Structural predictors of response to intra-articular steroid injection in symptomatic knee osteoarthritis

Maricar, Nasimah; Parkes, Matthew; Callaghan, Michael J.; Hutchinson, Charles E.; Gait, Andrew; Hodgson, Richard; Felson, David T.; O’Neill, Terence W

doi:10.1186/s13075-017-1292-2

Cited by 38 publications

(31 citation statements)

References 29 publications

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“…There are few data concerning the impact of psychological factors on treatment response 7 . In our recent open-label study of IASI in knee OA 14,15 , not all participants responded to the therapy in the short-term. Of those who responded, the majority had a recurrence of pain within 6-months.…”

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confidence: 90%

“…Of those who responded, the majority had a recurrence of pain within 6-months. In previous work, we looked at the impact of disease severity on outcome following IASI and found that those with more severe disease[either magnetic resonance imaging(MRI) or x-ray] were less likely to be longer-term responders 14,15 . The aim of the current study was to determine the impact of a range of clinical correlates of disease including symptoms, clinical signs of knee OA, psychologic factors and quality of life, on both short-term(within 2-weeks) and longer-term(6-months) outcome following IASI.…”

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confidence: 99%

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Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

Maricar

Parkes²,

Callaghan³

et al. 2019

J Rheumatol

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Objective.To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA.Methods.Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)–Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome.Results.One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10–1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03–1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04–1.55), anserine tenderness (RR 1.27, 95% CI 1.06–1.52), and a belief that treatment would be effective [RR/unit increase (range 0–10) = 1.05 (1.01–1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66–0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44–0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0–10) = 0.83, 95% CI 0.72–0.97], chronic widespread pain (RR 0.32, 95% CI 0.10–0.98), perceived chronicity of disease [RR/unit increase (range 0–10) = 0.86, 95% CI 0.78–0.94], and a higher depression score [RR/unit increase (range 0–21) = 0.89, 95% CI 0.81–0.99] were less likely to be longer-term responders.Conclusion.Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits.

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confidence: 90%

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confidence: 99%

Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

Maricar

Parkes²,

Callaghan³

et al. 2019

J Rheumatol

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“…Associations for linear regression models are presented as standardized regression coefficients (b). Estimates are presented from crude models, and from fully adjusted models which accounted for other predictors shown here or in previous studies to be associated with knee pain persistence (including age, sex, BMI, radiographic OA, and symptom duration) 3,4,12 . Spearman (r) and eta (h) CCC for univariate associations are also presented.…”

Section: Central Mechanisms Trait At Baseline As a Predictor Of Pain mentioning

confidence: 99%

“…Knee pain might either resolve or persist over time. Knee pain persistence after therapeutic intervention is weakly predicted by structural factors within the knee, including radiographic OA and ultrasound effusion 12 . Other characteristics have also been found to predict worse pain at follow up, particularly after surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Baseline self-report ‘central mechanisms’ trait predicts persistent knee pain in the Knee Pain in the Community (KPIC) cohort

Akin-Akinyosoye

Sarmanova

Fernandes

et al. 2020

Osteoarthritis and Cartilage

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Objectives: We investigated whether baseline scores for a self-report trait linked to central mechanisms predict 1 year pain outcomes in the Knee Pain in the Community cohort. METHOD: 1471 participants reported knee pain at baseline and responded to a 1-year follow-up questionnaire, of whom 204 underwent pressure pain detection thresholds (PPTs) and radiographic assessment at baseline. Logistic and linear regression models estimated the relative risks (RRs) and associations (b) between self-report traits, PPTs and pain outcomes. Discriminative performance for each predictor was compared using receiver-operator characteristics (ROC) curves. Results: Baseline Central Mechanisms trait scores predicted pain persistence (Relative Risk, RR ¼ 2.10, P ¼ 0.001) and persistent pain severity (b ¼ 0.47, P < 0.001), even after adjustment for age, sex, BMI, radiographic scores and symptom duration. Baseline joint-line PPTs also associated with pain persistence (RR range ¼ 0.65 to 0.68, P < 0.02), but only in univariate models. Lower baseline medial joint-line PPT was associated with persistent pain severity (b ¼ À0.29, P ¼ 0.013) in a fully adjusted model. The Central Mechanisms trait model showed good discrimination of pain persistence cases from resolved pain cases (Area Under the Curve, AUC ¼ 0.70). The discrimination power of other predictors (PPTs (AUC range ¼ 0.51 to 0.59), radiographic OA (AUC ¼ 0.62), age, sex and BMI (AUC range ¼ 0.51 to 0.64), improved significantly (P < 0.05) when the central mechanisms trait was included in each logistic regression model (AUC range ¼ 0.69 to 0.74). Conclusion: A simple summary self-report Central Mechanisms trait score may indicate a contribution of central mechanisms to poor knee pain prognosis.

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“…12 In addition, a recent study has shown that patients with extensive structural and joint damage from OA are less likely to respond to intraarticular steroid injections in the long term (> 6 months); however, in the short term, structural damage seems to have little effect on the efficacy of the injection. 13 Although the incidence of adverse effects is rare, intraarticular administration of glucocorticoids is not without inherent risk. Serial injections are often not recommended as it has been studied that long-term injections of intra-articular glucocorticoids may lead to greater structural damage and cartilage volume loss measured by magnetic resonance imaging (MRI).…”

Section: Intra-articular Injections Corticosteroidsmentioning

confidence: 99%

Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain

et al. 2018

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Chronic knee pain is a widely prevalent issue that can have a significant impact on a patient's quality of life. One of the leading causes of chronic knee pain is osteoarthritis. Total knee replacement is often the last and definitive resort for patients with severe symptomatic osteoarthritis after trial of less invasive interventions with failure to achieve symptomatic relief. Intra-articular injections are a mainstay of adjunctive conservative management and have demonstrated efficacy in reducing pain. Radiofrequency treatment is a viable option for poor surgical candidates, or for patients having persistent, chronic pain following knee surgery. Extracorporeal shockwave therapy is another modality growing in use that may offer short-term symptomatic relief. In this review, we will discuss widely used minimally invasive interventional options for the symptomatic management of osteoarthritic chronic knee pain.

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Structural predictors of response to intra-articular steroid injection in symptomatic knee osteoarthritis

Cited by 38 publications

References 29 publications

Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

Baseline self-report ‘central mechanisms’ trait predicts persistent knee pain in the Knee Pain in the Community (KPIC) cohort

Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain

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