Background/Purpose: Intra-articular steroids are in use since half-a-century, but choice of individual agents remains empirical in the absence of comparative trials. This study compared the efficacy of intra-articular injection of methylpredisolone acetate (MPA) with triamcinolone acetonide (TA) in treatment of acutely swollen knee joint in patients with chronic inflammatory arthritis.

Methods: This was a double-blind randomized controlled trial that included patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) having an acutely swollen knee (>1 week and <24 weeks). Patients were randomized (1:1) to receive intra-articular injection of either methylpredisolone acetate (MPA) or triamcinolone acetonide (TA) (80 mg, 2ml) and followed over 24 weeks. The primary outcome measure was time-to-relapse and secondary outcome measures were numerical rating scale (NRS) (0-10) of pain and swelling at 4, 12 and 24 weeks, range of motion and adverse effects. In addition assessed change in DAS28-3, Indian health assessment questionnaire and proportion with good improvement (>50% improvement). Primary analysis was intention-to-treat; in addition per-protocol (only completers) analysis also done. Trial # Clinical trials registry of India CTRI/2015/09/006187

Results: This study included 100 patients (RA:SpA=89:11, M:F=24:76). They were randomized (50 each) to MPA and TA, with no significant differences in baseline characteristics. At 24 weeks, 3 patients were lost and 9 relapsed in each group, with no significant difference in mean (+/-SEM) time-to-relapse (20.8±1.0, 20.9±1.0 weeks, p=0.96) (Figure 1). There was also no significant difference in change in NRS pain (-4.4±3.1, -3.9±2.8, p=0.46) and NRS swelling (-4.5±2.9, -3.9±2.8, p=0.36) in MPA and TA groups at 24 weeks from baseline. (Figure 2) At baseline, normal flexion of knee joint was present in 28 and 25 patients (p=0.17), and at 24 weeks, in 38 and 37 patients (p=0.7) respectively. There were no adverse effects in any patient. There was no significant difference in the change in DAS28-3 at 24 weeks from baseline (-1.4±1.1, -1.3±1.3) or in HAQ at 24 weeks from baseline (-0.7±0.5, -0.7±0.5, p=0.80).

Conclusion: There was no significant difference efficacy of intra-articular injection of MPA vs TA in knee arthritis over a period of 24 weeks. Figure 1:Kapan-Meier curve comparing time-to-relapse in MPA and TA groups

Figure 2: Composite outcomes over 24 weeks in the MPA and TA groups

ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-intra-articular-methylprednisolone-acetate-with-triamcinolone-acetonide-in-acutely-swollen-knee-joint-of-patients-with-chronic-inflammatory-arthritis-a-randomized-controlled-tr/