From the Guidelines
Methylprednisolone is the best corticosteroid for intra-articular knee injection.
Key Points
- Intra-articular corticosteroids have been found to reduce joint pain and improve function in OA-related knee pain 1.
- Methylprednisolone, when compared with placebo, improved knee pain and function at 4 and 24 weeks, whereas triamcinolone improved pain and function at 6 weeks but not 12 weeks 1.
- The effects of intra-articular corticosteroids are time limited without long-term improvement at 2-year follow-up 1.
- There is evidence (1B) that intra-articular injections of corticosteroid are effective but give relatively short lived benefit 1.
- The EULAR recommendations suggest that intra-articular injection of long acting corticosteroid is indicated for acute exacerbation of knee pain, especially if accompanied by effusion 1.
Corticosteroid Options
- Methylprednisolone: improved knee pain and function at 4 and 24 weeks 1.
- Triamcinolone: improved pain and function at 6 weeks but not 12 weeks 1.
Important Considerations
- Intra-articular corticosteroid injections should be used for short-term pain relief for patients with symptomatic OA of the knee 1.
- The dose and approach need to be defined for each indication and joint and might not be interchangeable across indications 1.
- Contextual factors such as effective communication, patient expectations or the setting in which the procedure takes place, which may influence the outcome of intra-articular therapies 1.
From the Research
Comparison of Corticosteroids for Intra-Articular Knee Injection
- The efficacy of intra-articular corticosteroid injections for knee osteoarthritis has been evaluated in several studies 2, 3, 4, 5.
- Triamcinolone hexacetonide was found to be superior to betamethasone for pain reduction up to four weeks post injection 2, 3.
- Comparisons of corticosteroids and hyaluronic acid (HA) products showed no statistically significant differences at one to four weeks post injection, but HA products were more effective between five and 13 weeks post injection 2, 3.
- The short-term benefit of intra-articular corticosteroids is well established, but longer-term benefits have not been confirmed 2, 3, 5.
Efficacy and Duration of Intra-Articular Corticosteroid Injection
- Intra-articular corticosteroid injection reduces knee pain for at least 1 week, with an average difference between groups of 22% 4.
- The efficacy of intra-articular corticosteroid injections decreases over time, with no significant difference between interventions in medium term (>6 weeks & <24 weeks) and a trend towards superiority of controls in long term follow-up (≥24 weeks) 5.
- Clinically relevant improvements in knee pain were reached up to 12 weeks after the injection in both intra-articular and intramuscular injection groups 6.
Types of Corticosteroids
- Triamcinolone acetonide, 40 mg, was used in a randomized clinical trial comparing intra-articular and intramuscular injection 6.
- Triamcinolone hexacetonide was found to be more effective than betamethasone for pain reduction up to four weeks post injection 2, 3.
- The type of corticosteroid used may affect the efficacy and duration of intra-articular corticosteroid injection, but more research is needed to confirm this 4.