The Efficacy of Intra-articular Triamcinolone Acetonide 5mg vs. 10 mg vs. 40 mg in Patients With Knee Osteoarthritis
NCT ID: NCT05806021
Last Updated: 2025-02-05
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
RECRUITING
Clinical Phase
PHASE4
Total Enrollment
327 participants
Study Classification
INTERVENTIONAL
Study Start Date
2024-01-15
Study Completion Date
2026-02-28
Brief Summary
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Osteoarthritis of the knee is a common problem that is increasing in prevalence as the population ages. In a knee with osteoarthritis, there is variable damage to the articular cartilage and underlying bone that can cause varying degrees of pain. When pain is bothersome, osteoarthritis is treated to improve functional abilities.
One of the most recognized and used treatments is intra-articular cortisone injection. Cortisone is a powerful anti-inflammatory drug that is used to reduce pain.
Unfortunately, cortisone can have significant side effects, even when injected locally. The frequency and intensity of these side effects depend largely on the total dose injected. The main side effects include increased blood sugar levels, increased blood pressure and a temporary decrease in the secretion of the stress hormone, cortisol. In the long term, a decrease in articular cartilage thickness in the injected join and overall bone density reduction is also reported.
Despite many years of routine use, the smallest effective dose of cortisone injected into the knee joint is unknown.
The main objective of the study is to determine the impact on pain and function of different doses of cortisone injected into the knee. The cortisone chosen for this study is triamcinolone acetonide (TA).
One of the most recognized and used treatments is intra-articular cortisone injection. Cortisone is a powerful anti-inflammatory drug that is used to reduce pain.
Unfortunately, cortisone can have significant side effects, even when injected locally. The frequency and intensity of these side effects depend largely on the total dose injected. The main side effects include increased blood sugar levels, increased blood pressure and a temporary decrease in the secretion of the stress hormone, cortisol. In the long term, a decrease in articular cartilage thickness in the injected join and overall bone density reduction is also reported.
Despite many years of routine use, the smallest effective dose of cortisone injected into the knee joint is unknown.
The main objective of the study is to determine the impact on pain and function of different doses of cortisone injected into the knee. The cortisone chosen for this study is triamcinolone acetonide (TA).
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Detailed Description
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Gonarthrosis is a very prevalent condition affecting especially people over the age of 60 years old. It is a major cause of pain and functional impairment in Canada. The prevalence and associated economic burden continue to increase.
Despite the prevalence of this condition, the management of symptomatic gonarthrosis remains a controversial subject. Multiple treatment alternatives are available, none of which has been proven to be superior to the others beyond any doubt. However, certain therapeutic modalities are better recognized and more frequently used, such as intra-articular corticosteroid injections. In 2022, an expert consensus review of the available literature concluded that the use of intra-articular corticosteroids is effective in the treatment of symptomatic gonarthrosis. This is also the conclusion of the most recent American College of Rheumatology (ACR) guideline, which "strongly recommends" the use of this type of injection in gonarthrosis .
Despite decades of use, there is insufficient evidence to recommend a specific type and dose of corticosteroid. The choice of cortisone type in the usual practice of physicians performing intra-articular knee infiltrations is therefore based on experience and the biochemical properties of the different cortisones. Those with larger particles due to esterification of the corticoid, such as triamcinolone acetonide (TA) and methylprednisolone acetate, are known to have a longer duration of action. They are therefore the two most frequently used in studies on the subject. The dose used is based on historical use and is not, to our knowledge, based on any fundamental evidence. This dose of TA injected into a joint is usually 40 mg. Some authors have shown us that it is not useful to inject higher doses than this into a knee because increasing the dose does not improve the outcome of the injection. However, there was no literature related to the minimally effective intra-articular TA dose in the knee, until recently. Indeed, Utamawatin et al. recently reported that 10mg of TA did not appear to be less effective than 40mg when injected into knees with primary osteoarthritis.
This minimally effective dose is important because side effects associated with cortisone use have been reported. The adverse effects of oral corticosteroids are better known and documented than intra-articular ones. By a mechanism that is only partially elucidated, intra-articular infiltrations can produce the same systemic effects as oral. Habib et al. reports that systemic side effects increase with the concentration and time of exposure to the substance. To our knowledge, the minimal dose of intra-articular corticosteroid to produce a systemic effect is not documented.
Systemic effects occur in multiple systems. They affect several metabolisms such as glucose, gastrointestinal, lipid, adipose tissue, bone, immune, cardiovascular, sex hormones and the hypothalamic-pituitary axis. The mood can also be affected.
Thus, intra-articular infiltrations can cause both local and systemic problems that are directly related to the dose injected.
PRIMARY OBJECTIVE
○ To demonstrate the non-inferiority of a 10 mg and 5 mg intra-articular corticosteroid injection compared to the standard 40 mg dose on patient function at 1 month post-injection.
SECONDARY OBJECTIVES
* To demonstrate the non-inferiority of a 10 mg and 5 mg intra-articular corticosteroid injection compared to the standard 40 mg dose on patient function at 2, 3 and 6 months post-injection.
* To demonstrate the non-inferiority of a 10 mg and 5 mg intra-articular corticosteroid injection compared to the standard 40 mg dose on pain and stiffness in patients at 1, 2, 3 and 6 months post-injection.
* To know the patient's satisfaction with the treatment at 3 and 6 month post-injection METHODOLOGY Type of study
* Randomized clinical trial
* Non-inferiority study Recruiting
* Outpatient clinic of the physiatry, rheumatology or orthopedics departments of the University of Montreal Hospital.
Participants
* Patients referred to physiatry for symptomatic primary gonarthrosis
* Physiatrists will complete a history and physical examination for each participant.
Randomization of participants
* Patients meeting the study inclusion criteria will be randomized into one of the three groups
* Group allocation will be done randomly by computer. The mechanism for running the allocation sequence for randomization will be with RedCAP software.
* Physiatrists evaluating outcomes, participants, and data analysis will be blinded.
* Syringes will be preassembled by someone external to the study. The syringes will be covered with opaque paper. The contents of the latter will therefore not be visible to the participant or the physician performing the procedure.
* Participants will be able to know at the end of the study in which group they were allocated.
Intervention
* For ethical reasons, considering the superiority of cortisone injections in the latest international recommendations, it was decided not to use a placebo group.
* All eligible patients will have a standing radiograph with weight-bearing anteroposterior view, lateral view, and patellar view that will be done at CHUM, unless a recent radiograph done at another center is available for review by a CHUM radiologist. This is to obtain standardized imaging results for our study.
* The technique of the procedure is done according to the practical guide Malanga and Mautner: Atlas of Ultrasound-Guided Musculoskeletal Injections.
* Ultrasound guidance will be used for all intra-articular knee injections. Canon I-700 ultrasound machine.
* Patients will be placed in the supine position with the knee resting on a towel for slight flexion.
* The procedure is performed under sterile conditions.
* The skin is disinfected with a CHUM-approved chlorhexidine-based product.
* The ultrasound probe is disinfected with an approved disinfectant product.
* With a sterile gel on the skin, the probe is positioned short-axis over the distal quadricipital tendon.
* The supra-patellar recess is visualized between the prefemoral fat pad posteriorly and the suprapatellar fat pad anteriorly as an area containing hypoechoic or anechoic fluid.
* If there is a significant intra-articular effusion, the fluid will by removed via punture prior to injection. This information will be noted on a sheet including the total volume removed.
* On the lateral border of the knee with an approach parallel to the probe, a 3ml syringe mounted on a 25G needle (or 18-20G if prior puncture) is inserted. A dermal point with 1% xylocaine will be made before the injection if prior puncture given the use of a larger needle gauge.
* In real time under ultrasound guidance, the needle is advanced from lateral to medial towards the supra-patellar recess.
* Once the needle is properly positioned in the recessus, the physiatrist injects the contents of the pre-mounted 3ml syringe.
* If there is no visible fluid in the supra-patellar recess, the medial mid-patellar region is targeted. This technique is not influenced by the presence or absence of effusion. The probe is placed in a short axis on the knee with the patella superior and the medial femoral condyle inferior. The joint space is located between the two structures under the patellar retinaculum. The needle is advanced parallel to the probe from medial to lateral to penetrate the joint space. This technique can also be performed lateral to the knee at the discretion of the physiatrist.
* After the injection, it is recommended to apply a cold water compress or ice to the injection site 5-10 min which can be repeated 3 to 4 times during the day in case of pain. Acetaminophen may be taken to reduce discomfort following the injection.
* All techniques under ultrasound guidance will be performed by a physiatrist trained in musculoskeletal ultrasound.
* Intra-articular cortisone infiltration is not the only treatment for gonarthrosis. Therefore, all patients will have as a recommendation some of the non-pharmacologic recommendations mentioned in the ACR8 guide.
* Patients will be suggested not to add other treatment modalities to avoid biasing the results such as orthotic, acupuncture, massage, anti-inflammatory or other medications, other injectable treatments etc. If the patient is already wearing an orthosis, he/she can continue to wear it.
Despite the prevalence of this condition, the management of symptomatic gonarthrosis remains a controversial subject. Multiple treatment alternatives are available, none of which has been proven to be superior to the others beyond any doubt. However, certain therapeutic modalities are better recognized and more frequently used, such as intra-articular corticosteroid injections. In 2022, an expert consensus review of the available literature concluded that the use of intra-articular corticosteroids is effective in the treatment of symptomatic gonarthrosis. This is also the conclusion of the most recent American College of Rheumatology (ACR) guideline, which "strongly recommends" the use of this type of injection in gonarthrosis .
Despite decades of use, there is insufficient evidence to recommend a specific type and dose of corticosteroid. The choice of cortisone type in the usual practice of physicians performing intra-articular knee infiltrations is therefore based on experience and the biochemical properties of the different cortisones. Those with larger particles due to esterification of the corticoid, such as triamcinolone acetonide (TA) and methylprednisolone acetate, are known to have a longer duration of action. They are therefore the two most frequently used in studies on the subject. The dose used is based on historical use and is not, to our knowledge, based on any fundamental evidence. This dose of TA injected into a joint is usually 40 mg. Some authors have shown us that it is not useful to inject higher doses than this into a knee because increasing the dose does not improve the outcome of the injection. However, there was no literature related to the minimally effective intra-articular TA dose in the knee, until recently. Indeed, Utamawatin et al. recently reported that 10mg of TA did not appear to be less effective than 40mg when injected into knees with primary osteoarthritis.
This minimally effective dose is important because side effects associated with cortisone use have been reported. The adverse effects of oral corticosteroids are better known and documented than intra-articular ones. By a mechanism that is only partially elucidated, intra-articular infiltrations can produce the same systemic effects as oral. Habib et al. reports that systemic side effects increase with the concentration and time of exposure to the substance. To our knowledge, the minimal dose of intra-articular corticosteroid to produce a systemic effect is not documented.
Systemic effects occur in multiple systems. They affect several metabolisms such as glucose, gastrointestinal, lipid, adipose tissue, bone, immune, cardiovascular, sex hormones and the hypothalamic-pituitary axis. The mood can also be affected.
Thus, intra-articular infiltrations can cause both local and systemic problems that are directly related to the dose injected.
PRIMARY OBJECTIVE
○ To demonstrate the non-inferiority of a 10 mg and 5 mg intra-articular corticosteroid injection compared to the standard 40 mg dose on patient function at 1 month post-injection.
SECONDARY OBJECTIVES
* To demonstrate the non-inferiority of a 10 mg and 5 mg intra-articular corticosteroid injection compared to the standard 40 mg dose on patient function at 2, 3 and 6 months post-injection.
* To demonstrate the non-inferiority of a 10 mg and 5 mg intra-articular corticosteroid injection compared to the standard 40 mg dose on pain and stiffness in patients at 1, 2, 3 and 6 months post-injection.
* To know the patient's satisfaction with the treatment at 3 and 6 month post-injection METHODOLOGY Type of study
* Randomized clinical trial
* Non-inferiority study Recruiting
* Outpatient clinic of the physiatry, rheumatology or orthopedics departments of the University of Montreal Hospital.
Participants
* Patients referred to physiatry for symptomatic primary gonarthrosis
* Physiatrists will complete a history and physical examination for each participant.
Randomization of participants
* Patients meeting the study inclusion criteria will be randomized into one of the three groups
* Group allocation will be done randomly by computer. The mechanism for running the allocation sequence for randomization will be with RedCAP software.
* Physiatrists evaluating outcomes, participants, and data analysis will be blinded.
* Syringes will be preassembled by someone external to the study. The syringes will be covered with opaque paper. The contents of the latter will therefore not be visible to the participant or the physician performing the procedure.
* Participants will be able to know at the end of the study in which group they were allocated.
Intervention
* For ethical reasons, considering the superiority of cortisone injections in the latest international recommendations, it was decided not to use a placebo group.
* All eligible patients will have a standing radiograph with weight-bearing anteroposterior view, lateral view, and patellar view that will be done at CHUM, unless a recent radiograph done at another center is available for review by a CHUM radiologist. This is to obtain standardized imaging results for our study.
* The technique of the procedure is done according to the practical guide Malanga and Mautner: Atlas of Ultrasound-Guided Musculoskeletal Injections.
* Ultrasound guidance will be used for all intra-articular knee injections. Canon I-700 ultrasound machine.
* Patients will be placed in the supine position with the knee resting on a towel for slight flexion.
* The procedure is performed under sterile conditions.
* The skin is disinfected with a CHUM-approved chlorhexidine-based product.
* The ultrasound probe is disinfected with an approved disinfectant product.
* With a sterile gel on the skin, the probe is positioned short-axis over the distal quadricipital tendon.
* The supra-patellar recess is visualized between the prefemoral fat pad posteriorly and the suprapatellar fat pad anteriorly as an area containing hypoechoic or anechoic fluid.
* If there is a significant intra-articular effusion, the fluid will by removed via punture prior to injection. This information will be noted on a sheet including the total volume removed.
* On the lateral border of the knee with an approach parallel to the probe, a 3ml syringe mounted on a 25G needle (or 18-20G if prior puncture) is inserted. A dermal point with 1% xylocaine will be made before the injection if prior puncture given the use of a larger needle gauge.
* In real time under ultrasound guidance, the needle is advanced from lateral to medial towards the supra-patellar recess.
* Once the needle is properly positioned in the recessus, the physiatrist injects the contents of the pre-mounted 3ml syringe.
* If there is no visible fluid in the supra-patellar recess, the medial mid-patellar region is targeted. This technique is not influenced by the presence or absence of effusion. The probe is placed in a short axis on the knee with the patella superior and the medial femoral condyle inferior. The joint space is located between the two structures under the patellar retinaculum. The needle is advanced parallel to the probe from medial to lateral to penetrate the joint space. This technique can also be performed lateral to the knee at the discretion of the physiatrist.
* After the injection, it is recommended to apply a cold water compress or ice to the injection site 5-10 min which can be repeated 3 to 4 times during the day in case of pain. Acetaminophen may be taken to reduce discomfort following the injection.
* All techniques under ultrasound guidance will be performed by a physiatrist trained in musculoskeletal ultrasound.
* Intra-articular cortisone infiltration is not the only treatment for gonarthrosis. Therefore, all patients will have as a recommendation some of the non-pharmacologic recommendations mentioned in the ACR8 guide.
* Patients will be suggested not to add other treatment modalities to avoid biasing the results such as orthotic, acupuncture, massage, anti-inflammatory or other medications, other injectable treatments etc. If the patient is already wearing an orthosis, he/she can continue to wear it.
Conditions
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Primary Gonarthrosis
Study Design
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Allocation Method
RANDOMIZED
Intervention Model
PARALLEL
Primary Study Purpose
TREATMENT
Blinding Strategy
QUADRUPLE
Participants
Caregivers
Investigators
Outcome Assessors
Study Groups
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Group A TA 40 mg
intra-articular injection of 40 mg of triamcinolone acetonide, which is the standard dose used
Group Type
EXPERIMENTAL
Triamcinolone Acetonide
Intervention Type
DRUG
Intra-articular injection. For each group, the total injected will be 3 ml. For syringes containing triamcinolone acetonide, the missing volume will be filled with 0.9% isotonic saline
Group B TA 10 mg
intra-articular injection of 10 mg of triamcinolone acetonide
Group Type
ACTIVE_COMPARATOR
Triamcinolone Acetonide
Intervention Type
DRUG
Intra-articular injection. For each group, the total injected will be 3 ml. For syringes containing triamcinolone acetonide, the missing volume will be filled with 0.9% isotonic saline
Group C TA 5 mg
intra-articular injection of 5 mg of triamcinolone acetonide
Group Type
ACTIVE_COMPARATOR
Triamcinolone Acetonide
Intervention Type
DRUG
Intra-articular injection. For each group, the total injected will be 3 ml. For syringes containing triamcinolone acetonide, the missing volume will be filled with 0.9% isotonic saline
Interventions
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Triamcinolone Acetonide
Intra-articular injection. For each group, the total injected will be 3 ml. For syringes containing triamcinolone acetonide, the missing volume will be filled with 0.9% isotonic saline
Intervention Type
DRUG
Other Intervention Names
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Kenalog
Eligibility Criteria
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Inclusion Criteria
* Symptomatic primary gonarthrosis of over 6 months duration (gonarthrosis according to the American College of Rheumatology criteria)
* Grade 1 to 3 Kellgren-Lawrence femorotibial osteoarthritis
* Knee pain provoked by activity over 4 and under 8 on 10 (Visual Analog Scale)
* Grade 1 to 3 Kellgren-Lawrence femorotibial osteoarthritis
* Knee pain provoked by activity over 4 and under 8 on 10 (Visual Analog Scale)
Exclusion Criteria
* Bilateral symptomatic primary gonarthrosis
* Grade 4 Kellgren-Lawrence femorotibial osteoarthritis
* Isolated patellofemoral osteoarthritis
* Intra-articular corticosteroid infiltration to the knee within the past 3 months or chronic use of per os corticosteroid
* Intra-articular hyaluronic acid infiltration within the past 12 months.
* Intra-articular infiltration of platelet-rich plasma within the past 12 months.
* Disease affecting the study joint (systemic inflammatory disease, history of septic arthritis, osteonecrosis, etc.).
* Suspicion or presence of active local infectious process.
* Presence or suspicion of local neoplasia or metastasis
* Recent severe trauma to the knee (≤ 3 months)
* Significant cognitive impairment or inadequate language proficiency not allowing adequate response to study questionnaires
* Any other serious medical condition that does not allow participation in the study or may be a contraindication to cortisone injection
* Grade 4 Kellgren-Lawrence femorotibial osteoarthritis
* Isolated patellofemoral osteoarthritis
* Intra-articular corticosteroid infiltration to the knee within the past 3 months or chronic use of per os corticosteroid
* Intra-articular hyaluronic acid infiltration within the past 12 months.
* Intra-articular infiltration of platelet-rich plasma within the past 12 months.
* Disease affecting the study joint (systemic inflammatory disease, history of septic arthritis, osteonecrosis, etc.).
* Suspicion or presence of active local infectious process.
* Presence or suspicion of local neoplasia or metastasis
* Recent severe trauma to the knee (≤ 3 months)
* Significant cognitive impairment or inadequate language proficiency not allowing adequate response to study questionnaires
* Any other serious medical condition that does not allow participation in the study or may be a contraindication to cortisone injection
Minimum Eligible Age
50 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
Yes
Sponsors
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Centre hospitalier de l'Université de Montréal (CHUM)
OTHER
Sponsor Role
lead
Responsible Party
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Responsibility Role
SPONSOR
Principal Investigators
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Dien Hung Luong, MD
Role: PRINCIPAL_INVESTIGATOR
Centre hospitalier de l'Université de Montréal (CHUM)
Locations
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Centre Hospitalier Universitaire de Montréal - Hôtel-Dieu
Montreal, Quebec, Canada
Site Status
RECRUITING
Countries
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Canada
Central Contacts
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Facility Contacts
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References
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Sharma L. Osteoarthritis of the Knee. N Engl J Med. 2021 Jan 7;384(1):51-59. doi: 10.1056/NEJMcp1903768. No abstract available.
Reference Type
BACKGROUND
Khan M, Bhandari M. Cochrane in CORR(R): Intra-articular Corticosteroid For Knee Osteoarthritis. Clin Orthop Relat Res. 2018 Jul;476(7):1391-1392. doi: 10.1097/CORR.0000000000000358. No abstract available.
Reference Type
BACKGROUND
Hunter CW, Deer TR, Jones MR, Chang Chien GC, D'Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA, Mazzola AJ, Michels JS, Layno-Moses A, Patel S, Tari J, Weisbein JS, Goulding KA, Chhabra A, Hassebrock J, Wie C, Beall D, Sayed D, Strand N. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res. 2022 Sep 8;15:2683-2745. doi: 10.2147/JPR.S370469. eCollection 2022.
Reference Type
BACKGROUND
HOLLANDER JL. Intra-articular hydrocortisone in arthritis and allied conditions; a summary of two years' clinical experience. J Bone Joint Surg Am. 1953 Oct;35-A(4):983-90. No abstract available.
Reference Type
BACKGROUND
HOLLANDER JL, BROWN EM Jr, JESSAR RA, BROWN CY. Hydrocortisone and cortisone injected into arthritic joints; comparative effects of and use of hydrocortisone as a local antiarthritic agent. J Am Med Assoc. 1951 Dec 22;147(17):1629-35. doi: 10.1001/jama.1951.03670340019005. No abstract available.
Reference Type
BACKGROUND
Johnston PC, Lansang MC, Chatterjee S, Kennedy L. Intra-articular glucocorticoid injections and their effect on hypothalamic-pituitary-adrenal (HPA)-axis function. Endocrine. 2015 Mar;48(2):410-6. doi: 10.1007/s12020-014-0409-5. Epub 2014 Sep 3.
Reference Type
BACKGROUND
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-162. doi: 10.1002/acr.24131. Epub 2020 Jan 6.
Reference Type
BACKGROUND
Shah A, Mak D, Davies AM, James SL, Botchu R. Musculoskeletal Corticosteroid Administration: Current Concepts. Can Assoc Radiol J. 2019 Feb;70(1):29-36. doi: 10.1016/j.carj.2018.11.002.
Reference Type
BACKGROUND
Cushman DM, Bruno B, Christiansen J, Schultz A, McCormick ZL. Efficacy of Injected Corticosteroid Type, Dose, and Volume for Pain in Large Joints: A Narrative Review. PM R. 2018 Jul;10(7):748-757. doi: 10.1016/j.pmrj.2018.01.002. Epub 2018 Jan 31.
Reference Type
BACKGROUND
Cushman DM, Ofek E, Syed RH, Clements N, Gardner JE, Sams JM, Mulvey JL, McCormick ZL. Comparison of Varying Corticosteroid Type, Dose, and Volume for the Treatment of Pain in Small- and Intermediate-Size Joint Injections: A Narrative Review. PM R. 2019 Jul;11(7):758-770. doi: 10.1016/j.pmrj.2018.09.040. Epub 2019 Jun 5.
Reference Type
BACKGROUND
Utamawatin K, Phruetthiphat OA, Apinyankul R, Chaiamnuay S. The efficacy of intra-articular triamcinolone acetonide 10 mg vs. 40 mg in patients with knee osteoarthritis: a non-inferiority, randomized, controlled, double-blind, multicenter study. BMC Musculoskelet Disord. 2023 Feb 3;24(1):92. doi: 10.1186/s12891-023-06191-6.
Reference Type
BACKGROUND
Kim KH, Park JW, Kim SJ. High- vs Low-Dose Corticosteroid Injection in the Treatment of Adhesive Capsulitis with Severe Pain: A Randomized Controlled Double-Blind Study. Pain Med. 2018 Apr 1;19(4):735-741. doi: 10.1093/pm/pnx227.
Reference Type
BACKGROUND
Stout A, Friedly J, Standaert CJ. Systemic Absorption and Side Effects of Locally Injected Glucocorticoids. PM R. 2019 Apr;11(4):409-419. doi: 10.1002/pmrj.12042. Epub 2019 Mar 29.
Reference Type
BACKGROUND
Habib GS. Systemic effects of intra-articular corticosteroids. Clin Rheumatol. 2009 Jul;28(7):749-56. doi: 10.1007/s10067-009-1135-x. Epub 2009 Feb 28.
Reference Type
BACKGROUND
Habib GS, Bashir M, Jabbour A. Increased blood glucose levels following intra-articular injection of methylprednisolone acetate in patients with controlled diabetes and symptomatic osteoarthritis of the knee. Ann Rheum Dis. 2008 Dec;67(12):1790-1. doi: 10.1136/ard.2008.089722. No abstract available.
Reference Type
BACKGROUND
Choudhry MN, Malik RA, Charalambous CP. Blood Glucose Levels Following Intra-Articular Steroid Injections in Patients with Diabetes: A Systematic Review. JBJS Rev. 2016 Mar 22;4(3):e5. doi: 10.2106/JBJS.RVW.O.00029.
Reference Type
BACKGROUND
Habib GS, Miari W. The effect of intra-articular triamcinolone preparations on blood glucose levels in diabetic patients: a controlled study. J Clin Rheumatol. 2011 Sep;17(6):302-5. doi: 10.1097/RHU.0b013e31822acd7c.
Reference Type
BACKGROUND
Taliaferro K, Crawford A, Jabara J, Lynch J, Jung E, Zvirbulis R, Banka T. Intraocular Pressure Increases After Intraarticular Knee Injection With Triamcinolone but Not Hyaluronic Acid. Clin Orthop Relat Res. 2018 Jul;476(7):1420-1425. doi: 10.1007/s11999.0000000000000261.
Reference Type
BACKGROUND
Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthop J Sports Med. 2015 Apr 27;3(5):2325967115581163. doi: 10.1177/2325967115581163. eCollection 2015 May.
Reference Type
BACKGROUND
McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017 May 16;317(19):1967-1975. doi: 10.1001/jama.2017.5283.
Reference Type
BACKGROUND
Wheeler SG. Steroid Knee Injections for Arthritis Are No Better than Placebo in a Randomized Controlled Trial. J Gen Intern Med. 2020 Oct;35(10):3137-3139. doi: 10.1007/s11606-020-05647-y. No abstract available.
Reference Type
BACKGROUND
Schneider BJ, Mattie R, Smith C. Cumulative Lifetime Steroid Exposure via Epidural Administration. Pain Med. 2019 Nov 1;20(11):2323-2324. doi: 10.1093/pm/pnz203. No abstract available.
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Related Links
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https://www.orthobullets.com/basic-science/9087/outcome-measure-tool
Outcome scale description
Other Identifiers
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21.411
Identifier Type: -
Identifier Source: org_study_id
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