From the Guidelines
Corticosteroid injections are a recommended treatment option for knee osteoarthritis, particularly for flare-ups of knee pain accompanied by effusion, as they can provide temporary pain relief and reduced inflammation, as supported by the 2022 American Academy of Orthopaedic Surgeons clinical practice guideline summary 1. The treatment of knee osteoarthritis with corticosteroid injections should be tailored to the individual patient, taking into account their specific risk factors, level of pain intensity and disability, and signs of inflammation.
- The optimal management of knee osteoarthritis requires a combination of non-pharmacological and pharmacological treatment modalities, including education, exercise, appliances, and weight reduction, as recommended by the 2003 EULAR guidelines 1.
- Corticosteroid injections can be used to manage flare-ups of knee pain, especially if accompanied by effusion, and can provide temporary pain relief and reduced inflammation, as supported by the 2020 American College of Rheumatology guideline 1.
- The procedure for corticosteroid injections typically involves injecting methylprednisolone (40-80mg) or triamcinolone acetonide (20-40mg) directly into the knee joint, often mixed with a local anesthetic like lidocaine 1%, and can be performed in an office setting after cleaning the injection site with antiseptic solution.
- Patients can receive up to 3-4 injections per year in the same joint, with at least 3 months between injections to minimize potential cartilage damage, and should rest the knee for 24-48 hours and apply ice to reduce post-injection pain.
- While corticosteroid injections are generally safe, potential side effects include temporary pain flare, infection risk, skin discoloration, and elevated blood sugar in diabetic patients, and should be used in conjunction with other treatments like physical therapy, weight management, and appropriate pain medications as part of a comprehensive osteoarthritis management plan.
From the Research
Efficacy of Corticosteroid Injections in Osteoarthritis of the Knee
- Corticosteroid injections have been shown to be effective in reducing pain and improving function in patients with osteoarthritis of the knee, at least in the short term 2.
- A study comparing intra-articular corticosteroid injections with placebo found that corticosteroids were more effective in reducing pain and improving patient global assessment at one week post-injection 2.
- However, the efficacy of corticosteroid injections in improving function was found to be limited, with no significant differences detected at one week post-injection 2.
Comparison with Other Treatments
- Corticosteroid injections have been compared with hyaluronic acid (HA) products, with some studies suggesting that HA products may be more effective in the long term 2, 3.
- A study comparing triamcinolone acetonide extended-release with placebo found that the treatment was effective in reducing pain and improving function in patients with osteoarthritis of the knee 4, 5.
- Another study compared intra-articular triamcinolone injection with placebo and found that the treatment was effective in reducing pain and improving function in patients with osteoarthritis of the knee 6.
Safety and Repeat Administration
- Corticosteroid injections have been found to be generally well-tolerated, with few side effects reported 2, 4, 6, 5.
- A study investigating the safety and efficacy of repeat administration of triamcinolone acetonide extended-release found that the treatment was well-tolerated and effective in reducing pain and improving function in patients with osteoarthritis of the knee 4.
- The use of corticosteroid injections in osteoarthritis of the knee is supported by several studies, which suggest that they can be an effective treatment option for patients with this condition 2, 4, 6, 5.