Intra-articular injection (IAI) with corticosteroids is a procedure that is commonly used in the management of osteoarthritis (OA). Parmigiani et al., Universidade Federal de São Paulo, São Paulo, Brazil, reported results from a randomized, double-blind, controlled study that compared medium-term effectiveness and tolerance between IAI with triamcinolone hexacetonide plus joint lavage (JL/TH Group) versus IAI with triamcinolone hexacetonide alone (TH Group) in patients with OA of the knee.

Patients with primary knee OA, with pain in at least one of the knees and grades II and III on the Kellgren-Lawrence index (KL II and III), were randomly assigned to treatment with joint lavage with 0.9% saline solution (1000 ml) followed by a 60-mg injection of triamcinolone hexacetonide (3 ml) (the JL/TH group) or to simulated joint lavage followed by a 60-mg injection of TH (3 ml) (the TH group). Patients were evaluated at baseline and at Weeks 1, 4, 8, and 12 by an observer, blinded to the treatment regimen. The following tools were used: visual analog scale (VAS) for pain at rest and during movement; goniometry; Womac index; Lequesne questionnaire; timed 50-foot walk; subjective perception of improvement; Likert scale (0–5) for improvement assessment; the need for nonhormonal anti-inflammatory medication and analgesics; and the number and type of local side effects. Statistical significance was set at p=0.05.

A total of 60 patients (mean age 63.7 ± 8.53 years; mean disease duration 5.69 ± 5.01 years). Thirty-three patients were KL II; 27 were KLIII. The study population was predominantly women (88.3%); 48.3% was white. The sample was homogeneous at baseline for all demographic variables as well as the use of symptom and chondroprotective medications, KL index, functional indexes, and previous IAIs.

Although both groups were found to have improved statistically in the intragroup analysis, there was no statistical difference in the intergroup analysis regarding any of the variables that were studied throughout the 12-week period (Tables 1 and 2).

One septic post-trauma arthritis event occurred in Week 8 in the JL/TH group. There were 5 cases of local hypochromia and 1 case of seepage from the JL orifice that was resolved spontaneously in the JL/TH group. One case of metrorrhagia and 1 case of hypochromia local were reported in the TH group.

The results of this study led the investigators to conclude that the combination of joint lavage and triamcinolone hexacetonide IAI is not more effective in the medium term than IAI triamcinolone hexacetonide alone for the treatment of moderate degrees of primary knee OA.