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PRIMARY CARE: Bruce Arroll and Felicity Goodyear-Smith Corticosteroid injections for osteoarthritis of the knee: meta-analysis BMJ 2004; 328: 869 [Abstract] [Full text]

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Experiential evidence

Dr.Sidha S Sambandan   (4 April 2004)

Corticosteroid injections for osteoarthritis of the knee

Louis I Jones   (22 April 2004)

What adverse effects of corticosteroid injections for osteoarthritis of the knee need consideration?

Andrew Herxheimer   (12 July 2004)

Experiential evidence 4 April 2004
Dr.Sidha S Sambandan, General Practitioner Yare Valley Medical Practice, 202 Thorpe Road, Norwich, NR1 1TJ Send response to journal: Re: Experiential evidence	Having used Methyprednisolone and lidocaine (80mgs)for over 15years for osteoarthiritis of the knee, after conservative treatment, I have found that a significant proportion of patients have had pain relief lasting upto 5 years. Anecdotal as it may seem, elderly patients, especially those who do not wish to have surgery, are very grateful for the pain relief. I have also had a few very elderly patients whom I have injected, so that they may fly over to see their family in USA and Canada. The steroids had enabled them to cope with the mechanical stress on the joints as a result of the travelling and extra walking they have to do on holiday. Competing interests: None declared
Corticosteroid injections for osteoarthritis of the knee 22 April 2004
Louis I Jones, Retired General Practitioner 6A Folleigh Drive,Long Ashton,Bristol,BS41 9JD Send response to journal: Re: Corticosteroid injections for osteoarthritis of the knee	Editor--Intra-articular corticosteroid injection improves osteoarthritis of the knee as shown by Arroll and Goodyear-Smith.I have used this procedure since 1961 and the reduction of pain and improvement in function is enhanced if any effusion is aspirated at the same time. Aspiration also aids diagnosis. It is a simple procedure that can be done easily in a General Practitioner surgery as long as a 19G times 1 1/2 inch (1.1 times 40 millimeter) needle is used because osteoarthritis fluid is viscous and will not flow through a smaller one.I use 80 milligrams of methylprednisolone together with some lignocaine.Improvement lasts from a few months to a few years. Details of technique :- Draw up 5 millilitres of 1% lignocaine in a 10 millilitre syringe.Using 19G needle infiltrate the lignocaine from the skin to the joint cavity.Best approach is beneath lateral border of patella.Aspirate any effusion completely.Clear viscous fluid indicates osteoarthritis.Cloudy non- viscous fluid indicates an inflammatory effusion,a sample should be sent for microscopy and culture.If clear fluid or none,with the 19G needle still in situ inject 80 milligrams of methylprednisolone into joint space. Competing interests: None declared
What adverse effects of corticosteroid injections for osteoarthritis of the knee need consideration? 12 July 2004
Andrew Herxheimer, emeritus fellow, UK Cochrane Centre 9 Park Crescent, London N3 2NL Send response to journal: Re: What adverse effects of corticosteroid injections for osteoarthritis of the knee need consideration?	The review of the ten trials which met the inclusion criteria focused entirely on improvement, but one component of this was "clinically relevant outcomes". I have two questions: 1. Did any of the ten trials report adverse events, or state that such events were ascertained or looked for? I would like to ask the authors please to have another look at those trial reports and to summarise what they say about possible negative effects of the injections. 2. More generally, what has been reported elsewhere on adverse effects of intra-articular injection of corticosteroids into an arthritic knee? In particular, were such effects noted in any of the studies that the authors found in their searches but which did not meet their inclusion criteria? Possible harm is certainly a clinically relevant outcome, and not mentioning it in the review risks serious bias, as the BMJ theme issue of 3 July 2004 emphasises. If harms or suspected harms were not mentioned in the trials reviewed, or were not reported similarly, then of course it would have been inappropriate or impossible to meta-analyse them, but that is not a reason for ignoring them. Competing interests: None declared