Painful osteoarthritic knee joints; a comparative study between intra-articular steroids and combined physiotherapy modalities treatment

Abstract

Thirty patients 13males(44%) 17females(56%) who had osteoarthritis of the knees according to ARA classification criteria and presented with acute pain without effusion where randomly assigned into 2 groups to evaluate the effects of intra-articular injection(IAS) and in the other hand combination of interferential current (IFC) with pulsed electromagnetic field (PEF) physiotherapy modalities in treating painful Knee OA. All patients were treated with acetaminophen 1g bid, meloxicam 7.5mg once daily. 15 patients 8males(53%)- 7females (47%) received intra-articular injection of methyl prednisolone acetate(IAS) 80mg/2ml depot. The other group 10females(66.6%) – 5 males (33.3%) was treated by interferential current(IFP) 10 minute sessions with 20 minutes sessions of pulsed electromagnetic field therapy(PEF). The WOMAC (Western Ontario and McMaster Universities) scores index of osteoarthritis were recorded at 0 week, 1st wk ,2nd wk, 4th wk, 8th wk and 16th wk. At follow up visits pain, stiffness and physical function are the parameters used for comparison. Both intra-articular injection group and combined physiotherapy modalities group had significant improvement. The IAS group had more rapid pain relief and continue till the end of the study. Slow improvement was achieved in the second group. Our current study suggest that IAS is preferable than IFP&PEF in the treatment of OA knee pain from the practical point of view regarding the cost of the instrument, patient compliance, poverty state of the patients and their needs for early return to their jobs. Availability of portable IFP or PEMF is more practical but under education of our patients & its cost are main obstacles in its way of use.