For patients with osteoarthritis of the knee, those undergoing physical therapy have less pain and functional disability at one year compared with those who receive an intraarticular glucocorticoid injection, according to a study published in the April 9 issue of the New England Journal of Medicine.
Gail D. Deyle, D.Sc., from Brooke Army Medical Center in San Antonio, and colleagues compared physical therapy with glucocorticoid injection in a primary care setting in the U.S. Military Health System. A total of 156 patients with osteoarthritis in one or both knees were randomly assigned to receive a glucocorticoid injection or physical therapy in a 1:1 ratio.
The researchers found mean baseline Western Ontario and McMaster Universities Osteoarthritis Index scores were 108.8 ± 47.1 and 107.1 ± 42.4 in the glucocorticoid injection and physical therapy groups, respectively. The mean scores at one year were 55.8 ± 53.8 and 37.0 ± 30.7, respectively (mean between-group difference, 18.8 points) in favor of physical therapy. Changes in the secondary outcomes were in the same direction.
“The results do not exclude a role for joint injection for treatment of a flare of acute pain, as acknowledged in guideline recommendations, but the implication could be that injections should not be used first, nor should they be used in place of a physical therapy program that includes exercise to manage symptoms of osteoarthritis of the knee,” write the authors of an accompanying editorial.