• MINU BABY Department of Pharmacology, Travancore Medical College Hospital, Kollam, Kerala, India.
  • KALA KESAVAN Department of Pharmacology, Government Medical College, Ernakulam, Kerala, India.



Osteoarthritis, Intra-articular, corticosteroids, WOMAC Score, Kellgren Lawrence Scale, Knee Range of Motion, Triamcinolone acetate, American College of Rheumatology


Objective: The objective of the study was to assess the safety and efficacy of intra-articular steroid injections in osteoarthritis of knee.

Methods: This prospective observational study was conducted for a period of 12 months in a tertiary care hospital. Patients were given intra-articular injections of triamcinolone hexacetonide 40 mg (1 cc) in the affected knee at the time of enrollment and thereafter at 6 and 12 weeks. The treatment response was evaluated based on the improvement in the various clinical scoring systems. Comparison of quantitative variables of successive follow-up with baseline value was analyzed. p < 0.05 was taken as level of significance.

Results: Of the 106 patients included in the study, the mean age was 64.12±8.69 years. The mean 50 foot walking time improved from 13.85 s to 12.64 s (p=0.003) by 24 weeks. Range of motion improved from a mean of 126.75–131.63° (p=0.001). The physician’s global assessment score improved from a baseline mean of 54.42–46.39 while the patient’s global assessment score progressed from 57.8 to 46.38 both being statistically significant. Patient’s pain assessment score reduced from baseline mean value of 57.32–45.95 and nocturnal pain improved to 30.24 at 24 weeks from a baseline value of 36.51. The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved to 45.93 from baseline of 56.92.

Conclusion: Repetitive IA steroid injections appear to be safe with no significant deleterious effects on the anatomical joint structure.


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Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil 2010;18:476-99. doi: 10.1016/j.joca.2010.01.013, PMID 20170770

Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: Meta-analysis. BMJ 2004;328:869. doi: 10.1136/ bmj.38039.573970.7C, PMID 15039276

Jaydeep N, Kothari SY, Rajendra S, Diganta B, Thukral BB, Rohini G. Clinical and imaging evaluation of efficacy of visco-supplementation in degenerative osteoarthritis knee-a prospective interventional study. IJPMR 2015;1:6-10.

Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis a prospective, double-blind, randomized trial. Am J Sports Med 2013;41:356-64. doi: 10.1177/0363546512471299, PMID 23299850

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum 1986;29:1039-49. doi: 10.1002/art.1780290816, PMID 3741515

Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64:455-74.

Valtonen EJ. Clinical comparison of triamcinolonehexacetonide and betamethasone in the treatment of osteoarthrosis of the knee-joint. Scand J Rheumatol Suppl 1981;41:1-7. PMID 6765509

Jones A, Doherty M. Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response. Ann Rheum Dis 1996;55:829-32. doi: 10.1136/ard.55.11.829, PMID 8976640

Wright V, Chandler GN, Morison RA, Hartfall SJ. Intra-articular therapy in osteo-arthritis; comparison of hydrocortisone acetate and hydrocortisone tertiary-butylacetate. Ann Rheum Dis 1960;19:257-61. doi: 10.1136/ard.19.3.257, PMID 13786828

Escalante Y, Saavedra JM, García-Hermoso A, Silva AJ, Barbosa TM. Physical exercise and reduction of pain in adults with lower limb osteoarthritis: A systematic review. J Back Musculoskelet Rehabil 2010;23:175-86. doi: 10.3233/BMR-2010-0267, PMID 21079296

Hawker GA, Davis AM, French MR, Cibere J, Jordan JM, March L, et al. Development and preliminary psychometric testing of a new OA pain measure-an OARSI/OMERACT initiative. Osteoarthr Cartil 2008;16:409-14. doi: 10.1016/j.joca.2007.12.015, PMID 18381179

Liu ZA, Kendzerska T, Elkayam J, Ram S, Hawker GA. Minimal clinically important difference and patient acceptable symptom state for the OARSI-omeract intermittent and constant OA pain (ICOAP) measure. Arthritis Rheum 2012;64:S105-6.

Raynauld JP, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: A randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2003;48:370-7. doi: 10.1002/art.10777, PMID 12571845

Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function international knee documentation committee. Measures of knee function: International Knee Documentation Committee (IKDC) subjective knee evaluation form, Knee Injury and Osteoarthritis Outcome Score (KOOS), knee injury and osteoarthritis outcome score physical function short form (KOOS-PS), knee outcome survey Activities of Daily Living scale (KOS-ADL), Lysholm knee scoring scale, Oxford Knee Score (OKS), western Ontario and McMaster universities osteoarthritis index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011;63:S208-28. doi: 10.1002/acr.20632, PMID 22588746

Bremander AB, Petersson IF, Roos EM. Validation of the rheumatoid and arthritis outcome score (RAOS) for the lower extremity. Health Qual Life Outcomes 2003;1:55. doi: 10.1186/1477-7525-1-55, PMID 14613567

Fransen M, McConnell S. Land-based exercise for osteoarthritis of the knee: A metaanalysis of randomized controlled trials. J Rheumatol 2009;36:1109-17. doi: 10.3899/jrheum.090058, PMID 19447940

Cooper C, McAlindon T, Coggon D, Egger P, Dieppe P. Occupational activity and osteoarthritis of the knee. Ann Rheum Dis 1994;53:90-3. doi: 10.1136/ard.53.2.90, PMID 8129467

Dieppe PA, Sathapatayavongs B, Jones HE, Bacon PA, Ring EF. Intra-articular steroids in osteoarthritis. Rheumatol Rehabil 1980;19:212-7. doi: 10.1093/rheumatology/19.4.212, PMID 7010511

Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8: 283-91.

Niu J, Zhang YQ, Torner J, Nevitt M, Lewis CE, Aliabadi P, et al. Is obesity a risk factor for progressive radiographic knee osteoarthritis? Arthritis Rheum 2009;61:329-35. doi: 10.1002/art.24337, PMID 19248122

Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: The minimal clinically important improvement. Ann Rheum Dis 2005;64:29-33. doi: 10.1136/ ard.2004.022905, PMID 15208174

Garratt AM, Brealey S, Gillespie WJ, DAMASK Trial Team. Patient-assessed health instruments for the knee: A structured review. Rheumatol (Oxf Engl) 2004;43:1414-23. doi: 10.1093/rheumatology/ keh362, PMID 15316121

Tangtrakulwanich B, Wiwatwongwana S, Chongsuvivatwong V, Geater AF. Comparison of validity, and responsiveness between general and disease-specific quality of life instruments (Thai version) knee osteoarthritis. J Med Assoc Thai 2006;89:1454-9.

Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957;16:494-502. doi: 10.1136/ard.16.4.494, PMID 13498604



How to Cite

BABY, M., and K. KESAVAN. “SAFETY AND EFFICACY OF INTRA-ARTICULAR STEROID INJECTIONS IN OSTEOARTHRITIS OF THE KNEE – A PROSPECTIVE OBSERVATIONAL STUDY”. Asian Journal of Pharmaceutical and Clinical Research, vol. 15, no. 6, June 2022, pp. 29-33, doi:10.22159/ajpcr.2022.v15i6.44521.



Original Article(s)