Brumini Christine, Furtado Rita Nely Vilar, Jones Anamaria, da Silva Raphael Vilela Timóteo, Natour Jamil
Universidade Federal de Sao Paulo / Escola Paulista de Medicina (UNIFESP/EPM) - Disciplina de Reumatologia, Rua dos Otonis, 863 - Vila Clementino, Sao Paulo, SP, CEP 04025-002, Brazil.
Adv Rheumatol. 2025 Apr 28;65(1):21. doi: 10.1186/s42358-025-00452-9.
To evaluate the effectiveness of intra-articular injections (IAIs) with triamcinolone hexacetonide (TH) combined with a progressive resistance exercise program (PREP) in improving pain, function, muscle strength, and quality of life in elderly patients with knee osteoarthritis (OA).
Fifty-nine elderly individuals with knee OA were randomized into three groups: IAI with TH (IAI-TH) + PREP, IAI with saline solution (IAI-SS) + PREP, and IAI with placebo + PREP. The IAIs were administered once, one week before starting PREP, which was performed twice weekly for 12 weeks. Outcomes assessed at baseline and at 2, 6, and 12 weeks post-IAI included pain (Numerical Pain Scale - NPS), swelling, function (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC), quality of life (Short Form-36 - SF-36), performance tests (Six-Minute Walk Test - 6MWT, Timed Up and Go Test - TUGT, Short Physical Performance Battery - SPPB), and muscle strength (one-repetition maximum test - 1RM). Due to the COVID-19 pandemic, only 15 participants per group completed the study protocol.
All groups showed significant intragroup improvements over time in pain, function, muscle strength, and quality of life. However, no statistically significant differences were found between the groups for any of the assessed outcomes. The bodily pain domain of the SF-36 and analgesic consumption were the only measures showing differences over time.
The combination of IAI-TH and a 12-week PREP (twice weekly) was not superior to IAI-SS or placebo combined with the same PREP in improving pain, function, or quality of life in elderly patients with knee OA. These findings highlight the role of exercise as a key therapeutic strategy, regardless of prior IAI. Future studies with larger sample sizes and long-term follow-ups are needed to better assess the role of intra-articular corticosteroid injections in OA rehabilitation.
ensaiosclinicos.gov.br (RBR-556md5g). Registered 27 October 2022.
评估己曲安奈德（TH）关节内注射（IAI）联合渐进性抗阻运动计划（PREP）对改善老年膝骨关节炎（OA）患者疼痛、功能、肌肉力量和生活质量的有效性。
59名老年膝OA患者被随机分为三组：TH关节内注射（IAI-TH）+PREP组、生理盐水关节内注射（IAI-SS）+PREP组和安慰剂关节内注射+PREP组。IAI在开始PREP前一周注射一次，PREP每周进行两次，共12周。在基线以及IAI后2周、6周和12周评估的结果包括疼痛（数字疼痛量表-NPS）、肿胀、功能（西安大略和麦克马斯特大学骨关节炎指数-WOMAC）、生活质量（简明健康状况调查量表-SF-36）、性能测试（6分钟步行试验-6MWT、计时起立行走试验-TUGT、简短体能测试电池-SPPB）和肌肉力量（1次重复最大负荷测试-1RM）。由于新冠疫情，每组只有15名参与者完成了研究方案。
所有组在疼痛、功能、肌肉力量和生活质量方面随时间均显示出显著的组内改善。然而，在任何评估结果中，各组之间均未发现统计学上的显著差异。SF-36的身体疼痛领域和镇痛药物消耗是仅有的随时间显示出差异的指标。
在改善老年膝OA患者的疼痛、功能或生活质量方面，IAI-TH与为期12周（每周两次）的PREP联合使用并不优于IAI-SS或安慰剂与相同PREP联合使用。这些发现凸显了运动作为关键治疗策略的作用，无论之前是否进行IAI。需要进行更大样本量和长期随访的未来研究，以更好地评估关节内注射皮质类固醇在OA康复中的作用。
ensaiosclinicos.gov.br（RBR-556md5g）。2022年10月27日注册。
