Osteoarthritis Pain

Intra-articular Corticosteroids and Viscosupplements

Patients with moderate to severe pain and signs of joint inflammation may benefit from intra-articular injections of corticosteroids or hyaluronic acid. Intra-articular glucocorticoid injections are particularly effective for short-term pain relief in patients with knee pain in association with signs of joint effusion or inflammation. One randomized double-blind study of intra-articular triamcinolone in patients with OA of the knee reported significant long-term reductions in pain.⁵³ Intra-articular corticosteroid injections are generally limited to 3 or 4 injections per year, although this limit is not supported by clinical trial data. Hyaluronic acid injections (also referred to as viscosupplementation) are thought to replace lubrication lost to the disease, and pain relief following injection is comparable to that achieved with NSAIDs.^54,57 Studies have shown that a 3- to 5-week series of once-weekly hyaluronic acid injections may reduce OA symptoms for as long as 6 months in some patients⁵⁶ with persistent symptoms refractory to medical therapy. Hyaluronic acid injections are contraindicated in patients with chicken or egg allergies.⁵⁷