University of California San Diego School of Medicine, 9350 Campus Point Drive, La Jolla, CA 92037, USA.
J Rheumatol. 2010 Mar;37(3):650-5. doi: 10.3899/jrheum.090575. Epub 2010 Jan 15.
To assess whether inflammation on ultrasound is predictive of clinical response to intraarticular (IA) corticosteroid injections in patients with knee osteoarthritis (OA).
Patients with symptomatic knee OA were randomized to receive either an IA injection of 40 mg triamcinolone acetonide in the treatment group or 1 cc 0.9% saline in the placebo group. Clinical response was assessed by changes in baseline Western Ontario and McMaster Universities (WOMAC) index scores and physician global assessment at 4 and 12 weeks. Ultrasounds were performed at each visit. Patients and assessors were blinded to treatment status.
Seventy-nine patients were enrolled into the study. Four-week data were available for 67 patients in the primary analysis comparing change in WOMAC pain score from baseline to 4 weeks. There was almost no change in the WOMAC pain subscale score from baseline to 4 weeks in the control group, but there was a significant improvement in WOMAC pain subscale score from 10.8 (SD +/- 3.2) at baseline to 8.75 (SD +/- 4.0) at 4 weeks in the treatment group (adjusted p = 0.001). Of the 34 patients in the treatment group; 16 (47%) had inflammatory disease and 18 (53%) had noninflammatory disease as determined by ultrasound. There was no difference in the change in WOMAC pain score between the inflammatory and noninflammatory patients in the treatment group at 4 weeks. There was a statistically significant greater improvement in pain subscale scores among noninflammatory patients than among inflammatory patients at 12 weeks.
Intraarticular corticosteroid injections are an effective short-term treatment for symptomatic knee OA compared to placebo. Patients with noninflammatory characteristics on ultrasound had a more prolonged benefit from IA corticosteroids compared to inflammatory patients.
评估膝关节骨关节炎（OA）患者关节内（IA）皮质类固醇注射后的炎症是否与临床反应相关。
将有症状的膝关节 OA 患者随机分为治疗组（接受 40mg 曲安奈德的 IA 注射）或安慰剂组（接受 1cc 生理盐水 IA 注射）。通过基线 Western Ontario 和 McMaster 大学（WOMAC）指数评分和 4 周及 12 周时医生整体评估的变化来评估临床反应。每次就诊时均进行超声检查。患者和评估者均对治疗状况进行盲法。
79 名患者入组本研究。主要分析中，有 67 名患者可提供基线至 4 周时 WOMAC 疼痛评分变化的 4 周数据。对照组的 WOMAC 疼痛亚量表评分从基线到 4 周几乎没有变化，但治疗组的 WOMAC 疼痛亚量表评分从基线的 10.8（SD +/- 3.2）显著改善至 4 周时的 8.75（SD +/- 4.0）（调整后的 p = 0.001）。在治疗组的 34 名患者中；16 名（47%）患者的疾病为炎症性，18 名（53%）患者的疾病为非炎症性，通过超声确定。在治疗组中，4 周时炎症和非炎症患者的 WOMAC 疼痛评分变化无差异。在治疗组中，非炎症患者的疼痛亚量表评分在 12 周时的改善程度明显大于炎症患者。
与安慰剂相比，IA 皮质类固醇注射是治疗膝关节 OA 症状的有效短期治疗方法。超声显示非炎症特征的患者接受 IA 皮质类固醇治疗的获益时间比炎症患者更长。
