Evidence-Based Knee Injections for the Management of Arthritis
Pain Medicine, 05/25/2012
Evidence Based Medicine
Cheng OT et al. – The authors conclude that strong evidence supports the use of intraarticular knee injection as a valuable intervention in the continuum of management of arthritis between conservative treatment and knee surgeries.Methods
- The authors systematically searched PUBMED/MEDLINE and the Cochrane databases for articles published on knee injections and evaluated their level of evidence and recommendations according to established criteria.
- The evidence supports the use of intraarticular corticosteroid injections for rheumatoid arthritis (1A+ Level), osteoarthritis (1A+ Level), and juvenile idiopathic arthritis (2C+ Level).
- Pain relief and functional improvement are significant for months up to 1 year after the injection.
- Triamcinolone hexacetonide offers an advantage over triamcinolone acetonide and should be the intraarticular steroid of choice (2B+ Level).
- Intraarticular injection of hyaluronate may provide longer pain relief than steroid injection in osteoarthritis (2B+ Level).
- It can also be effective for rheumatoid arthritis knee pain (1A+ Level).
- However, it is only recommended for patients with significant surgical risk factors and for patients with mild radiographic disease in whom conservative treatment has failed (2B± Level).
- Botulinum toxin type A injection is effective in reducing arthritic knee pain (2B+ Level), and so is tropisetron (2B+ Level) and tanezumab (2B+ Level).
- The new agents, such as rAAV2–TNFR:Fc, SB–210396/CE 9.1, and various radioisotopes have provided various degrees of success, but their long–term safety and efficacy remains to be determined.