Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial.

Abstract

OBJECTIVE:

To determine the efficacy of fluoroscopically guided corticosteroid injection for hip osteoarthritis (OA) in a randomized, double-blind, placebo-controlled trial.

METHODS:

Fifty-two patients with symptomatic hip OA were randomly allocated to receive placebo (10 mg bipuvicaine, 2 ml saline) (n = 21) or corticosteroid treatment (10 mg bipuvicaine, 40 mg triamcinolone hexacetonide) (n = 31). Patients were followed up for 1, 2, 3, and 6 months. The primary outcome measure was the pain improvement response, defined as a 20% decrease in the Western Ontario and McMaster Universities OA Index (WOMAC) pain score (on 5 100-mm visual analog scales [VAS]) (WOMAC20) from baseline to 2 months postinjection. Secondary outcomes were a 50% decrease in the WOMAC pain score (WOMAC50), changes in other WOMAC subscale scores, patient's global assessment of health (on a 100-mm VAS), and Short Form 36 (SF-36) quality of life indices. Analyses were based on the intent-to-treat principle.

RESULTS:

The mean WOMAC pain score fell 49.2% (decreasing from 310.1 mm to 157.4 mm) at 2 months postinjection in patients receiving corticosteroid, compared with a decrease of 2.5% (from 314.3 mm to 306.5 mm) in the placebo group (P < 0.0001). The proportion of WOMAC20 responders at 2 months' followup was significantly higher in the corticosteroid group (67.7%) compared with the placebo group (23.8%) (P = 0.004); similar proportions of WOMAC50 responders were observed between groups (61.3% in the corticosteroid group versus 14.3% in the placebo group; P = 0.001). Response differences were maintained at 3 months' followup (58.1% responders in the corticosteroid group versus 9.5% responders in the placebo group; P = 0.004). Significant differences in the WOMAC stiffness and physical function scores (P < 0.0001), patient's global health scores (P = 0.005), and SF-36 physical component scores (P = 0.04) were observed, with patients in the corticosteroid group showing greater improvements. There were no differences in the frequency of adverse events between groups.

CONCLUSION:

This placebo-controlled trial confirms that corticosteroid injection can be an effective treatment of pain in hip OA, with benefits lasting up to 3 months in many cases. Future studies should address questions related to the benefits of repeated steroid injection and the effects of this treatment on disease modification.

• Authors: Robert G W Lambert, Edna J Hutchings, Michael G A Grace, Gian S Jhangri, Barbara Conner-Spady, Walter P Maksymowych
• Journal: Arthritis and rheumatism (Arthritis Rheum) Vol. 56 Issue 7 Pg. 2278-87 (Jul 2007) ISSN: 0004-3591 [Print] United States
• PMID: 17599747 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Placebos
• Triamcinolone Acetonide
• triamcinolone hexacetonide

Topics

• Adrenal Cortex Hormones (administration & dosage, therapeutic use)
• Aged
• Double-Blind Method
• Female
• Follow-Up Studies
• Humans
• Joints (drug effects, physiopathology)
• Male
• Middle Aged
• Osteoarthritis (drug therapy, physiopathology)
• Pain (drug therapy, etiology)
• Pain Measurement
• Patient Selection
• Placebos
• Triamcinolone Acetonide (administration & dosage, analogs & derivatives, therapeutic use)