Department of Physical and Rehabilitation Medicine, Kocaeli Government Hospital, Kocaeli, Turkey.
Clin Rheumatol. 2019 Nov;38(11):3243-3252. doi: 10.1007/s10067-019-04641-y. Epub 2019 Jun 26.
Although intra-articular corticosteroid injections are widely applied in the treatment of knee osteoarthritis (OA), its effect is short term. Additionally, apart from oral use, tenoxicam is also applied as an intra-articular treatment option to minimize gastrointestinal side effects of NSAIDs. Clinical evidence suggests that the combined use of NSAIDs and corticosteroids is synergistic (especially macular edema after cataract surgery in ophthalmology). Therefore, the aim of this study is to determine whether the combination of intra-articular steroid and tenoxicam was more effective for a long period rather than only tenoxicam and steroid injection alone in OA treatment.
Ninety patients were randomly divided into three groups (30 patients per group): group 1, group 2, and group 3 were treated by intra-articular injection of tenoxicam, triamcinolone hexacetonide, and triamcinolone hexacetonide plus tenoxicam, respectively. Visual analog scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were enrolled at baseline and 1, 3, and 6 months post-injection.
The mean age of patients was 68.07 ± 8.08, 65.83 ± 10.13, and 67.07 ± 6.01 in group 1, group 2, and group 3, respectively. In tenoxicam group, median pre- and post-treatment (at 1, 3, and 6 months) VAS/WOMAC scores were 7.30 ± 0.53/32.50 ± 3.79, 2.27 ± 0.98/10.83 ± 2.61, 6.73 ± 1.14/30.33 ± 5.93, and 7.03 ± 0.80/31.37 ± 4.38, respectively. In steroid group, median pre- and post-treatment VAS/WOMAC scores were 7.60 ± 0.49/34.33 ± 3.40, 1.37 ± 1.21/8.83 ± 2.70, 6.87 ± 1.35/30.80 ± 7.70, and 7.27 ± 0.86/32.83 ± 4.87, respectively. In steroid plus tenoxicam group, median pre- and post-treatment VAS/WOMAC scores were 7.57 ± 0.50/33.20 ± 3.66, 0.33 ± 0.47/6.67 ± 0.95, 0.93 ± 0.98/7.87 ± 1.96, and 1.97 ± 1.12/10.43 ± 3.70, respectively. VAS and WOMAC scores in 1 month after the injection significantly decreased in both groups compared to baseline (p < 0.01). Steroid plus tenoxicam group showed significantly improved VAS and WOMAC scores when compared to only steroid and tenoxicam group at follow-up 3 and 6 months (p < 0.01).
The combined therapy seems to produce a more effective result for a long period than monotherapy in reducing pain and improving functional recovery.
• There is an evidence of short-term effects of intra-articular corticosteroid injection in treatment of knee OA; however, there is no consensus for the long-term benefit of this treatment yet. • Apart from oral use, tenoxicam is also applied as an intra-articular treatment option to minimize gastrointestinal side effects of NSAIDs. • Clinical evidence suggests that the combined use of NSAIDs and corticosteroids is synergistic (especially macular edema after cataract surgery in ophthalmology). • The combined therapy seems to produce a more effective result for a long period than alone therapy.
虽然关节内皮质类固醇注射在治疗膝骨关节炎（OA）中广泛应用，但效果是短期的。此外，除了口服使用外，替诺昔康也被用作关节内治疗选择，以最小化 NSAIDs 的胃肠道副作用。临床证据表明， NSAIDs 和皮质类固醇的联合使用具有协同作用（特别是眼科白内障手术后的黄斑水肿）。因此，本研究的目的是确定关节内类固醇和替诺昔康联合使用是否比单独使用替诺昔康和类固醇注射在 OA 治疗中更有效。
将 90 例患者随机分为三组（每组 30 例）：第 1 组、第 2 组和第 3 组分别接受关节内注射替诺昔康、曲安奈德和曲安奈德加替诺昔康治疗。在基线和注射后 1、3 和 6 个月时使用视觉模拟量表（VAS）和西部安大略省和麦克马斯特大学关节炎指数（WOMAC）进行评估。
第 1 组、第 2 组和第 3 组患者的平均年龄分别为 68.07±8.08、65.83±10.13 和 67.07±6.01。替诺昔康组治疗前后（1、3 和 6 个月）VAS/WOMAC 评分中位数分别为 7.30±0.53/32.50±3.79、2.27±0.98/10.83±2.61、6.73±1.14/30.33±5.93 和 7.03±0.80/31.37±4.38。在类固醇组中，治疗前后 VAS/WOMAC 评分中位数分别为 7.60±0.49/34.33±3.40、1.37±1.21/8.83±2.70、6.87±1.35/30.80±7.70 和 7.27±0.86/32.83±4.87。在类固醇加替诺昔康组中，治疗前后 VAS/WOMAC 评分中位数分别为 7.57±0.50/33.20±3.66、0.33±0.47/6.67±0.95、0.93±0.98/7.87±1.96 和 1.97±1.12/10.43±3.70。与基线相比，注射后 1 个月时两组的 VAS 和 WOMAC 评分均显著降低（p<0.01）。与仅用类固醇和替诺昔康组相比，类固醇加替诺昔康组在 3 和 6 个月的随访时 VAS 和 WOMAC 评分显著改善（p<0.01）。
与单独治疗相比，联合治疗在减轻疼痛和改善功能恢复方面似乎具有更长期的有效效果。
关节内皮质类固醇注射在治疗膝骨关节炎方面有短期效果，但尚未达成对该治疗长期获益的共识。
除了口服使用外，替诺昔康也被用作关节内治疗选择，以最小化 NSAIDs 的胃肠道副作用。
临床证据表明， NSAIDs 和皮质类固醇的联合使用具有协同作用（特别是眼科白内障手术后的黄斑水肿）。
与单独治疗相比，联合治疗在长期内似乎具有更有效的效果。
