An Update on Methylprednisolone Acetate Intra-Articular Injection Efficacy in Managing Knee Osteoarthritis
Intra-articular methylprednisolone acetate (MPA) injection has shown to provide symptomatic relief in knee osteoarthritis (OA). However, if the drug is given beyond efficacy it may impact the suitability and clinical efficiency of an injection.
A review of clinical evidence and printed literature on factors affecting the efficacy and safety of a knee injection has been carried out. The list of factors include dose, frequency, contraindications, precautions, drug interactions, side-effects, and procedural and patient-related considerations.
After evaluation, clinical benefit was seen with 40 mg dose of injection. Apart from the pain severity, no strong response was marked. The add on advantage for outcomes from higher doses, local anesthetic, ultrasound guidance or particular anatomical approaches is not confirmed till now. The damaging effects observed with the dose and duration recommends the wise use and injection frequency. The current assessment suggested the need to consider and monitor number of contraindications and precautions arising from the drug pharmacology, concurrent medications, comorbidities and adverse events. Only partial safety data was observed regarding anticoagulation.
The findings from the review advised that the safety issues regarding warfarin may be improved by ensuring that the international normalized ratio level is within therapeutic range. However, the risk-benefit analysis regarding non vitamin K antagonist oral anticoagulants remains challenging. A lack of clinical studies, safety evidence and reversibility advocates caution, although there is published guidance.
Overall, this review states that in many areas, there is a need for an individualized approach for injection decisions and procedures as its supporting evidence is limited. To optimize the benefits and safety of a knee injection, analysis and discussion of benefits and risks, peri-procedural and post-injection management and tailoring to the context and individual’s preferences are essential.