ORIGINAL ARTICLE Efficacy comparisons of the intraarticular steroidal agents in the patients with knee osteoarthritis Umut Yavuz • Sami So ¨ku ¨cu ¨ • Akif Albayrak • Kahraman O ¨ ztu ¨rk Received: 14 May 2011 / Accepted: 22 October 2011 / Published online: 5 November 2011 Ó Springer-Verlag 2011 Abstract Osteoarthritis is a chronic disease that causes serious pain and limitations in activities. Intraarticular corticosteroid injections combined with pharmacological treatment and physiotherapy have been used for years to control the local inflammation and relieve pain in the patients with osteoarthritis. There are several animal experiments which suggested that the intraarticular corti- costeroid injections impair cartilage protein synthesis. However, there are no serious evidences suggesting the increase of cartilage impairment. The aim of our study was to compare the efficacy of placebo and intraarticular cor- ticosteroid agents in the patients with symptomatic knee osteoarthritis. One hundred and twenty patients with painful knee osteoarthritis were included in the prospec- tive, randomized, controlled study. The patients were ran- domized into four groups. Each group consisted of thirty patients. Intraarticular single dose of methylprednisolone acetate (40 mg, 1 ml), Betametazone disodium phosphate (3 mg, 1 ml), Triamsinolon acetonate (40 mg, 1 ml), and serum physiological (0.09% NaCl, 1 ml) were adminis- trated to the groups, respectively. The patients were eval- uated by Visual Analog Scale (0–10 cm [VAS]) for the pain severity, and by Lequesne Functional Index for functional state before treatment, and at the 1st, 3rd, 6th, and 12th weeks. Our results showed that single doses of three agents provided symptomatic and functional relief and their effects reduced at the 12th week. However, methylprednisolone acetate was a statistically more effec- tive analgesic as compared to the other agents until the sixth week. Keywords Knee osteoarthritis Á Methylprednisolone acetate Á Betametazone disodium phosphate Á Triamsinolon acetonate Introduction Knee osteoarthritis (OA) is the most common form of arthritis, and it is usually concomitant with cartilage impairment. In the clinical setting, these patients present us with the complaints of pain, stiffness and immobility [1, 2]. The prevalence of radiological knee osteoarthritis is about 30% in the people above 50 years old and 80% in the people above 65 years old. The pain limits overload on the painful knee and protects the affected knee. Therefore, pain relief may cause joint and cartilage destruction in the future [3, 4]. However, pain relief is the primary objective of the knee osteoarthritis treatment. Intraarticular (IA) steroidal injection provides pain relief by the prostoglandin synthe- sis inhibition and controls local inflammation by decreas- ing the activity of collagenase and the other destructive enzymes. Therefore, intraarticular corticosteroid injection combined with medical treatment and physiotherapy is a common management strategy [5–8]. The use of intraarticular corticosteroid agents is still controversial. Though several animal experiments sug- gested that the multiple corticosteroid injections increase cartilage protein synthesis and cartilage destruction [9–11], there are no serious evidences suggesting the increase of knee joint destruction or cartilage impairment [12, 13]. Intraarticular corticosteroid injection is recommended as a part of the knee osteoarthritis management protocol by American Rheumatology College [14]. Though several studies suggested that the intraarticular steroidal injection has a poor effect [16–20], there are studies suggesting that U. Yavuz (&) Á S. So ¨ku ¨cu ¨ Á A. Albayrak Á K. O ¨ ztu ¨rk Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey e-mail: umut78@yahoo.com 123 Rheumatol Int (2012) 32:3391–3396 DOI 10.1007/s00296-011-2188-0