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McAlindon TE, et al. Intra-articular triamcinolone versus saline on knee cartilage volume and pain. JAMA. 2017;317:1967–1975. PMID 28510679

One-paragraph summary

This double-blind trial randomized 140 people with symptomatic Kellgren–Lawrence grade 2–3 knee OA and ultrasound synovitis to 40 mg intra-articular triamcinolone or saline every 12 weeks for two years; 119 (85%) completed follow-up. Triamcinolone caused greater index-compartment cartilage-thickness loss (-0.21 versus -0.10 mm) and did not improve pain relative to saline.

Key findings

  • Between-group cartilage-thickness difference: -0.11 mm (95% CI -0.20 to -0.03).
  • Pain difference: -0.6 points on a 0–20 WOMAC scale (95% CI -1.6 to 0.3), not significant.
  • The study evaluated scheduled repeated treatment, not an isolated injection for a selected flare.
  • The minimum clinically important difference for the MRI cartilage endpoint was not established.

Limitations

  • Single-center study with a selected synovitis-positive population.
  • Saline injection has contextual and possibly biological effects; it is not a no-treatment comparison.
  • Findings should not be generalized to every corticosteroid preparation, interval or one-off use.

Why it matters

The trial changed the safety interpretation of automatic serial corticosteroid injection by directly measuring structure and symptoms over two years.

Cited by wiki pages

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  • injections and orthobiologics
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