Intramuscular Triamcinolone Acetate Injection for OA Hip Pain

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For this study, patients who had symptomatic hip osteoarthritis for ≥6 months and moderate to severe hip pain were recruited.
For this study, patients who had symptomatic hip osteoarthritis for ≥6 months and moderate to severe hip pain were recruited.

In patients with painful hip osteoarthritis, an intramuscular glucocorticoid injection may effectively alleviate hip pain in the short-term, according to a study published in the Annals of Rheumatic Diseases.

For this study, 106 patients who had symptomatic hip osteoarthritis for ≥6 months and moderate to severe hip pain (score ≥3 on a 10-point numeric rating scale [NRS]) were randomly assigned to receive a glucocorticoid (40 mg triamcinolone acetate; n=52) or saline (n=54) injection in the gluteus muscle. Patients, researchers, treating physicians, research assistants, and outcome assessors were all blinded to injections.

Hip pain severity 2 weeks after injection, assessed with the NRS and the 100-point Western Ontario and McMaster University Osteoarthritis Index pain (WOMAC) subscale, at rest and during walking was the study's primary outcome. An intention-to-treat analysis was also conducted at 2, 4, 6, and 12 weeks.

Participants who had received the glucocorticoid vs saline injection reported hip pain reductions at 2 weeks at rest, using the NRS (between group difference, −1.3 point; 95% CI, −2.3 to −0.3; P =.01). There was no significant difference between the groups in terms of hip pain during walking assessed with the NRS (between-group difference, −0.9) or using the WOMAC pain scale score (range, 0-100) at the 2-week follow-up.

Reductions in hip pain at rest, assessed with the NRS, were maintained 4 weeks (between-group difference, −1.2; 95% CI, −2.1 to −0.2; P =.01), 6 weeks (between-group difference, −1.4; 95% CI, −2.4 to −0.5; P =.005), and 12 weeks (between-group difference, −1.2; 95% CI, −2.3 to −0.2; P =.02) after glucocorticoid injection. Hip pain during walking, also assessed with the NRS, was reduced at 4 weeks (between-group difference, −1.1; 95% −2.0 to −0.2; P =.01), 6 weeks (between-group difference, −1.4; 95% CI, −2.3 to −0.4; P =.004), and 12 weeks (between-group difference, −1.3; 95% CI, −2.2 to −0.3; P =.01) after glucocorticoid injection.

The WOMAC function score (range, 0-100) indicated an improvement at 4 weeks (between-group difference, −9.3; 95% CI, −17.2 to −1.4; P =.02), 6 weeks (between-group difference, −8.2; 95% CI, −16.5 to 0.1; P =.05), and 12 weeks (between-group difference, −8.9; 95% CI, −17.6 to −0.1; P =.05) after glucocorticoid vs placebo injection. Stiffness, assessed with the WOMAC stiffness scale, was also improved at 6 and 12 weeks after glucocorticoid vs placebo injection.

A limitation of this study was the assessment of only 1 injection, resulting in the lack of evaluation of whether multiple injections would provide a greater effect on hip pain.

"The administration of an [intramuscular] injection is much easier than an [intra-articular] hip joint injection without the need for ultrasound/radiologic guidance and can, therefore, be performed in both secondary and primary care," concluded the study authors.

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Reference

Dorleijn DMJ, Luijsterburg PAJ, Reijman M, et al. Intramuscular glucocorticoid injection versus placebo injection in hip osteoarthritis: a 12-week blinded randomised controlled trial [published online March 7, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2017-212628

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