Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 08 01 1636 1636 Shakiba Khalilian Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farsad Imani Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Yeganeh Shali Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Khajavi Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Reza Bahman Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Sharifnia Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Azam Biderafsh Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Sina Javidmehr Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2026 05 11 2026 06 22 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. https://aacc.tums.ac.ir/index.php/aacc/article/view/1636