Corticosteroid injections are not more effective than physical therapy in the management of knee osteoarthritis (OA) in patients followed up to 1 year, according to data presented here at the Osteoarthritis Research Society International (OARSI) 2019 World Congress.

"Many more patients [with knee osteoarthritis] undergo injections instead of having physical therapy," said Daniel Rhon, MD, Brooke Army Medical Center, San Antonio, Texas. "We were comparing the efficiencies of 2 treatments that have both been proven to work -- non-surgical approaches."

They researchers examined data from 78 patients with knee OA who received corticosteroid injections and 78 patients with knee OA who received physical therapy.

Patients who were pregnant, had a history of gout or any other systemic joint disease, or joint infection were excluded.

The median percent change in total WOMAC scores at 1 year was 51.8% for the corticosteroid injection group and 70.8% for the physical therapy group. In addition, the mean between-group differences on the WOMAC were significant at 8 weeks, 6 months, and 1 year in favour of physical therapy.

Patients in the physical therapy group were also significantly (P = .032) more likely than patients receiving corticosteroid injections to report that they were "moderately better" or higher on the global rating of change at 1 year.

"The evidence shows the relief [with corticosteroids] is short-term," said Dr. Rhon. "The pain comes back, and there is also the potential for infection."

He noted that some of the perceived barriers to physical therapy is the time commitment required and the thinking that therapy will be painful.

"There is an unfounded premise that physical therapy will be painful," said Dr. Rhon. "It should not be painful. There can be discomfort but not pain. There is a difference between the two."

[Presentation title: Corticosteroid Injection Versus a Physical Therapy Approach for the Management of Knee Osteoarthritis: a Randomized Clinical Trial. Abstract 13]

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