title: Joint lavage associated with triamcinolone hexacetonide injection in knee osteoarthritis: a randomized double-blind controlled study.
abstract: Compare the medium-term effectiveness and tolerance between joint lavage (JL) in combination with triamcinolone hexacetonide (TH) intra-articular injection (IAI) and IAI with TH alone for treatment of primary osteoarthritis (OA) of the knee. A randomized, double-blind, controlled study was carried out on 60 patients with primary OA of the knee, randomized into two intervention groups: JL/TH group, joint lavage in combination with TH intra-articular injection and TH group, TH intra-articular injection. Patients were followed for 12 weeks by a blind observer using the following outcome measurements: visual analogue scale for pain at rest and in movement, goniometry, WOMAC, Lequesne's index, timed 50-ft walk, perception of improvement, Likert scale for improvement assessment, use of nonsteroidal anti-inflammatory drugs and analgesics, and local side effects. There were no statistical differences in the inter-group analysis for any of the variables studied over the 12-week period. Although both groups demonstrated statistical improvement in the intra-group evaluation (except for Likert scale according to patient and the use of anti-inflammatory drugs). In the Kellgren-Lawrence scale (KL) 2 and 3 sub-analysis, there was a statistical difference regarding joint flexion among patients classified as KL 2, favoring the TH group (p=0.03). For the KL 3 patients, there were statistical differences favoring the JL/TH group regarding Lequesne (p=0.021), WOMAC pain score (p=0.01), and Likert scale according to the patient (p=0.028) and the physician (p=0.034). The combination of joint lavage and IAI with TH was not more effective than IAI with TH alone in the treatment of primary OA of the knee. However, KL 3 patients may receive a major benefit from this combination.
authors.affiliation: Rheumatology Division, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Parmigiani
authors.forename: Rita N V
authors.initials: RN
authors.lastname: Furtado
authors.forename: Roberta V
authors.initials: RV
authors.lastname: Lopes
authors.forename: Luiza H C
authors.initials: LH
authors.lastname: Ribeiro
authors.forename: Jamil
authors.initials: J
authors.lastname: Natour
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D007719:Knee Joint / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D012219:Rheumatology / Q000379:methods; D012984:Software; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide