Intramuscular glucocorticoid injections have similar efficacy to intraarticular injections to reduce knee pain osteoarthritis but without concerns about joint infection and administration challenges, according to the results of a controlled, randomized trial reported at the OARSI 2021 World Congress.
Intraarticular glucocorticoid injections are commonly used to relieve OA pain, but some general practitioners have difficulty administering them to patients, he said. Qiuke Wang, PhD student at Erasmus University Medical Center in Rotterdam, the Netherlands. There are also concerns about whether intra-articular injections can cause damage to knee cartilage, Wang said at the conference, sponsored by the International Osteoarthritis Research Society.
Wang and his colleagues performed one randomized and controlled trial in which 145 patients with symptomatic knee OA received an intramuscular or intraarticular injection of 40 mg of triamcinolone acetonide and then followed up regularly at 24 weeks.
The study showed that outcome scores for knee injuries and osteoarthritis for pain improved in both the intraarticular and intramuscular groups. Improvements in pain scores peaked in the intra-articular injection group at the 4-week mark, when the difference with intramuscular injections was statistically significant. However, the two groups showed no significant differences in pain improvement at the 8, 12, and 24-week follow-up points.
“Intraarticular injection can act immediately on the inhibition of joint inflammation after injection,” Wang said in an interview. “Instead, for intramuscular injection, the glucocorticoid must first be absorbed by the muscle into the bloodstream and then travel to the knee through the circulatory system.”
The study also did not show significant differences between the two groups in the secondary outcomes of symptoms, stiffness, function, and sport score, and patients’ quality of life. There were more adverse events in the intra-articular injection group: 42% of patients reported an adverse event, compared with 33% in the intramuscular group, and adverse events reported in the intramuscular group were adverse events. not serious, such as headache and washing.
Wang told the conference that while intramuscular injection was lower than intraarticular injections at 4 weeks, it was not less than 8 and 24 weeks and should be considered an effective way to reduce pain in patients. with knee OA.
“This trial provides evidence for shared decision making because in some cases a patient may prefer a specific injection and the GP may feel incompetent to administer the intra-articular injection,” he said.
A member of the audience noted that there was now a growing body of evidence suggesting that intra-articular injections may contribute to faster progression of knee AO due to the effects on knee cartilage.
Wang acknowledged that his own research had demonstrated these side effects of intra-articular injections, which is why it was intended to examine whether intramuscular injections could achieve the same pain relief.
“In real practice, I would say both injections are effective, but intra-articular injection can provide some [better] short-term effect, ”he said.
Commenting on the findings, Martin van der Esch, doctor, of the Amsterdam University of Applied Sciences, said there were no guidelines on whether intra-articular or intramuscular injections were the best option, so it really came down to the doctor’s decision.
“So this is really an interesting study, because it gives a little bit of light, not the answer, but a little bit in what direction it could be directed for specific groups of patients,” Van der Esch said in an interview.
Van der Esch suggested that intramuscular injections might be more appropriate for patients with more systemic diseases affecting multiple joints, but intraarticular injections could offer greater benefits in a patient with severe and long-lasting disease in a single joint.
No conflicts of interest were declared.
This article originally appeared on MDedge.com, which is part of the Medscape professional network.