About 595 million individuals worldwide suffer with osteoarthritis, a very common joint condition that mostly affects the knee. Although intra-articular glucocorticoid injections are often used to treat knee osteoarthritis (OA) pain, there is evidence that these injections may result in cartilage loss. In individuals with inflammatory knee OA, injecting glucocorticoids into the infrapatellar fat pad and synovium may have both anti-inflammatory and cartilage-degrading effects. Thus, this study assessed the safety and efficacy of glucocorticoid injections into the IPFP in patients with inflammatory knee OA.
The patients with inflammatory knee OA who were 45 years of age or older participated in this study at 4 Chinese locations. Enrollment of patients took place between April 2022 and June 2023. The patients were divided into 2 groups at random: the treatment group (n = 30) and the placebo group (n = 30).
Under ultrasonographic supervision, each group received injections of either saline or glucocorticoids into the IPFP with hyaluronic acid as a background therapy. Changes in knee discomfort on a visual analog scale (VAS) and effusion synovitis volume as determined by magnetic resonance imaging (MRI) were the main results.
The study was finished by all 60 participants. There was no statistically significant decrease in VAS pain between the treatment group and the placebo group (−39.3 mm vs. −31.4 mm; between-group difference, −7.9 mm; 95% CI, −19.7 to 4.0 mm). Effusion volume decrease did not differ significantly across groups (−4.9 mL vs. −5.4 mL; between-group difference, 0.5 mL; 95% CI, −1.9 to 2.9 mL).
The treatment group significantly reduced the WOMAC pain score (−113.0 points vs. −66.8 points; between-group difference, −46.2 points; 95% CI, −90.0 to −2.4 points; P =.04) and cartilage defect (−0.1 vs. 0.4; between-group difference, −0.5; 95% CI, −1.0 to −0.1; P =.03). One individual in each group had one adverse response. Overall, over a 12-week period, glucocorticoid injections into the IPFP did not significantly reduce effusion synovitis volume or improve pain in patients with knee OA with effusion synovitis and Hoffa synovitis.
Source:
Zhang, Y., Ruan, G., Fan, T., Zheng, P., Zhu, Z., He, J., Wei, X., Hu, W., Huang, S., Chang, Q., Gao, P., Chen, H., Zhou, X., Liu, X., Tang, S., Jiang, L., & Ding, C. (2026). Infrapatellar fat pad glucocorticoid injection in knee osteoarthritis: A randomized clinical trial: A randomized clinical trial. JAMA Network Open, 9(1), e2549938. https://doi.org/10.1001/jamanetworkopen.2025.49938
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