If you have knee osteoarthritis, you know how frustrating and debilitating the pain can be. Thankfully, there are a variety of treatment options available to help manage symptoms, including glucocorticoid injections. However, there is some debate among physicians about the safety of intra-articular (IA) glucocorticoid injections, which are administered directly into the knee joint. An alternative approach is intramuscular (IM) glucocorticoid injection, which is injected into the muscle. But which is more effective?
A recent clinical trial, known as the KIS trial, sought to answer this question. The trial involved 145 patients with symptomatic knee osteoarthritis and was conducted in 80 primary care general practices in the southwest of the Netherlands. Patients were randomly assigned to receive either an IM injection of the glucocorticoid triamcinolone acetonide in the ipsilateral ventrogluteal region or an IA injection in the knee joint. All patients were followed up for 24 weeks.
The trial found that clinically relevant improvements in knee pain were reached up to 12 weeks after both types of injection. However, at 4 weeks, the estimated mean difference in the Knee Injury and Osteoarthritis Outcome Score between the two groups was -3.4, indicating that IM injection may be inferior to IA injection in reducing pain at this time point. However, at 8 and 24 weeks after injection, IM injection was found to be non-inferior to IA injection.
While both types of injection were found to be effective strategies for managing knee osteoarthritis pain, the trial suggests that a shared decision-making process should take place between clinicians and patients when deciding which type of injection to use.
Patients should be made aware of the advantages and disadvantages of each option and be given the opportunity to make an informed decision based on their individual needs and preferences. It is worth noting that the most frequently reported adverse events were hot flush and headache, which were classified as nonserious.
Overall, the trial provides valuable data for both clinicians and patients when considering the use of glucocorticoid injections for knee osteoarthritis. While IM injection may present an inferior effect at 4 weeks compared to IA injection, it can still be an effective treatment option in the long run. As always, patients should consult with their healthcare provider to determine the best course of action for their individual needs.