Summary
OA is a common problem in many communities and is a commonly seen presentation in both General and Sport Medicine Practice.
Although there are several corticosteroid compounds available for use in the IA injection of the knee joint, there is scant comparative data for the compounds, although there appears to be a tendency for trimacinolone to be the most efficacious compound. Available research on corticosteroid use by Practitioners demonstrates the great influence of training tradition upon corticosteroid selection.
Disagreement exists amongst Medical Practitioners as to the optimal dose of each corticosteroid for injection into the knee joint. There is no evidence to suggest that doses other than those recommended by the manufacturers for each compound should be administered. Presentation of the commercially available preparations of the different corticosteroid compounds may influence their usage patterns.
There is disagreement too on dosing frequency. Although there is a large body of evidence from animal studies demonstrating a direct toxic effect of corticosteroid upon intra-articular structures, studies in humans are inconclusive. There is evidence that the generation of the 'Charcot joint' secondary to large doses of corticosteroid may be due to an overuse of the treated joint rather than a direct effect of corticosteroid upon the joint structures.
There is too little experimental or observational data to draw any conclusions as to an optimal frequency of IA corticosteroid injection, and current usage patterns are determined by practitioner opinion.
Finally, IA injection of corticosteroid is a treatment adjunct and should not be used as monotherapy for patients with chronic, stable OA.
This paper highlights the need for practitioners to refine, and individually tailor, their selection of corticosteroid and dosing regimen in the treatment of OA of the knee and other joints.