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Both intramuscular and intra-articular glucocorticoid injections are effective strategies to alleviate knee osteoarthritis pain in primary care settings.
In adults diagnosed with symptomatic knee osteoarthritis, intramuscular glucocorticoid injection might present an inferior effect in decreasing pain at four weeks when compared to standard intra-articular injection. The noninferiority of intramuscular injection was noted at 8 and 24 weeks after injection (but not at 2 and 12 weeks), as elucidated from the KIS randomized clinical noninferiority trial. Researchers aimed to find out if an intramuscular glucocorticoid injection is non-inferior to an intra-articular glucocorticoid injection to decrease knee osteoarthritis pain.
Participants were randomly assigned to get an injection of 40 mg triamcinolone acetonide, either intramuscular in the ipsilateral ventrogluteal region or intra-articular in the knee joint and were followed up for twenty-four weeks. In this multicenter, open-label study, the pain intensity at four weeks estimated with Knee Injury and Osteoarthritis Outcome Score (KOOS), along with the noninferiority margin of -7 (intramuscular minus intra-articular) was the major endpoint ascertained. A per-protocol assessment was prespecified as the primary evaluation.
Overall, 145 volunteers were included. Out of 145, 138 volunteers (Intra-articular-66; Intramuscular-72) were incorporated in the per-protocol assessment. In both groups, significant improvements in knee pain were attained up to twelve weeks following glucocorticoid injection. At four weeks, the estimated mean difference in KOOS between the study groups was found to be -3.4. Since the lower limit exceeded the noninferiority margin, noninferiority could not be stated.
At 8 and 24 weeks, intramuscular injection illustrated significant noninferiority to intra-articular injection. Regarding secondary outcomes, no considerable difference was noted. In intention-to-treat population, the results were comparable for the sensitivity assessment. Hot flush and headache were the most commonly reported adverse events. All the events were classified as nonserious.
Hence, a shared decision-making process should take place between people suffering from knee osteoarthritis and doctors when a glucocorticoid injection is indicated.
JAMA Network Open
Effect of Intramuscular vs Intra-articular Glucocorticoid Injection on Pain Among Adults With Knee Osteoarthritis: The KIS Randomized Clinical Trial
Qiuke Wang et al.
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