Intra-articular steroids in the knee for rheumatoid arthritis

Intra-articular steroid injections in the knee appear to improve pain, movement, stiffness and swelling of the joint in adults with rheumatoid arthritis. The knee should be rested after a steroid injection.

A Cochrane review included 7 studies with a total of 346 adult subjects. There was inconclusive conflicting evidence from two trials that walking time was reduced in the steroid injection group. There was evidence from one moderate quality trial that pain was reduced at 1-day post-injection (0–100 VAS from 28.33 to 13.46; McGill Pain Scale from 8.89 to 3.96) but not at 1 week or 7–12 weeks post-injection. There is some evidence that IA injections improved knee flexion (by 14 degrees) and reduced knee extension lag (by 20 degrees), knee circumference (median reduction = 0.3 cm) and morning stiffness (reduced from 60 mins to 7.6 mins). In one trial (n=91), rest following injection in the knee produced significant improvement in pain, stiffness, knee circumference, and walking time when compared with the non-rested group.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).

Ədəbiyyat

1. Wallen M, Gillies D. Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. Cochrane Database Syst Rev 2006 Jan 25;(1):CD002824.