From the Guidelines
Intra-articular glucocorticoid injections are conditionally recommended for patients with knee osteoarthritis, including those with tricompartmental osteoarthritis and degenerative medial meniscus tearing, as they provide short-term pain relief and have higher quality evidence compared to other forms of intraarticular injection. However, given the patient's uncontrolled type 2 diabetes, corticosteroid injections should be used cautiously as they can temporarily elevate blood glucose levels 1.
Considerations for Injection Therapy
- The patient's diabetes should be better controlled before proceeding with any injection, and blood glucose levels should be monitored closely following the procedure.
- Physical therapy, weight management, and appropriate diabetic management should accompany injection therapy for optimal outcomes.
- The injection should be performed under sterile conditions, and the patient should be advised to rest the joint for 24-48 hours post-injection to maximize benefit and reduce risk of complications.
- Hyaluronic acid injections may be considered as an alternative, providing pain relief for 3-6 months without affecting blood glucose, but the evidence for their efficacy is of lower quality compared to glucocorticoid injections 1.
Risks and Benefits
- The potential benefits of intra-articular glucocorticoid injections, including short-term pain relief, should be weighed against the potential risks, including temporary elevation of blood glucose levels and increased risk of joint infection if surgery is performed within 3 months of the injection 1.
- The patient's individual circumstances, including the severity of their osteoarthritis and diabetes, should be taken into account when making a decision about injection therapy.
Recommendation
Based on the most recent and highest quality evidence, intra-articular glucocorticoid injections are the recommended injection therapy for this patient, despite the need for caution in patients with uncontrolled diabetes 1.
From the Research
Injection Therapy Options
- For a 71-year-old female with tricompartmental osteoarthritis and degenerative medial meniscus tearing, complicated by uncontrolled type 2 diabetes (T2D), the best injection therapy option is not explicitly stated in the provided studies.
- However, studies 2, 3 suggest that triamcinolone acetonide extended-release (TA-ER) may be a suitable option for patients with knee osteoarthritis and T2D, as it has been shown to have minimal disruption on blood glucose levels compared to standard triamcinolone acetonide crystalline suspension (TAcs).
Considerations for Patients with T2D
- Patients with T2D and knee osteoarthritis often face challenges in managing their conditions, as knee OA can negatively impact blood glucose control 4.
- The use of dulaglutide, a medication for T2D, has been shown to have dual benefits in improving glycemic control and reducing knee OA pain in elderly patients with T2D 5.
Treatment of Degenerative Meniscus Tears
- For patients with degenerative meniscus tears, initial treatment should always be conservative and include physical therapy, NSAIDs, topical treatment, and supervised exercise 6.
- Injections, including viscosupplementation and the use of orthobiologics, can be considered in the presence of osteoarthritis 6.