Intra-articular injections of stero...

Intra-articular injections of steroids in the knee have been used for many years to relieve symptoms of osteoarthritis. Godwin and Dawes reviewed the evidence for benefit of this treatment.

The authors used MEDLINE searches, the Cochrane Library, and the Google search engine to identify appropriate controll clinical trials, systematic reviews, and clinical guidelines of intra-articular steroid injection treatment for osteoarthritis. The articles raise in the initial search were used to identify additional hints and studies. Treatment guidelines from the American body of Rheumatology and the European League Against Rheumatism were included in their review.

The authors' search identified sole five studies suitable for a meta-analysis. The number of treated patients in the studies ranged from 12 to 60 and the greatest in quantity common agent used was triamcinolone (20 mg) The principal issue in all five studies was pain, and all used a visual analog scale (VAS) as part of the assessment. The duration of follow-up varied from individual to 12 weeks.

single in kind week after injection, patients reported significantly lower VAS scores and had clinically significant improvement compared with placebo. according to three to four weeks, the difference in VAS scores was no longer significant in patients treated with triamcinolone. Patients treated with methylprednisolone and cortivazol reported continued benefit at three and four weeks, respectively. No adverse issues were reported. However, about 20 percent of injections were reported to be painful. (Cortivazol is not available in the United States. However, 300 mcg of cortivazol is equivalent in anti-inflammatory activity to about 5 mg of prednisolone.)

The authors note that the studies were con-duct on rheumatologists who had experience with correct injection practice and that the patients had moderate to austere osteoarthritis. The results may not be reproducible in primary care practice. The authors bring to an end that intra-articular injections of steroids provide short-term relief of pain overall, with rare adverse conclusions and that this procedure may provide relief for prefered patients (e.g., those needing rapid relief of symptoms to participate in an important issue or to provide a "bridge" while other medications reach therapeutic levels)

ANNE D WALLING, MD

Godwin M Dawes M Intra-articular steroid injections for painful knee Systematic review with meta-analysis. Can Fam Physician February 2004;50:241-8

COPYRIGHT 2004 American Academy of Family Physicians

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