Comparison of the Analgesic Effects of Intra-Articular Injection of Methylprednisolone versus Methylprednisolone-Ketorolac in Knee Osteoarthritis

Abstract

Background: Knee osteoarthritis (OA) is one of the most common causes of chronic pain and functional limitation, particularly among middle-aged and elderly populations. Intra-articular corticosteroid injections are widely used for short-term pain relief; however, their analgesic effect is often limited in duration. The addition of nonsteroidal anti-inflammatory drugs (NSAIDs) may enhance therapeutic efficacy. This study aimed to compare the analgesic effects of intra-articular methylprednisolone versus methylprednisolone-ketorolac in patients with knee osteoarthritis.
Methods: In this randomized clinical trial, 82 patients with knee osteoarthritis were enrolled at Sina Hospital between 2024 and 2026. Patients were randomly assigned to receive either intra-articular methylprednisolone (Group T) or Methylprednisolone-ketorolac (Group TK). Pain intensity was assessed using the Numeric Rating Scale (NRS) during walking, rising after prolonged sitting or waking up, and stair climbing at baseline and at 2 and 4 weeks post-injection. Statistical analyses were performed using appropriate tests, with a significance level set at P<0.05.
Results: A total of 79 patients were included in the final analysis. Both treatment groups demonstrated significant reductions in pain scores compared with baseline. However, the reduction in walking-related pain was significantly greater in the methylprednisolone-ketorolac group at both 2 and 4 weeks of follow-up (P<0.001). No statistically significant differences were observed between the two groups regarding pain during stair climbing or post-rest stiffness. No major adverse events were reported in either group.
Conclusion: The findings suggest that adding ketorolac to intra-articular methylprednisolone provides a clinically and statistically superior analgesic effect on walking-related pain in patients with knee osteoarthritis, likely due to synergistic inhibition of inflammatory pathways. This combination appears to be a safe and more effective short-term treatment option for pain control in knee OA. Further studies with larger sample sizes and longer follow-up periods are recommended to evaluate long-term outcomes and structural joint effects.