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Ultrasound detected synovial change and pain response following intra-articular injection of corticosteroid and a placebo in symptomatic osteoarthritic knees: a pilot study
  1. Michelle Hall1,2,
  2. Sally Doherty1,
  3. Philip Courtney3,
  4. Khalid Latief3,
  5. Weiya Zhang1,
  6. Michael Doherty1
  1. 1Academic Rheumatology, University of Nottingham, Nottingham, UK
  2. 2School of Health Sciences, University of Nottingham, Nottingham, UK
  3. 3Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to Dr Michelle Hall, School of Health Sciences, Clinical Sciences Building, Hucknall Rd, Nottingham NG5 1PB UK; michelle.hall{at}

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Intra-articular injection (IAI) of steroid is a safe and effective treatment for painful knee osteoarthritis (OA).1 The mechanism of action is thought to be partly mediated by an anti-inflammatory effect on the synovium which may be detected by changes observed on ultrasound (US) examination.2 Placebo IAI of saline can also significantly reduce pain though the mechanisms are not generally thought to associate with a peripheral effect.3–5 This pilot study aimed to investigate whether improved knee pain correlated with improved US measures following IAI of a corticosteroid or a placebo in OA knees.

Twenty-five participants with painful knee OA (Kellgren and Lawrence grade ≥2) were randomised to one of two treatment sequences (IAI of methylprednisolone (40 mg in 1 mL) followed by IAI of saline placebo (1 mL, 0.9%), or vice versa) to their most painful knee. Synovial fluid equal to volume injected …

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  • Contributors MH, PC, KL, WZ and MD conceived the study. SD performed the US examination. MH and WZ analysed the data. MH, WZ and MD drafted the manuscript, PC and KL contributed to revising the manuscript.

  • Funding We are grateful to Arthritis Research UK for funding this work (AHP Training Fellowship Grant no. 18861).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Derbyshire Research Ethics Committee approved this study.

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