title: The effects of intra-articular glucocorticoids and exercise on pain and synovitis assessed on static and dynamic magnetic resonance imaging in knee osteoarthritis: exploratory outcomes from a randomized controlled trial.
abstract: The aims of the present knee osteoarthritis (KOA)-study were to: (1) describe and compare the changes in magnetic resonance imaging (MRI)-measures of synovitis following an exercise program preceded by an intra-articular injection of either corticosteroid or isotonic saline and (2) investigate if any of the changes in patient reported outcome measures (PROMs) were associated with changes in MRI-measures of synovitis.
  
  
  
  We performed a randomized, double-blinded, placebo-controlled clinical trial evaluating the effects of intra-articular corticosteroid vs placebo injections given before exercise therapy in KOA-patients. PROMs were assessed using the KOOS (knee injury and osteoarthritis outcome score). Synovitis was assessed on conventional non-contrast-enhanced, conventional contrast-enhanced (CE) and dynamic contrast-enhanced (DCE) MRI. PROMs and MRIs were obtained prior to the intra-articular injection, after termination of the exercise program (week 14-primary time point) and week 26.
  
  
  
  Of 100 randomized participants (50 in each allocation group), 91 had complete MRI-data at baseline (63% female, mean age: 62 years, median Kellgren-Lawrence-grade: 3). There were no statistically significant differences between the two interventions in regards of changes in MRI-measures of synovitis at any time-point. At week 14, we found no statistical significant MRI-explanatory variables of either of the PROMs.
  
  
  
  The present study does not justify the use of intra-articular corticosteroids over intra-articular saline when combined with an exercise program for reduction of synovitis in KOA. The improvement in pain and function following the intervention with intra-articular corticosteroids/saline and exercise could not be explained by a decrease in synovitis on MRI indicating other pain causing/relieving mechanisms in KOA.
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Zealand University Hospital, Holbaek, Denmark. Electronic address: riis.robert@gmail.com.
authors.forename: R G C
authors.initials: RGC
authors.lastname: Riis
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Physical & Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. Electronic address: marius.henriksen@regionh.dk.
authors.forename: M
authors.initials: M
authors.lastname: Henriksen
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. Electronic address: louise.klokker.madsen@regionh.dk.
authors.forename: L
authors.initials: L
authors.lastname: Klokker
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Physical & Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. Electronic address: cecilie.roedgaard.bartholdy@regionh.dk.
authors.forename: C
authors.initials: C
authors.lastname: Bartholdy
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. Electronic address: karen.ellegaard@regionh.dk.
authors.forename: K
authors.initials: K
authors.lastname: Ellegaard
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. Electronic address: elisabeth.ann.bandak@regionh.dk.
authors.forename: E
authors.initials: E
authors.lastname: Bandak
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. Electronic address: dr.bjarke@gmail.com.
authors.forename: B B
authors.initials: BB
authors.lastname: Hansen
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. Electronic address: henning.bliddal@regionh.dk.
authors.forename: H
authors.initials: H
authors.lastname: Bliddal
authors.affiliation: The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. Electronic address: mikael.boesen@regionh.dk.
authors.forename: M
authors.initials: M
authors.lastname: Boesen
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000628:therapy*; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000628:therapy*; D000071066:Patient Reported Outcome Measures; D013585:Synovitis / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Corticosteroids; Dynamic contrast-enhanced magnetic resonance imaging; Exercise; Knee osteoarthritis; Patient reported outcome measures; Synovitis