New study adds weight to argument for steroid injections in patients with hip osteoarthritisNew evidence, presented on Saturday (24 June) at the Annual European Congress of Rheumatology, suggests significant benefits for patients with hip osteoarthritis (OA) when receiving intraarticular (IA) steroid treatment. The treatment had earlier been labeled by EULAR as having low evidence of its effectiveness, but has been included in the committee's recommendation guidelines as an option for hip OA patients in a report from 20051. The study, presented by Professor Walter Maksymowych, is the first randomized, double-blind, placebo controlled trial showing significant effectiveness of the treatment, and supports the recommendations by EULAR.
Prof. Maksymowych, Division of Rheumatology, University of Alberta, Edmonton, Canada, and his radiologist colleagues recognized the importance of image-guided IA steroid placement for accurate treatment and the significant effects this might have on the clinical responses in an earlier trial showing that the treatment was not effective. Precision image-guided injections can be very helpful and at times are essential to help localize the structural origin of a patient's pain, especially in places where it might be difficult to detect the pain source, such as in the hip and the spine.
OA is the most common type of arthritis affects approximately 2.95 women per 1000 population and approximately 1.71 men per 1000 population.2 The typical symptoms of hip OA are stiffness, as well as pain, which is usually felt in the groin, but may radiate to the knee, buttock, or inner thigh, and is mainly felt on weight-bearing and aggravated by movement. Over time, the patient might get increased stiffness and might find it difficult to reach down to tie shoe laces, or put on socks and shoes. The functional ability may also progress to difficulties in rising from a chair, using stairs, walking and dressing.
The 52 patients enrolled in the trial, received fluoroscopically guided IA injection and were randomly allocated placebo (2 ml of normal saline) or 40 mg of the treatment (triamcinolone hexacetonide). Assessments were performed at baseline, one and two months post-injection. The study found that the patients given steroids improved significantly compared to placebo in all primary and secondary endpoints; pain, stiffness, physical function and global assessment, after 2 months.
"This is 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 osteoarthritis is to minimize the effects of the disease and its consequences over time. The study shows that the treatment with steroids offers many patients with late stage OA some hope of pain relief when conservative therapy has failed", said Prof. Maksymowych.
1. W. Zhang, M. Doherty, N. Arden et. Al, EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT), Annals of the Rheumatic Diseases 2005;64:669-681 (http://ard.bmjjournals.com/cgi/content/abstract/64/5/669)
2. WHO Scientific Group, The Global Economic and Healthcare Burden of Musculoskeletal Disease; http://www.ota.org/downloads/bjdExecSum.pdf
Abstract number: OP0195
For further information on these studies, or to request an interview with the study leads, please do not hesitate to contact the EULAR congress press office on:
Jim Baxter - Onsite tel: +44 (0) 7900 605652
Jo Spadaccino - Onsite tel: +44 (0) 7773 271930
Mia Gannedahl - Office tel: +44 (0) 20 7331 2325
- The European League Against Rheumatism (EULAR) is the organization which represents the patient, health professional and scientific societies of rheumatology of all the European nations.
- The aims of EULAR are to reduce the burden of rheumatic diseases on the individual and society and to improve the treatment, prevention and rehabilitation of musculoskeletal diseases. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with musculoskeletal diseases by the governing bodies in Europe.
- Diseases of bones and joints, such as rheumatoid arthritis and osteoarthritis cause disability in 4 - 5 % of the adult population and are predicted to rise as people live longer.
- As new treatments emerge and cellular mechanisms are discovered, the 7th Annual European Congress of Rheumatology in Amsterdam (EULAR 2006) brings together more than 10,000 experts - scientists, clinicians, healthcare workers, pharmaceutical companies and patients - to share their knowledge in a global endeavour to challenge the pain and disability caused by musculo-skeletal disorders.
- To find out more information about the activities of EULAR, visit: www.eular.org.
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