Background/Purpose: Intra-articular(IA) corticosteroid injections for knee osteoarthritis (OA) have been performed for over 60 years. However, the appropriate dose of IA corticosteroids has not been determined. To determine if the dose of Triamcinolone acetonide (TA) used in IA injections for the treatment of knee OA made any significant difference in the patient outcomes, we studied the effects of 10 mg vs 20 mg vs 40 mg of TA intra-articular injections in knee OA. 

Methods: This was a blinded, randomized controlled trial conducted in 30 symptomatic knee OA Veterans Administration patients. The subjects were 1:1:1 randomized to receive 10 mg, 20 mg or 40 mg of TA into the affected knee. The primary outcome was the 6- week difference from baseline in the modified Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Inclusion criteria were age 45-95; Kellgren and Lawrence ( K&L) grade 2-4; visit for unilateral knee joint injection. Exclusion criteria were bilateral knee injections; history of inflammatory arthritis; history of joint injections within the last 12 weeks; knee surgery within past 6 months; local infection. Adverse events were recorded. 

Results: Baseline characteristics were similar between the 3 groups. The average age of patients in the 10 mg group was 72.66 years (45-86 years), 20 mg group was 74 years (49-92 years) and the 40 mg group was 68.63 years (46-86). BMI was comparable between the 10 mg, 20 mg and 40 mg groups with values of 33.7 kg/m2, 31.7 kg/m2, and 31.05 kg/m2, respectively. K&L scores ranged between 2-4 with an average score of 2.77 in the 10 mg group, 2.8 in the 20 mg group, and a slightly lower average of 2.45 in the 40 mg group. The 6-week WOMAC score compared to the baseline showed an average of 6.07 percentage points decrease in the 10 mg group (-34.37 to 27.97), 9.56 percentage point decrease in the 20 mg group (-18.75 to 42.71) and 29.29 percentage point decrease in the 40 mg group(-9.38 to 87.47). 

Conclusion: IA corticosteroid dose of 40 mg of TA was found to be superior in improving knee OA symptoms when compared to the 10 mg and the 20 mg TA dose with an average improvement in WOMAC by 29.29 percentage points in the 20 mg TA dose group compared to 6.07 percentage point improvement in the 10 mg TA dose group and 9.56 percentage point improvement in the 20 mg TA dose group. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/intra-articular-corticosteroid-injections-for-knee-osteoarthritis-does-the-dose-matter/