title: Efficacy of Triamcinolone Hexacetonide versus Methylprednisolone Acetate Intraarticular Injections in Knee Osteoarthritis: A Randomized, Double-blinded, 24-week Study.
abstract: OBJECTIVE
  Intraarticular (IA) corticosteroid injections are broadly used in knee osteoarthritis (OA); however, the best corticosteroid agent is not well defined. The aim of the present study was to compare the efficacy of triamcinolone hexacetonide (TH) and methylprednisolone acetate (MA) injections in knee OA.
  
  
  METHODS
  Patients with symptomatic knee OA and Kellgren-Lawrence grade II or III were randomized to receive 40 mg of IA TH or MA. Evaluations were performed at 4, 12, and 24 weeks. The primary outcome was a change in the patient's assessment of pain by visual analog scale from baseline to Week 4. Secondary outcomes included a global assessment of the disease by patients and physicians, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index (LI), and Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria of response. Generalized estimating equations were used in statistical analysis.
  
  
  RESULTS
  The intention-to-treat population included 100 patients; 50 in each study arm. A significant improvement in pain was observed at Week 4 for both groups (p < 0.0001), with no difference between them (p = 0.352). This improvement was sustained up to Week 24. A significant improvement from the baseline was observed for both the patient's and the physician's global assessments, WOMAC questionnaire, and LI, with no differences between the groups. Improvements in the secondary outcomes were sustained during the study. The OMERACT-OARSI criteria of response was achieved by 74% and 72% of patients in the TH and the MA groups, respectively.
  
  
  CONCLUSIONS
  Both IA therapies are equally effective, and improvement in pain and function can be sustained for up to 24 weeks. Controlled-trials.com identifier: ISRCTN15077843.
authors.affiliation: From Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.A.B. Lomonte, MD, Rheumatologist, Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; M.G. de Morais, MD, Rheumatologist; L.O. de Carvalho, MD, Rheumatologist, Department of Rheumatology, Hospital Heliópolis; C.A. Zerbini, MD, PhD, Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo. ceredo.reuma@gmail.com.
authors.forename: Andrea Barranjard Vannucci
authors.initials: AB
authors.lastname: Lomonte
authors.affiliation: From Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.A.B. Lomonte, MD, Rheumatologist, Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; M.G. de Morais, MD, Rheumatologist; L.O. de Carvalho, MD, Rheumatologist, Department of Rheumatology, Hospital Heliópolis; C.A. Zerbini, MD, PhD, Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo.
authors.forename: Marina Gonçalves Veras
authors.initials: MG
authors.lastname: de Morais
authors.affiliation: From Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.A.B. Lomonte, MD, Rheumatologist, Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; M.G. de Morais, MD, Rheumatologist; L.O. de Carvalho, MD, Rheumatologist, Department of Rheumatology, Hospital Heliópolis; C.A. Zerbini, MD, PhD, Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo.
authors.forename: Lina Oliveira
authors.initials: LO
authors.lastname: de Carvalho
authors.affiliation: From Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.A.B. Lomonte, MD, Rheumatologist, Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo; M.G. de Morais, MD, Rheumatologist; L.O. de Carvalho, MD, Rheumatologist, Department of Rheumatology, Hospital Heliópolis; C.A. Zerbini, MD, PhD, Department of Rheumatology, Hospital Heliópolis, and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo.
authors.forename: Cristiano Augusto de Freitas
authors.initials: CA
authors.lastname: Zerbini
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010147:Pain Measurement; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D018501:Antirheumatic Agents; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide; D008775:Methylprednisolone
keywords: ADRENAL CORTEX HORMONES; INTRAARTICULAR INJECTIONS; KNEE OSTEOARTHRITIS; METHYLPREDNISOLONE ACETATE; QUESTIONNAIRES; TRIAMCINOLONE HEXACETONIDE