Arden N K, Reading I C, Jordan K M, Thomas L, Platten H, Hassan A, Ledingham J
MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton, UK.
Osteoarthritis Cartilage. 2008 Jun;16(6):733-9. doi: 10.1016/j.joca.2007.10.011. Epub 2008 Feb 20.
Patients with knee osteoarthritis (OA) often suffer pain that is not fully controlled by analgesics and often require intra-articular therapies. The aim of this study was to compare the benefits of intra-articular corticosteroid injections (CSIs) and tidal irrigation (TI) in patients with OA of the knee.
We performed a dual-centre, single blind, randomised, parallel group trial comparing TI and CSI. Patients with knee OA were randomised to either irrigation using a 3.2mm arthroscope under local anaesthesia or an intra-articular injection of 40 mg triamcinolone acetonide and 1% lidocaine. Patients were followed for 6 months. The primary outcome measure was the Western Ontario and McMaster Universities OA Index total pain score (visual analogue scale, VAS).
One hundred and fifty patients were recruited of whom 71 received TI and 79 CSI. In both treatment groups, over 80% of patients reported improvement at 2 and 4 weeks. After this time, the benefit of CSI decreased whereas that of TI was maintained: at 26 weeks the pain relief afforded by TI was significantly greater than that of CSI. At 26 weeks 29% of the CSI group reported improvement vs 64% of the TI group (P<0.001). Patients with a knee effusion responded better to both treatments, however, this was most apparent for CSI. Patients with less severe radiographic OA also obtained the greatest improvement from both treatments.
Both procedures lead to significant short-term pain relief of at least 4 weeks, however, TI displayed a significantly greater duration of benefit. Patients with effusions and milder radiographic change obtained the best response to treatment.
膝骨关节炎（OA）患者常遭受疼痛，且镇痛药物无法完全控制，常需关节内治疗。本研究旨在比较关节内注射皮质类固醇（CSIs）和潮式灌洗（TI）对膝骨关节炎患者的疗效。
我们进行了一项双中心、单盲、随机、平行组试验，比较TI和CSIs。膝骨关节炎患者被随机分为局部麻醉下使用3.2mm关节镜进行灌洗或关节内注射40mg曲安奈德和1%利多卡因。对患者进行6个月的随访。主要结局指标是西安大略和麦克马斯特大学骨关节炎指数总疼痛评分（视觉模拟量表，VAS）。
共招募了150名患者，其中71名接受TI，79名接受CSIs。在两个治疗组中，超过80%的患者在2周和4周时报告病情改善。此后，CSIs的疗效下降，而TI的疗效得以维持：在26周时，TI提供的疼痛缓解明显大于CSIs。在26周时，CSIs组29%的患者报告病情改善，而TI组为64%（P<0.001）。膝关节积液患者对两种治疗的反应都更好，不过，CSIs更为明显。影像学OA较轻的患者从两种治疗中获得的改善也最大。
两种治疗方法均能在至少4周内显著缓解短期疼痛，然而，TI的疗效持续时间明显更长。有积液和影像学改变较轻的患者对治疗的反应最佳。
