THU0466 THE EVALUATION OF THE EFFECTIVENESS OF INTRA-ARTICULAR STEROID, TENOXICAM AND COMBINED STEROID-TENOXICAM INJECTIONS IN THE TREATMENT OF PATIENTS WITH KNEE OSTEOARTHRITIS
Authors: YILMAZ Ebru
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Intra-articular corticosteroid injections are widely applied in the treatment of symptomatic knee osteoarthritis (OA). There is an evidence of short-term effects of intra-articular corticosteroid injection (up to 3-4 weeks), however there is no consensus for the long-term benefit of this treatment yet (1). Tenoxicam is an effective analgesic and anti-inflammatory drug for symptomatic treatment of OA. Additionally, apart from oral use, tenoxicam is also applied as an intra-articular treatment option to minimize gastrointestinal side effects of NSAIDs (2). Clinical evidence suggests that the combined use of NSAIDs and corticosteroids is synergistic (especially macular edema after cataract surgery in ophthalmology) (3). <h3>Objectives</h3> The aim of this study is to compare the effectiveness of intra-articular administration of these treatments and their combination and determine whether the combination of intraarticular steroid and tenoxicam was more effective for a long period rather than only tenoxicam and steroid injection alone in OA treatment. <h3>Methods</h3> 90 patients (56 female, 34 male) with diagnosis of knee osteoarthritis were randomly divided into three groups (30 patients per group): Group 1 were treated by intra-articular injection of tenoxicam. Group 2 were treated by intra-articular injection of triamcinolone hexacetonide. Group 3 were treated by intra-articular injection of triamcinolone hexacetonide combined with tenoxicam. The estimation of the severity of pain by the visual analog scale (VAS) were enrolled at baseline and 1, 3, 6 months post-injection. Additionally, the Western Ontario and McMaster Universities Index (WOMAC) was used to determine the outcome measures of pain, stiffness and physical functioning at baseline and 1, 3, 6 months post-injection. <h3>Results</h3> The mean age of patients was 65.97±9.29 years. In tenoxicam group, median pre- and post-treatment (at 1, 3 and 6 months) VAS/WOMAC scores were 7.00/32.00, 2.00/10.00, 7.00/32.00 and 7.00/32.00, respectively. In steroid group, median pre- and post-treatment (at 1, 3 and 6 months) VAS/WOMAC scores were 8.00/34.00, 1.00/8.00, 8.00/34.00 and 8.00/34.00, respectively. In steroid plus tenoxicam group, median pre- and post-treatment (at 1, 3 and 6 months) VAS/WOMAC scores were 7.00/34.00, 0.00/6.00, 1.00/8.00 and 2.00/10.00, respectively. VAS and WOMAC scores in 1 month after the injection significantly decreased in both groups compared to baseline (p&lt;0.01). However, there was a pronounced improvement in only steroid plus tenoxicam group at 3 and 6 months post-injection (p&lt;0.01). Steroid plus tenoxicam group showed significantly improved VAS and WOMAC scores when compared to only steroid and tenoxicam group at follow-up 3 and 6 months (p&lt;0.01). <h3>Conclusion</h3> The combination of corticosteroids and tenoxicam seems to produce a more effective result than alone therapy in reducing pain and improving functional recovery. <h3>References</h3> 1)Maricar N, Callaghan MJ, Felson DT, O'Neill TW. Predictors of response to intra-articular steroid injections in knee osteoarthritis- a systematic review. Rheumatology. 2013;52:1022-1032. [2] Evcik D, Kızılay B, Maralcan G. The efficacy of intraarticular tenoxicam in the treatment of knee osteoarthritis. The Pain Clinic. 2003;15:405-408. [3] Malik A, Sadafale A, Gupta YK, Gupta A. A comparative study of various topical nonsteroidal anti-inflammatory drugs to steroid drops for control of post cataract surgery inflammation. Oman J Ophthalmol. 2016;9:150-156. <h3>Acknowledgement</h3> None <h3>Disclosure of Interests</h3> None declared