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Intra-articular steroid for knee osteoarthritis

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Available evidence suggests that intra-articular steroid injection for knee osteoarthritis usually gives relief for perhaps one to four weeks although longer benefit has been reported. There is concern though, that repeated injections might damage the joint. Workers in New Zealand have carried out a meta-analysis of randomised, placebo controlled trials.

Although ten studies satisfied the inclusion criteria the main analysis was confined to six of them. With a total of 160 patients in the treatment groups and 157 in control groups the relative risk of improvement in symptoms up to two weeks after steroid injection was 1.66 (95% confidence interval 1.37–2.01). The number needed to treat to achieve one improvement varied between 1.3 and 3.5. Two studies were considered to be of high quality. Neither study alone provided significant evidence of improvement at 16–24 weeks but pooling of data (63 treated patients, 61 controls) did show significant improvement at that time (relative risk 2.09 (1.20 to 3.65), number needed to treat 4.4). Doses (prednisone equivalent) varied from 6.25 mg to 80 mg. The authors of the review comment that a triamcinolone dose of 20 mg (equivalent to 25 mg of prednisone) seems to be efficacious for pain control at two weeks. Only one study included measurements of joint space. In this study repeated injections of triamcinolone 40 mg were used and there was no significant loss of joint space at two years compared with controls. The two studies using high doses reported longer benefit. One study led to a recommendation that joint lavage should be added to steroid injection when knee effusion persists after one or two steroid injections.

Steroid injections produce symptomatic improvement for up to two weeks and possibly for 16–24 weeks though a higher dose (equivalent to 50 mg of prednisone) may be needed to achieve the longer term improvement.