Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis

• Published in: Journal of rheumatology 2018-08, Vol.45 (9), p.1316-1324
• Main Authors: Liu, Shao-Hsien, Dubé, Catherine E, Eaton, Charles B, Driban, Jeffrey B, McAlindon, Timothy E, Lapane, Kate L
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Aged; Female; Humans; Hyaluronic Acid - administration & dosage; Hyaluronic Acid - therapeutic use; Injections, Intra-Articular; Knee Joint - physiopathology; Male; Middle Aged; Osteoarthritis, Knee - drug therapy; Osteoarthritis, Knee - physiopathology; Pain Measurement; Patient Reported Outcome Measures; Treatment Outcome; Viscosupplements - administration & dosage; Viscosupplements - therapeutic use
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.171385

We examined the longterm effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA). Using Osteoarthritis Initiative data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injections (n = 412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect on symptoms of newly initiated injection use compared to nonusers over 2 years of followup. Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. About 18.9% had additional injection use after initiation, but switching between injection types was common. Compared to nonusers, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points, 95% CI 0.82-1.66), stiffness (yearly worsening: 0.30 points, 95% CI 0.10-0.49), and physical functioning (yearly worsening: 2.62 points, 95% CI 0.94-4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50, 95% CI -0.11 to 1.11; stiffness: -0.07, 95% CI -0.38 to 0.24; and functioning: 0.49, 95% CI -1.34 to 2.32). Although intraarticular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptom relief over 2 years of followup for persons with knee OA.