Pain Reduction in Osteoarthritis: Two New Options
Effective alternatives you may want to consider for your patients.
References1. Dorleijn DMJ, Luijsterburg PAJ, Reijman M, et al. Intramuscular glucocorticoid injection versus placebo injection in hip osteoarthritis: a 12-week blinded randomised controlled trial. Ann Rheum Dis. 2018;77:875-882.2. Bagla S, Piechowiak R, Hartman T, et al. Geniculate artery embolization (GAE) for osteoarthritis (OA)-related knee pain: interim results from a multicenter US trial. Presented at: Society of Interventional Radiology Annual Scientific Meeting; March 17-22, 2018; Los Angeles, CA. Abstract 210.
Two recent studies looked at advances in treating pain related to osteoarthritis. Dorleijn and colleagues in the Netherlands found that intramuscular glucocorticoid injection is effective for hip osteoarthritis pain, while Bagla and associates in Virginia report that embolization of the geniculate artery reduces pain and disability in knee osteoarthritis.1,2
Scroll through the slides for details on these two studies and for take-home points for clinicians.
(Hip radiograph: ©Akawath/Shutterstock.com; knee radiograph: ©thailoei92/Shutterstock.com)
The intra-articular treatment effect was large at 1 week post-injection but declined afterward.
Injection into the hip joint is challenging because the joint cannot be palpated and is adjacent to important neurovascular structures.
A double-blinded, randomized, controlled trial (RCT) showed no important differences in effectiveness on pain of ultrasound-guided subacromial glucocorticoid injection compared with gluteal injection.
Concerns about joint sepsis have been raised in the past with intra-articular injections.
For hip pain at 2 weeks, the between-group difference was −1.3 (95% CI, −2.3 to −0.3).
For injection pain on walking, between-group difference was −0.9 (95% CI, −1.9 to 0).
The effect of IM glucocorticoid injection was still present at a similar degree at 12-week follow-up.
Previous studies on intra-articular glucocorticoid injections in hip osteoarthritis mostly showed a peak effect after 1 to 3 weeks, but they still demonstrated significant pain reduction at 8 to 12 weeks’ follow-up.
Following the brief surgery, no physical therapy is needed to recover.
The authors point out that reducing opioid requirements is a high priority in light of the nationwide epidemic of abuse.
Pain was quantified using the visual analog scale (VAS).
Disability or function was measured using the Western Ontario and McMaster University Osteoarthritis Index.
Patients who underwent follow-up had reductions of 58 mm on the VAS and 36.3 on the Western Ontario and McMaster University Osteoarthritis Index.
“This procedure could have a significant impact in the treatment of osteoarthritis pain as a whole,” stated Dr Bagla.
