Knee Tenderness Linked to Better Short-Term Outcomes With Intra-Articular Steroid Injections in OA

Tenderness around the knee was linked to better short-term outcomes in patients with knee osteoarthritis who received intra-articular steroid injections.

In patients with symptomatic knee osteoarthritis (OA), tenderness around the knee was linked to better short-term outcomes with intra-articular steroid injections, according to study results published in The Journal of Rheumatology.

However, the results indicated that clinical factors did not predict longer-term response to intra-articular steroid injections. In addition, patients with chronic widespread pain and depressive symptoms had a reduced likelihood of achieving longer-term benefits.

The study included participants age ≥40 with painful OA who participated in an open label trial of intra-articular steroid injections (n=199). Participants completed questionnaires and underwent clinical examination. The researchers used OMERACT-OARSI criteria to assess short-term response to therapy (within 2 weeks).

In participants who initially responded, patients whose pain had not returned to within 20% of their baseline Knee Injury and Osteoarthritis Outcome Score (KOOS)-pain score at 6 months were considered longer-term responders. The researchers used log binomial regression to determine factors associated with outcome.

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Of 199 participants, 73.4% (n=146) were short-term responders and 20.1% (n=40) were longer-term responders.

Compared with short-term nonresponders, participants with 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 the belief that treatment would be effective (RR per unit increase, 1.05; 95% CI, 1.01-1.09) were more likely to be short-term responders.

The results indicated that aspiration of joint fluid (RR, 0.79; 95% CI, 0.66-0.95) and previous ligament or meniscus injury (RR, 0.63; 95% CI, 0.44-0.91) were associated with a reduced risk of being a short-term responder.

The researchers found that participants with a higher number of pain sites (RR per unit increase, 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 per unit increase, 0.86; 95% CI, 0.78-0.94) and a higher depression score(RR per unit increase, 0.89; 95% CI, 0.81-0.99) were less likely to be longer-term responders compared with initial non-responders and patients whose pain recurred within 6 months.

“Our data suggest there may be a limited role for clinical phenotyping in relation to targeting [intra-articular steroid injections] therapy in patients with joint disease though due to the exploratory nature of our study, other studies are required to confirm our findings,” the researchers wrote.

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Maricar N, Parkes MJ, Callaghan M, et al. Do clinical correlates of knee osteoarthritis predict outcome to intra-articular steroid injections? [published online April 1, 2019]. J Rheumatol. doi:10.3899/jrheum.180233

This article originally appeared on Rheumatology Advisor