brand logo

Am Fam Physician. 2022;106(5):584-585

Clinical Question

Is an intramuscular glucocorticoid injection noninferior to an intra-articular glucocorticoid injection in reducing knee pain in adults with knee osteoarthritis?

Bottom Line

This study found that intra-articular glucocorticoid injection may work better for reducing pain from knee osteoarthritis at one month, but there was no significant difference in pain resolution between intra-articular injection and intramuscular injection at two months or six months. (Level of Evidence = 1b)


Intra-articular glucocorticoid injections are associated with greater cartilage loss and a rare but increased risk of joint infections and septic arthritis. The investigators identified adults (N = 145), 45 years and older, with knee osteoarthritis diagnosed by their primary care physician, presence of symptomatic knee osteoarthritis for at least three months, and moderate to severe knee pain over the past week (i.e., at least 3 on a scale of 0 to 10; 0 indicates no pain). Eligible participants randomly received (concealed allocation assignment) an intramuscular injection (40 mg triamcinolone acetonide) in the gluteal region or the same drug and dose given as an intra-articular injection in the index knee. Patients self-reported severity of knee pain at two, four, eight, 12, and 24 weeks after treatment using a previously validated knee pain scoring tool (0 to 100; 0 indicates extreme pain). Although the minimum clinically important difference for this tool is 9, the investigators chose to prespecify the noninferiority margin at 7. Per-protocol data were available for 138 (95%) of participants at 24 weeks.

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.