Severity Of Symptoms and Presence of Effusion May Predict Response to Intra-Articular Corticosteroid Injection for Knee Osteoarthritis

EBM Focus - Volume 8, Issue 20

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Reference: Rheumatology (Oxford) 2013 June;52(6):1022

Intra-articular steroid injections are a common treatment for osteoarthritis of the knee, and are recommended by the American College of Rheumatology for initial management and strongly recommended for patients without satisfactory clinical response to full-dose acetaminophen (Arthritis Care Res (Hoboken) 2012 Apr;64(4):465). However, the magnitude and duration of benefit from steroid injections varies widely across patients. A recent systematic review of 11 studies assessing the efficacy of steroid injections sought to identify factors associated with good response in 624 patients with knee osteoarthritis.

Factors associated with response were identified primarily through post hoc analyses in the original articles, and no meta-analysis could be performed due to differences in outcome measures and criteria for symptom change. Dichotomous factors predictive of good response in at least one study included presence of effusion, withdrawal of fluid from the knee, absence of synovitis, and use of ultrasound guidance for injection delivery. Increasing efficacy was also associated with increasing severity of radiographic degeneration and increasing severity of pain, stiffness, and loss of function. Duration of symptoms was not associated with response. Although it would be ideal to have these findings validated in a prospective study, this information may help guide patient selection when intra-articular steroids are being considered.

For more information, see the Degenerative joint disease of the knee topic in DynaMed.