Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial

McAlindon TE, LaValley MP, Harvey WF, et al. · JAMA

Repeated triamcinolone caused significantly greater cartilage volume loss than saline (-0.21 vs -0.10 mm index-compartment thickness) with no difference in knee pain over 2 years. The authors conclude the findings do not support this treatment.

Population

140 patients with symptomatic knee OA and synovitis (70 per arm; 85% completed)

Intervention

Intra-articular triamcinolone 40 mg every 12 weeks for 2 years

Comparator

Saline injections on the same schedule (double-blind)

Limitations

Cartilage volume is a surrogate; single centre (Tufts); applies to a fixed 3-monthly schedule rather than occasional single injections. Pain was never measured in the four weeks after an injection, which is the window in which relief is expected — the trial tested whether benefit persists across three months, not whether an injection relieves pain at all. Entry required ultrasound-confirmed synovitis. NIH-funded, no industry support.