Ultrasound-guided Injection of Glucocorticoid Into Infrapatellar Fat Pad in Patients With Knee Osteoarthritis

Study Overview
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Brief Summary
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This aims of this study is to investigate the efficacy and safety of the glucocorticoid injection into the infrapatellar fat pad among knee osteoarthritis patients with an inflammatory phenotype.

Official Title
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Ultrasound-guided Injection of Glucocorticoid Into Infrapatellar Fat Pad Versus Placebo Injection in Knee Osteoarthritis: a 12-week Double-blinded Controlled Trial

Conditions
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Osteoarthritis, Knee

Intervention / Treatment
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* Drug: Glucocorticoids
* Drug: Saline
* Drug: Hyaluronic acid


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with symptomatic knee osteoarthritis (OA) according to American College of Rheumatology criteria; Age > 45 years; Have knee pain for more than six months and the knee pain over the past week assessed by VAS (100 mm) ≥ 40 mm; Ultrasonography showed obvious synovitis with effusion in the knee joint; Both MRI-assessed Hoffa-synovitis score (MOAKS method) and effusion-synovitis score (modified WORMS method) ≥ 1, and their total score ≥ 3; Being able to listen, speak, read and understand Chinese, capable of understanding the study requirements and cooperating with the researchers during the study, and providing written informed consent. Exclusion Criteria: Allergy to glucocorticoids; Knee injection of glucocorticoid or hyaluronic acid within the past six months; Severe trauma or arthroscopy in the knee within the past six months; Planned hip or knee surgery (including arthroscopy, arthroplasty, and other open joint surgeries) in the next six months; Contraindication to having magnetic resonance imaging (MRI) (e.g., implanted pacemaker, artificial metal valve or cornea, aneurysm clipping surgery, arterial dissection, metal foreign bodies in the eyeball, claustrophobia); Presence of other arthritis, such as rheumatoid arthritis and psoriatic arthritis; Other physical condition that is more painful than their knee OA; Malignant tumors or other life-threatening diseases; Infection, diabetes, coagulopathy, osteonecrosis, or gastric/duodenal ulcer within the past 12 months; Current use of oral corticosteroids, nonsteroidal anti-inflammatory drugs, or immunosuppressive medication; Pregnancy or lactating female; Use any investigational drugs or devices in the recent 30 days.

Ages Eligible for Study
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Minimum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: glucocorticoid injection into infrapatellar fat pad<br> | Drug: Glucocorticoids<br>* The product of the glucocorticoid is betamethasone injectable suspension and the dosage is 1 ml. To alleviate the discomfort on local tissues, the suspension injected into the infrapatellar fat pad will be pre-mixed with 0.5 ml saline and 0.5 ml lidocaine. That is, the total amount of the drug injected into the infrapatellar fat pad for the glucocorticoid group will be 2.0 ml.<br>Drug: Hyaluronic acid<br>* After completing the process of infrapatellar fat pad injection, the participants in both groups will receive 2.5 ml hyaluronic acid suspension injection through the suprapatellar bursa into the intra-articular space.<br>|
| Placebo Comparator: placebo injection into infrapatellar fat pad<br> | Drug: Saline<br>* A total of 2.0 ml drug including 1.5 ml saline and 0.5 ml lidocaine will be injected into the infrapatellar fat pad for the placebo group.<br>Drug: Hyaluronic acid<br>* After completing the process of infrapatellar fat pad injection, the participants in both groups will receive 2.5 ml hyaluronic acid suspension injection through the suprapatellar bursa into the intra-articular space.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the knee pain change | the knee pain change measured with visual analogue scale (VAS, 0-100), a higher VAS score means more severe pain | baseline, the 4th week, the 8th week, and the 12th week | 
| the change of effusion-synovitis volume | the change of magnetic resonance imaging assessed effusion-synovitis volume | baseline and the 12th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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knee osteoarthritis, infrapatellar fat pad, inflammatory osteoarthritis, glucocorticoid