Comparison of Varying Corticosteroid Type, Dose, and Volume for the Treatment of Pain in Small- and Intermediate-Size Joint Injections: A Narrative Review.

Abstract

OBJECTIVE:

To systematically evaluate the scientific literature examining the effect of corticosteroid type, dose, and volume of small- and intermediate-size joint injections on pain and function. TYPE: Narrative review.

LITERATURE SURVEY:

Medline (PubMed), Cochrane Central Register of Controlled Trial, and SportDiscus databases were searched.

METHODOLOGY:

Inclusion criteria included prospective studies evaluating pain- and/or function-related improvements following a corticosteroid injection of a small- or intermediate-size joint.

SYNTHESIS:

A total of 28 articles were included, all studying patients with osteoarthritis and/or rheumatoid arthritis. Eleven studies were randomized-controlled trials comparing corticosteroid injections to a control treatment and three were randomized trials comparing corticosteroid dose or type; the rest were prospective case series without a control. Most studies used 10 to 20 mg of methylprednisolone or triamcinolone for small joints and 20 to 40 mg for intermediate joints; wrist joints were the only joint studied that directly compared doses-20 mg was noninferior to 40 mg. Triamcinolone hexacetonide was found to be superior to methylprednisolone in the interphalangeal finger joints in a single randomized-controlled trial; no other studies compared steroid types in any joint. No studies evaluated the effect of volume on clinical outcomes.

CONCLUSIONS:

Very few studies directly examine the effect of corticosteroid type, corticosteroid dose, or injectate volume on clinical outcomes for small- or intermediate-size joint arthralgia. Future studies are needed to better elucidate the most effective treatment protocols.

LEVEL OF EVIDENCE:

IV.

• Authors: Daniel M Cushman, Erika Ofek, Raafay H Syed, Nathan Clements, James E Gardner, Jessica M Sams, Jade L Mulvey, Zachary L McCormick
• Journal: PM & R : the journal of injury, function, and rehabilitation (PM R) Vol. 11 Issue 7 Pg. 758-770 (07 2019) ISSN: 1934-1563 [Electronic] United States
• PMID: 31166662 (Publication Type: Journal Article, Review)
• Copyright: © 2018 American Academy of Physical Medicine and Rehabilitation.

Chemical References

• Glucocorticoids

Topics

• Arthralgia (diagnosis, drug therapy)
• Dose-Response Relationship, Drug
• Glucocorticoids (administration & dosage)
• Humans
• Injections, Intra-Articular
• Joints (diagnostic imaging)
• Organ Size
• Pain Measurement