The effects of intra-articular glucocorticoids and exercise on pain and synovitis assessed on static and dynamic magnetic resonance imaging in knee osteoarthritis: exploratory outcomes from a randomized controlled trial

Osteoarthritis Cartilage. 2017 Apr;25(4):481-491. doi: 10.1016/j.joca.2016.10.009. Epub 2016 Oct 13.

Abstract

Objective: The aims of the present knee osteoarthritis (KOA)-study were to: (1) describe and compare the changes in magnetic resonance imaging (MRI)-measures of synovitis following an exercise program preceded by an intra-articular injection of either corticosteroid or isotonic saline and (2) investigate if any of the changes in patient reported outcome measures (PROMs) were associated with changes in MRI-measures of synovitis.

Design: We performed a randomized, double-blinded, placebo-controlled clinical trial evaluating the effects of intra-articular corticosteroid vs placebo injections given before exercise therapy in KOA-patients. PROMs were assessed using the KOOS (knee injury and osteoarthritis outcome score). Synovitis was assessed on conventional non-contrast-enhanced, conventional contrast-enhanced (CE) and dynamic contrast-enhanced (DCE) MRI. PROMs and MRIs were obtained prior to the intra-articular injection, after termination of the exercise program (week 14-primary time point) and week 26.

Results: Of 100 randomized participants (50 in each allocation group), 91 had complete MRI-data at baseline (63% female, mean age: 62 years, median Kellgren-Lawrence-grade: 3). There were no statistically significant differences between the two interventions in regards of changes in MRI-measures of synovitis at any time-point. At week 14, we found no statistical significant MRI-explanatory variables of either of the PROMs.

Conclusions: The present study does not justify the use of intra-articular corticosteroids over intra-articular saline when combined with an exercise program for reduction of synovitis in KOA. The improvement in pain and function following the intervention with intra-articular corticosteroids/saline and exercise could not be explained by a decrease in synovitis on MRI indicating other pain causing/relieving mechanisms in KOA.

Keywords: Corticosteroids; Dynamic contrast-enhanced magnetic resonance imaging; Exercise; Knee osteoarthritis; Patient reported outcome measures; Synovitis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Arthralgia / therapy*
  • Double-Blind Method
  • Exercise Therapy / methods*
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Injections, Intra-Articular
  • Magnetic Resonance Imaging
  • Male
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / therapy*
  • Patient Reported Outcome Measures
  • Synovitis / diagnostic imaging
  • Synovitis / therapy*

Substances

  • Glucocorticoids
  • Methylprednisolone