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Intraarticular steroid injections effective for hip osteoarthritis
Evidence, presented at the Annual European Congress of Rheumatology, suggests significant benefits for patients with hip osteoarthritis (OA) when receiving intraarticular (IA) steroid treatment.
The treatment had earlier been labeled by EULAR as having low evidence of its effectiveness,[link widoczny dla zalogowanych], but has been included in the committee's recommendation guidelines as an option for hip OA patients in a report from 20051. The study, presented by Professor Walter Maksymowych, is the first randomized, double-blind,[link widoczny dla zalogowanych], placebo controlled trial showing significant effectiveness of the treatment, and supports the recommendations by EULAR.
Prof. Maksymowych, Division of Rheumatology, University of Alberta,[link widoczny dla zalogowanych], Edmonton, Canada, and his radiologist colleagues recognized the importance of image-guided IA steroid placement for accurate treatment and the significant effects this might have on the clinical responses in an earlier trial showing that the treatment was not effective. Precision image-guided injections can be very helpful and at times are essential to help localize the structural origin of a patient's pain,[link widoczny dla zalogowanych], especially in places where it might be difficult to detect the pain source, such as in the hip and the spine.
OA is the most common type of arthritis affects approximately 2.95 women per 1000 population and approximately 1.71 men per 1000 population.2 The typical symptoms of hip OA are stiffness, as well as pain,[link widoczny dla zalogowanych], which is usually felt in the groin, but may radiate to the knee,[link widoczny dla zalogowanych], buttock, or inner thigh, and is mainly felt on weight-bearing and aggravated by movement. Over time, the patient might get increased stiffness and might find it difficult to reach down to tie shoe laces,[link widoczny dla zalogowanych], or put on socks and shoes. The functional ability may also progress to difficulties in rising from a chair, using stairs, walking and dressing.
The 52 patients enrolled in the trial, received fluoroscopically guided IA injection and were randomly allocated placebo (2 ml of normal saline) or 40 mg of the treatment (triamcinolone hexacetonide). Assessments were performed at baseline,[link widoczny dla zalogowanych], one and two months post-injection. The study found that the patients given steroids improved significantly compared to placebo in all primary and secondary endpoints; pain,[link widoczny dla zalogowanych], stiffness, physical function and global assessment, after 2 months.
"This is very encouraging data, which I believe will have a great response in the medical community. Because there is no cure, the therapeutic goal of treatment for osteoarthritis is to minimize the effects of the disease and its consequences over time. The study shows that the treatment with steroids offers many patients with late stage OA some hope of pain relief when conservative therapy has failed",[link widoczny dla zalogowanych], said Prof. Maksymowych.
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