A Cochrane review «Intra‐articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis»1 «Wallen M, Gillies D. Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. Cochrane Database Syst Rev 2006 Jan 25;(1):CD002824»1 included 7 studies with a total of 346 adult subjects. There was inconclusive conflicting evidence from two trials that walking time was reduced in the steroid injection group. There was evidence from one moderate quality trial that pain was reduced at 1-day post-injection (0–100 VAS from 28.33 to 13.46; McGill Pain Scale from 8.89 to 3.96) but not at 1 week or 7–12 weeks post-injection. There is some evidence that IA injections improved knee flexion (by 14 degrees) and reduced knee extension lag (by 20 degrees), knee circumference (median reduction = 0.3 cm) and morning stiffness (reduced from 60 mins to 7.6 mins). In one trial (n=91), rest following injection in the knee produced significant improvement in pain, stiffness, knee circumference, and walking time when compared with the non-rested group.
An RCT «Konai MS, Vilar Furtado RN, Dos Santos MF, et al. Monoarticular corticosteroid injection versus systemic administration in the treatment of rheumatoid arthritis patients: a randomized double-blind con»2 included 60 subjects with rheumatoid arthritis. An intraarticular (i.a.) knee injection of triamcinolone hexacetonide 60 mg + xylocaine chloride and intramuscular (i.m.) injection of 1 ml of xylocaine chloride 2% (IAI group) was compared to 1 ml of xylocaine chloride 2% i.a. and triamcinolone acetonide 60 mg + xylocaine chloride i.m. (IM group). Patients in the IAI group had significantly better results for VAS for knee pain, edema and morning stiffness as well as for improvement evaluation by the patient and physician.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).