AMSTERDAM, The Netherlands— Intra-articular (IA) steroid injections for hip osteoarthritis (OA) are included  as an option in the most recent EULAR treatment guidelines, but with a notation that there is low evidence of efficacy. This treatment was considerably bolstered by Walter Maksymowych, MD, of the Division of Rheumatology, University of Alberta, Edmonton, Canada, who reported at the 2006 EULAR meeting that data from a randomized, placebo-controlled trial show that patients treated with steroid injections improve on all measures of pain, stiffness, and physical function.1

"These are very encouraging data, which I believe will have a great response in the medical community. Because there is no cure, the therapeutic goal of treatment for OA is to minimize the effects of the disease and its consequences over time. The study shows that treatment with steroids offers many patients with late-stage OA some hope of pain relief when conservative therapy has failed," said Dr. Maksymowych, who was senior investigator on the study.

"The study shows that treatment with steroids offers many patients with late-stage OA some hope of pain relief when conservative therapy has failed." — Walter Maksymowych, MD
Dr. Maksymowych noted that inaccurate placement of IA steroid when injected without imaging guidance is likely to have a significant effect on clinical response. This study assessed the efficacy of image-guided IA steroid injections vs placebo in OA of the hip.

Patients met ACR criteria for hip OA (ACR standard criteria) and had a minimum mean pain score of 40 mm (as a composite score of five visual analog scales from the WOMAC OA index) despite standard therapy.

Fifty-two patients were randomly allocated to one of two groups: placebo (2 ml normal saline) or treatment (40 mg triamcinolone hexacetonide). Injections were guided fluoroscopically. At baseline and at 1 and 2 months post-injection, patients were assessed for pain using the WOMAC, with response defined as 20% or greater improvement in pain. Secondary endpoints included comparison of responders with 50% or greater improvement, WOMAC subscales, SF-36, and global assessment.

At 2 months after injection, patients randomized to steroid had significant improvements from baseline and compared to placebo on all measures of pain, stiffness, physical function, and global assessment, Dr. Maksymowych said.

Table: