in Veterinary Science
Osteoarthritis is an incapacitating disease characterized by pain and a progressive decrease in joint mobility. The implantation of mesenchymal stem cells (MSCs) has shown promising results for its treatment. The challenge remains to keep the cells longer at the site of action, increasing their therapeutic potential. The aim of this study was to evaluate the effectiveness of the Qtracker® 655 nanocrystal marking on allogeneic synovial membrane (SM) MSCs, encapsulated in alginate hydrogel, evaluating the migration of these cells. The 10 radiocarpal joints were submitted to arthroscopic surgery (D0), divided into two groups. The chondral defect was treated according to the group: GA free-labelled MSC_SM and GB labelled MSC_SM microcapsules. Seven days after lesion induction and implantation of labelled cells, biopsies of the lesion site were performed in two animals, and fragments of SM and joint capsule also collected, which were frozen and later processed for fluorescence microscopy. The synovial fluid of the three animals was analyzed by flow cytometry three times – 3, 7 and 21 days after application. The cellular marking with the nanocrystals allowed the visualization of the cells in cartilage, synovial membrane, synovial fluid and articular capsule, but with a predilection for the synovial membrane and the lesion site was scarce. The labelled MSC_SM in microcapsules were scarce in the synovial fluid and could be related to the small quantity of MSCs leaving the pores of the microcapsules, also favorable results, as the cells release paracrine effects acting for a long period until the cellular differentiation.
Knee effusion-synovitis volume measurement and effects of vitamin D supplementation in patients with knee osteoarthritis
2017, Osteoarthritis and Cartilage
Citation Excerpt :
Importantly, compared to articular and bony alterations, synovial inflammation has a greater potential to regress or resolve21 which creates a treatment opportunity. Pharmaceutical managements such as non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular steroid injection have been recommended for OA patients particularly for those with joint effusion22; however, these treatments can result in side-effects and drug intolerance during long-term use23,24. It is therefore important to identify safer and more cost-effective interventions targeting synovial inflammation in OA25.
To develop a measure of knee joint effusion-synovitis volume and to examine the effect of vitamin D supplementation on effusion-synovitis in people with knee osteoarthritis (OA) and low vitamin D levels over 24 months.
Symptomatic knee OA patients with low 25-(OH)D levels (12.5–60 nmol/l) were recruited for a multi-centre, randomised, placebo-controlled and double-blind trial. Participants (age 63 ± 7 years, 208 females) were allocated to either 50,000 IU monthly vitamin D₃ (n = 209) or placebo (n = 204) for 24 months. Knee effusion-synovitis volume in suprapatellar and other regions was measured on magnetic resonance imaging (MRI) using OsiriX software. The intra-class correlation coefficients (ICCs) were used to test inter- and intra-rater reliabilities. The least significant change criterion was used to define the increase/decrease in effusion-synovitis volume.
The reproducibilities of effusion-synovitis volume measurement were high with ICCs ranging from 0.93 to 0.99. Over 24 months, effusion-synovitis volume remained stable in the vitamin D group but increased in placebos with a significant between-group difference (−1.94 ml, 95% confidence interval (CI): −3.54, −0.33). This effect was evident in those with baseline effusion-synovitis and with suprapatellar effusion-synovitis. The proportion with an increase in effusion-synovitis volume was lower in the vitamin D group than placebo (risk ratio (RR): 0.87, 95% CI: 0.77, 0.97).
This highly reproducible effusion-synovitis volume measurement could be a promising outcome measure in OA trials. Vitamin D supplementation could retard the progression of effusion-synovitis which can potentially benefit people with an inflammatory OA phenotype.

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Regular ArticleInjections in the treatment of osteoarthritis

Abstract

Osteoarthritis and Cartilage

Current Therapeutic Research

Clinical Therapeutics

Osteoarthritis and Cartilage

Osteoarthritis and Cartilage

Current Therapeutic Research

Osteoarthritis and Cartilage

Knee osteoarthritis: efficacy and contribution of local treatments

La Presse Médicale

The value of intra-articular injections in osteoarthritis of the knee

Journal of Bone and Joint Surgery

Intra-articular therapy in osteo-arthritis. Comparison of hydrocortisone acetate and hydrocortisone tertiary-butylacetate

Annals of the Rheumatic Diseases

Intraarticular prednisolone injection for osteoarthritis of the knee. A double blind test with placebo

Acta Chirurgica Scandinavica

The efficacy of intraarticular steroids in osteoarthritis: a double blind study

Journal of Rheumatology

Intra-articular steroids in osteoarthritis

Rheumatology and Rehabilitation

Intra-articular triamcinolone hexacetonide in knee osteoarthritis: factors influencing the clinical response

Annals of the Rheumatic Diseases

Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response

Annals of the Rheumatic Diseases

Effects of joint lavage and steroid injection in patients with osteoarthritis of the knee

Arthritis and Rheumatism

Local injection of hydrocortisone and procaine in osteo-arthritis of the hip joint

Annals of the Rheumatic Diseases

Intra-articular therapies in osteoarthritis

Guidelines for the medical management of osteoarthritis

Arthritis and Rheumatism

Intra-articular corticosteroid treatment in osteoarthritis

Current Opinion in Rheumatology

EULAR recommendations for the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT)

Annals of the Rheumatic Diseases

Painful juxtameniscal areas in certain arthropathies of the knee and their treatment by juxtameniscal cortisone infiltration

Annals of the Rheumatic Diseases

Corticosteroid injection for osteoarthritis of the knee; peripatellar compared to intra-articular route

Clinical Experimental Rheumatology

Intra-articular corticosteroids

Drugs

Intra-articular corticosteroids: an updated assessment

Clinical Orthopaedics and Related Research

Intrasynovial corticosteroid therapy in arthritis

Maryland Medical Journal

Frequency of sepsis after local corticosteroid injection

Rheumatology

Clinical comparison of triamcinolone hexacetonide and betamethasone in the treatment of osteoarthrosis of the knee joint

Scandinavian Journal of Rheumatology

Facial flushing after intra-articular injection of bupivacaine and methylprednisolone

British Medical Journal

Radiographic follow-up of joints injected with triamcinolone hexacetonide for the management of childhood arthritis

Arthritis and Rheumatism

Corticosteroid injection in rheumatoid arthritis does not increase rate of total joint arthroplasty

Journal of Rheumatology

Repeated corticosteroid injections into knee joints

Rheumatology and Rehabilitation

Clinical trials: impact of IA steroid injections on the progression of knee osteoarthritis

Osteoarthritis and Cartilage

Intra-articular therapy for rheumatoid synovitis of the knee: effects of the post-injection rest regimen

Clinical Rheumatology in Practice

Regular Article
Injections in the treatment of osteoarthritis