8 responses to “Decreasing pain of osteoarthritic knees”

  1. good article. I wonder about periodic injection of steroid compared to regular injections as described

  2. what about hyaluronic acid injection?

  3. Prolotherapy to treat osteoarthritis of the knee has been proven to be a useful treatment. See dextrose prolotherapy for knee osteoarthritis, a randomized controlled study: http://www.annfammed.org/content/11/3/229.full.
    In my hands, the success rate for this treatment is 89% and it can be carried out in the average family practitioner’s office. Before I do prolotherapy, I ensure that the knee is tracking straight by providing the patient with prescription orthotics. This avoids undue strain being applied to the ligaments stabilizing it.

  4. Braces are a good option and appear to work but are expensive for pts who lack additional insurance

  5. Great topic and article! The McAlindon et al study (JAMA 2017;317(19):1967-1975) asked patients about pain every 3 months. Finding a lack of difference between placebo and steroid injection at the 3 month mark post injection doesn’t really tell us if there was a difference within the 3 months. If the steroid injections significantly improved pain and function for 2 months, for example, this study design wouldn’t capture it. (Correct me if I’m misunderstanding this).
    I didn’t know about the Cochrane review before now- a quick look at the summary indicates that the authors found the studies to have poor methodological quality, so we can’t be certain about the effect being limited to 3 weeks. It would be great if there were better studies for this common condition. It would also be great if physiotherapy hadn’t been cut from MSP. We’re trying to avoid harmful pain medications, but many of our patients cannot afford physiotherapy…

  6. Role of PRP injections?

  7. Thank you for your questions!
    Q Periodic injection of steroid compared to regular injections?
    A: Good question. I am not aware of any large scale studies on periodic injections compared to regular injections. I think will be a difficult study to do. Mainly would revolve around a number of injections will be safe. I think periodic injections are definitely safer than regular injections but the risk of cartilage damage is still there. I just will not do more than once every 3-4 months for the injections. In my experience, periodic injections for severe OA flares or if the patient has swelling and warmth in the joint can be quite helpful. I think the amount of damage that occurs from 1 periodic injection is quite minimal.

    Q: Hyaluronic acid injection?
    A: Hyaluronic acid injections can also be an option. Looking at the systematic reviews and meta analysis, there seems to be some benefit for knee osteoarthritis only. I usually tell patients that there is a 60% chance of benefit with hyaluronic acid injections. The companies will say these injections last up to 6 month but studies show an average 6 weeks to 3 months of relief. There is still a lack of evidence on long-term benefit for hyaluronic acid injections but so far, it does not seem to have the same side effects and cartilage damage as steroid injections. If patients can afford it, I usually offered as another option.

    Q: Prolotherapy?
    A: I agree with you that prolotherapy does have positive studies. Rabago et al has done many studies on prolotherapy. In the systematic reviews and meta analysis that I reviewed, prolotherapy is still controversial and there does not seem to be a full consensus on prolotherapy for the knee joint. I performed prolotherapy for ligaments and back pain. One of the issues is I think Prolotherapy can be quite user dependent. I think prolotherapy does work in certain patients. In my mind, prolotherapy is a sclerosing agent and I think one of my concerns is whether intra-articular prolotherapy will cause damage to cartilage although one study in the past showed that the joint space actually increased after using prolotherapy which is very interesting and needs further investigations. Overall on review of literature, prolotherapy is still not widely accepted but with more and larger studies in the future, it may become much more accepted.

  8. Good artucle. If saline had similiar effect to steriod, why not periodic saline injections instead of steriod injections, for those pt that do not respond to other treatments

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