Combo of steroid injections and exercise therapy relieve long-standing Achilles tendinopathy: JAMA Study

Denmark: In comparison to exercise therapy and a placebo injection, corticosteroid injections coupled with exercise therapy improved outcomes in the treatment of long-standing Achilles tendinopathy. The findings of this study were published in the Journal of American Medical Association (JAMA). 

Corticosteroid injections and exercise treatment are routinely used to relieve severe midportion Achilles tendinopathy, however, there is insufficient evidence to support this combination. As a result, this study was designed to evaluate the effects of corticosteroid injection and exercise treatment for individuals with Achilles tendinopathy to those of placebo injection and exercise therapy.

This was a randomized clinical study of individuals with Achilles tendinopathy confirmed by ultrasonography that was physician-blinded, participant-blinded, and assessor-blinded. Pain and function were evaluated at the start, 1, 2, 3, 6, 12, and 24 months. Between April 2016 and September 2018, patients were recruited from a university medical clinic and a private rheumatology clinic in Denmark. From June to September 2021, data was analyzed. Ultrasonography was used to guide the administration of corticosteroids and placebo. Based on prior research, exercise treatment consisted of three exercises performed every other day.

At 6 months, the primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) score (range: 1-100, with 100 signifying no symptoms). The discomfort was evaluated using a 100-mm Visual Analog Scale for morning pain and pain during exercise (with greater scores indicating worse pain), global evaluation (Likert scale), and tendon thickness were secondary outcomes.

The key findings of this study were as follows:

1. A total of 100 individuals participated in the study, with 52 assigned to placebo and 48 assigned to corticosteroid injection.

2. At baseline, patients in both groups had similar heights (mean, 177 cm), weights (mean, 79 kg), and VISA-A scores (mean, 46).

3. At 6 months, patients receiving exercise treatment coupled with corticosteroid injections improved their VISA-A score by 17.7 points more than patients receiving exercise therapy combined with placebo injections.

4. There were no serious adverse effects in either group, and there was no long-term worsening (2-year follow-up).

In conclusion, when compared to placebo injections paired with exercise treatment, corticosteroid injections coupled with exercise therapy result in a greater improvement in patient-reported outcomes. The benefit is seen at both short-term and long-term (up to 24 months) follow-up and is not linked with a greater risk of adverse events when compared to placebo injections.

Reference:

Johannsen F, Olesen JL, Øhlenschläger TF, et al. Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(7):e2219661. doi:10.1001/jamanetworkopen.2022.19661