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[Arthroscopic lavage plus corticosteroids is more effective than joint aspiration plus corticosteroids in patients with arthritis of the knee].

OBJECTIVE
To compare the efficacy of arthroscopic lavage plus corticosteroids (ALC), arthroscopic lavage plus placebo (ALP), and joint aspiration plus corticosteroids (JAC) in patients with arthritis of the knee, and to identify clinical or histological factors that predict outcome.


DESIGN
Prospective, randomised.


METHOD
Patients with arthritis of the knee (not due to gout, osteoarthritis or septic arthritis) were randomised to 1 of 3 treatment arms: ALC, ALP or JAC. The primary endpoint was time to recurrence; recurrence was defined as recurrent or persistent symptomatic knee swelling requiring local treatment, and/or non-improvement in knee joint score. Synovial tissue specimens were collected for histological analysis.


RESULTS
Of the 78 patients enrolled, 3 did not receive the intended therapy and 3 were lost to follow-up. The median time to recurrence was 9.6 months in the ALC group, 3.0 months in the JAC group and 1.0 month in the ALP group. Compared with ALC, the relative risk of recurrence of arthritis (RR) was 2.2 for JAC (95% CI: 1.2-4.2; p = 0.02) and 4.7 for ALP (95% CI: 2.3-9.4; p < 0.0001). In the ALC group, extensive synovial fibrosis was associated with a higher risk of recurrence (RR 5-7; 95% CI: 1.6-20.5; p < 0.01).


CONCLUSION
Arthroscopic lavage plus corticosteroids was more effective than arthroscopic lavage plus placebo or joint aspiration plus corticosteroids. The absence of synovial fibrosis predicted a beneficial response.