Evaluation of the Benefit of Corticosteroid Injection Before Exercise Therapy in Patients With Osteoarthritis of the Knee

Henriksen, Marius; Christensen, Robin; Klokker, Louise; Bartholdy, Cecilie; Bandak, Elisabeth; Ellegaard, Karen; Boesen, Mikael; Riis, R.; Bartels, Else Marie; Bliddal, Henning

doi:10.1001/jamainternmed.2015.0461

Cited by 72 publications

(102 citation statements)

References 27 publications

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“…In a randomized, double-blinded, placebo-controlled clinical knee OA trial examining the effect of either intra-articular corticosteroids or saline administered 2 weeks prior to initiation of 12 weeks exercise therapy there was no detectable clinical effect of corticosteroids 17 , ultrasound-assessed measures of joint inflammation 18 or MRI detected synovitis on contrast enhanced sequences at follow-up after 14 and 26 weeks, respectively 19 . Concomitant analysis of BML changes was not performed in this study.…”

Section: Introductionmentioning

confidence: 99%

The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial

Nielsen

Boesen

Jurik

et al. 2018

Osteoarthritis and Cartilage

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Section: Introductionmentioning

confidence: 99%

The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial

Nielsen

Boesen

Jurik

et al. 2018

Osteoarthritis and Cartilage

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“…Patients with severe radiologic OA and patients with sensitization of the central nervous system might benefit more from other treatment options. In addition, the use of intraarticular steroid injections as a preparation for exercise therapy should be reconsidered .…”

Section: Discussionmentioning

confidence: 99%

Optimization of Analgesics for Greater Exercise Therapy Participation Among Patients With Knee Osteoarthritis and Severe Pain: A Feasibility Study

Tunen

Leeden

Bos

et al. 2016

Arthritis Care & Research

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Objective. Severe pain in patients with knee osteoarthritis (OA) hampers the ability to exercise. A protocol for the standardized optimization of analgesics in combination with exercise therapy was developed. The purpose of this protocol was to reduce pain, thereby allowing the patient to participate in exercise therapy. The objective of the present study was to evaluate the feasibility and outcome of the protocol. Methods. Forty-nine patients with knee OA and severe knee pain (numerical rating scale for pain ‡7) were included. Analgesics were prescribed following an incremental protocol. After 6 weeks, a 12-week exercise therapy program was added. Information about analgesic use and exercise therapy content was recorded. Knee pain and activity limitations were assessed at baseline, after 6 weeks, and after 18 weeks. Results. Statistically significant improvements in pain and activity limitations were found in intent-to-treat analysis after 6 weeks of analgesic use and after the intervention was completed. Mean improvements from baseline were 30% (P < 0.001) for pain and 17% (P < 0.001) for activity limitations after the intervention was completed. Seventy-eight percent of the patients were able to exercise according to the protocol. In these patients, exercise therapy following 6 weeks of analgesic use resulted in a further improvement of activity limitations of 10% (P 5 0.004). Conclusion. The combined intervention of standardized analgesic prescription and exercise therapy allows most patients with knee OA and severe pain to participate in exercise therapy, leading to reduction of pain and activity limitations. These promising results need to be confirmed in a randomized controlled trial.

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“…For the sample size calculation, we used data from the study of Henriksen et al that evaluated the clinical benefits of an IA glucocorticoid injection given before exercise therapy in patients with knee OA [40]. The results of the study reported a baseline standard deviation of 16 for the KOOS pain (recommended by the KOOS for sample size calculations is a standard deviation of 15).…”

Section: Sample Sizementioning

confidence: 99%

Effectiveness of intramuscular gluteal glucocorticoid injection versus intra-articular glucocorticoid injection in knee osteoarthritis: design of a multicenter randomized, 24 weeks comparative parallel-group trial

Mol

Runhaar

Bos

et al. 2020

BMC Musculoskelet Disord

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Background: The knee is symptomatically the most frequent affected joint in osteoarthritis and, in the Netherlands and other Western countries, is mainly managed by general practitioners (GPs). An intra-articular glucocorticoid injection is recommended in (inter) national guidelines for patients with knee osteoarthritis as an option for a flare of knee pain and/or for those who are not responding well to pain medication. An innovative approach that could replace the intra-articular injection is an intramuscular gluteal glucocorticoid injection. An intramuscular injection is easier to perform than an intra-articular injection with lesser risk of severe local adverse reactions. We hypothesize that intramuscular gluteal glucocorticoid injection is non-inferior in reducing knee pain compared to intra-articular glucocorticoid injection, with potentially a longer lasting effect than intra-articular injection. Methods/design: The study will be a pragmatic randomized controlled non-inferiority trial with two parallel groups. A total of 140 patients aged 45 years and older with knee osteoarthritis who contacted their general practitioner and have persistent knee pain (score ≥ 3 on 0-10 numerical rating scale; 0 = no knee pain) will be included. Patients will be randomly allocated (1:1) to an injection of 40 mg triamcinolone acetonide intra-articular in the knee joint or intramuscular in the ipsilateral ventrogluteal area. The effect of treatment will be evaluated by questionnaires at 2, 4, 8, 12, and 24 weeks after injection. The primary outcome is patients' reported severity of knee pain measured with the pain subscale of the Knee injury and Osteoarthritis Outcome Score 4 weeks after injection. Statistical analysis will be based on both the per-protocol and the intention-to-treat principle.(Continued on next page)

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Evaluation of the Benefit of Corticosteroid Injection Before Exercise Therapy in Patients With Osteoarthritis of the Knee

Cited by 72 publications

References 27 publications

The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial

The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial

Optimization of Analgesics for Greater Exercise Therapy Participation Among Patients With Knee Osteoarthritis and Severe Pain: A Feasibility Study

Effectiveness of intramuscular gluteal glucocorticoid injection versus intra-articular glucocorticoid injection in knee osteoarthritis: design of a multicenter randomized, 24 weeks comparative parallel-group trial

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