BIOMEDIKA
ISSN: 2085-8345.
E-ISSN: 2541-2582
Vol 18.
No.
1 Februari 2026 doi: 10.
23917/biomedika.
Comparison of Quality of Life Between Combined Therapy and Additional Corticosteroid Injections in Advanced Knee Osteoarthritis at Siti Khodijah Hospital Muhammad Naufaldi Hefni.
Brilliant Citra Wirashada.
Eka Ari Puspita
AFFILIATIONS
Faculty of Medicine.
Universitas Muhammadiyah Surabaya This work is licensed under a Creative Commons AttributionNonCommercial 4.
International License.
ABSTRACT
Background: Knee osteoarthritis (OA) causes pain, stiffness, and functional decline, reducing quality of life.
Objective: This study compared the quality of life of advanced knee OA patients (KellgrenAeLawrence grade 3Ae.
receiving the combination of pharmacological and physiotherapy treatment alone and those who received the same combination with the addition of intra-articular corticosteroid injections.
Methods: This research is a quantitative analytic observational study using crosectional collecting method involving 44 patients diagnosed in the year of 2023 with advanced knee OA at Siti Khodijah Sidoarjo Hospital.
Data were collected through medical records and WOMAC questionnaires, and analyzed using the MannAeWhitney U test and mean rank comparison between treatment groups.
Results showed that the injection group had significantly lower WOMAC Scores .
2 A 14.
compared to the non-injection group .
07 A 8.
and p-value of 0.
< 0.
Conclusion:
The addition of intra-articular corticosteroid injections significantly improves the quality of life in patients with advanced knee OA.
KEYWORDS:
Knee Osteoarthritis.
Quality of Life.
WOMAC.
Corticosteroid Injection.
Combined Therapy CORRESPONDING AUTHOR:
Muhammad Naufaldi Hefni hefni-2021@fk.
um-surabaya.
INTRODUCTION
functions, leading to sleep disturbances, social Osteoarthritis (OA) is a common degenerative isolation, and increased risk of depression .
Given joint disease marked by progressive cartilage this significant burden and its multidimensional degradation, osteophyte formation, subchondral bone changes, and mild synovial inflammation .
management is crucial to reduce symptoms and Knee OA is a leading cause of disability among the prevent further functional decline.
Patients with OA require therapy to relieve elderly, significantly impacting daily activities, quality of life, and healthcare burden .
The Global Burden Treatment of Disease 2019 report estimated over 528 million individuals globally suffer from OA, with the highest Non-surgical management is further prevalence in individuals over 55 years old, predominantly females .
non-surgical non-pharmacological Non-pharmacological In Indonesia, knee OA affects approximately therapy is the first-line treatment for all OA patients 5% of men and 12.
7% of women aged 40Ae60 and includes education, self-management, and years .
OA impairs physical and psychosocial physiotherapy such as exercise and weight reduction Avalaible online at https://journals2.
id/index.
php/biomedika Comparison of Quality of Life Between Combined A (Muhammad Naufaldi Hefn.
Ae.
Pharmacological therapy may involve the use and the other group received the same treatment of topical or oral NSAIDs, or intra-articular injections plus intra-articular corticosteroid injections.
of corticosteroids or hyaluronic acid .
Ae.
Surgical Data were collected from medical records and procedures are considered the last resort for WOMAC questionnaires.
WOMAC questionnaires is a patients with knee OA, with total knee arthroplasty valid and reliable instrument that measures patientAos followed by rehabilitation being the most effective pain, stiffness, and physical function knee related surgical intervention .
quality of life .
The WOMAC measurement was The effectiveness of corticosteroid injections in conducted among patients with varying durations of improving long-term quality of life remains debated .
Although short-term improvements in pain and treatment duration dated back to 2022, while the function are well-documented, repeated use may most recent treatment initiation occurred in 2024.
lead to cartilage degeneration .
Therefore, the interval between treatment initiation Specifically.
This study aims to compare the effectiveness of and WOMAC measurement ranged from 2 to 4 years.
combined pharmacological-physiotherapy treatment The primary outcome of this study was the intra-articular quality of life of each treatment group, assessed injections in improving the quality of life of patients with advanced knee OA using the Western Ontario independent variable was the type of therapy and McMaster Universities Osteoarthritis (WOMAC) .
ombination of pharmacologic and physiotherapy The findings are expected to aid clinicians in treatment vs.
same treatment plus intra-articular selecting evidence-based treatment strategies.
corticosteroid injection.
METHODS
WOMAC
The Data analysis was performed by using the Mann- This observational analytic study employed a Whitney U test and mean rank WOMAC score cross-sectional design, conducted at Siti Khodijah between the therapy.
This test was used to assess Sidoarjo Hospital.
The population included 44 patients diagnosed with grade 3 or 4 knee OA based difference in the patientAos quality of life between the on Kellgren-Lawrence classification who met the two treatment groups.
inclusion and exclusion criteria.
The sample was RESULT AND DISCUSSION divided into two groups: one group received pharmacological and physiotherapy treatment only.
This study involved 44 respondents diagnosed with advanced knee osteoarthritis .
rade 3Ae4 based on the Kellgren-Lawrence scal.
, consisting of 14 BIOMEDIKA.
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patients receiving combined pharmacological and without injections .
07 A 8.
The physiotherapy treatment, and 30 patients who combination group was classified as moderate, whereas the group with the addition of intra-articular The respondents were predominantly corticosteroid injection was classified as mild, based female .
9%), in line with OA epidemiology, which on WOMAC interpretation.
intra-articular shows a higher prevalence among postmenopausal The age distribution of the respondents ranged from 35 to 74 years, with the 55Ae64 age group being the most represented.
Based Table 2.
Univariate Analysis of WOMAC Scores WOMAC Therapy Pharmacological Physiotherapy (Combinatio.
Combination with Intraarticular Corticosteroid Injection group reported moderate to severe symptoms.
Higher radiological grades of OA .
were also more frequently found in the injection therapy Table 1.
Characteristic of Respondent Sex Male Female Age 35Ae44 44Ae54 55Ae64 65Ae74 KellgrenLawrence OA Grade Grade 3 Grade 4 Category 35,07 A Moderate 19,2 A Mild Based on the results of the Mann-Whitney U test.
Z = -3.
701, p < 0.
001 were obtained.
Highly significant p-value indicates that the difference between the two treatment groups is statistically In other words, there is a clear difference in the quality of life of patients with advanced knee Characteristics Median (Source: Author, 2.
additional corticosteroid injections were categorized as experiencing milder pain, while the non-injection WOMAC Score (Mean A SD) Therapy Combination Pharmacological with Intraand Physiotherapy Corticosteroid (Combinatio.
Injection
,8%)
,8%)
,5%)
,3%)
,5%)
,6%)
,0%)
,6%)
,8%)
,4%)
,3%)
,4%)
,8%)
,7%)
osteoarthritis who received a combination of pharmacological and physiotherapy treatment with 16 .
,4%) 14 .
,8%) The mean WOMAC score shows that patients receiving corticosteroid injections had lower WOMAC intra-articular without corticosteroid injections.
Table 3.
Mann-Whitney U Test Results Kelompok
,0%)
,8%)
(Source: Author, 2.
Pharmacological and Physiotherapy (Combinatio.
Combination with Intra-articular
Corticosteroid
Injection
Mean
Rank
18,23
31,64
Z score Asymp.
Sig.
-3,701 0,000 (Source: Author, 2.
2 A 14.
compared to those BIOMEDIKA.
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The results of this study indicate a significant articular corticosteroid injections not only provide difference in the quality of life of patients with temporary relief but also contribute to an overall advanced knee osteoarthritis (OA) between the two improvement in quality of life including reduced dependence on oral pharmacotherapy, increased The combination of pharmacological and physiotherapy with the mobility, and greater comfort in daily activities.
addition of intra-articular These findings also affirm the sensitivity of the corticosteroid injections recorded significantly lower WOMAC index as a tool for measuring quality of life WOMAC scores compared to the group that received and detecting clinical changes in OA patients.
The three main domains of the WOMACAipain, stiffness, without injections.
This difference in scores reflects improvement in the domains of pain, stiffness, and determining patient disability and well-being.
The physical function, which are key determinants of significant reduction in WOMAC scores in the quality of life in OA patients.
These findings are consistent with a previous functionAiare highly relevant improvement across all three domains.
study by Tammachote et al.
, which showed However, the long-term effectiveness of intra- that intra-articular corticosteroid injections were effective in reducing pain and improving knee A study by McAlindon et al.
function in OA patients for 4Ae6 weeks post- reported that repeated corticosteroid uses over two The analgesic effect of corticosteroids years led to greater cartilage thinning in the knee is attributed to their ability to suppress inflammation joint compared to the placebo group, despite by inhibiting the production of prostaglandins and patients reporting subjective improvement .
proinflammatory cytokines (IL-1.
TNF-), which play Therefore.
Indonesian Rheumatology a major role in cartilage degradation.
Additionally.
Association .
recommends that corticosteroid direct injection into the joint cavity allows for high injections should not be administered more than local drug concentrations with minimal systemic three times per year, especially in weight-bearing effects .
joints, to avoid destructive effects on the cartilage In this study, the non-injection group had a .
mean WOMAC score of 35.
oderate categor.
Based on the study data, the patient with the while the injection group recorded a mean score of longest treatment duration had received adjunctive 2 .
ild categor.
These data suggest that intra- corticosteroid injections since 2022, whereas the BIOMEDIKA.
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most recent patient began receiving them in 2024.
Particularly in secondary healthcare facilities Accordingly, for the patient with the longest such as RS Siti Khodijah Sidoarjo, this approach is duration, the injection period had exceeded two relatively practical, cost-effective, and can provide This surpasses the risk threshold described by rapid symptom relief.
Timothy E.
McAlindon et al.
, who reported CONCLUSION Intra-articular that repeated corticosteroid uses over two years than two years may increase the risk of cartilage thinning in knee joint, despite patients reporting On the other hand, this practice remains Indonesian Rheumatology significantly improve quality of life in advanced knee OA patients when added to pharmacological and Association .
, considered in personalized, non-operative treatment However, cautious use is recommended due to potential adverse long-term effects on cartilage.
As a recommendation, future studies using provided that the frequency of administration does not exceed three injections per year, as the guideline This study has several limitations.
Its crosectional design captures only a single time point and does not allow for evaluation of long-term Additionally, the use of total sampling from a single hospital with a limited population may restrict the The comprehensively evaluate long-term outcomes and does not specify a cumulative duration limit.
physiotherapy treatments.
This approach should be subjective improvement.
WOMAC
questionnaire, while quantitative, also relies on patientsAo subjective perceptions, which can be capture developmental trajectories over extended Such an approach would allow researchers to observe patterns of change, stability, and causal relationships that may not be apparent in crosectional investigations.
By incorporating repeated measurements across time points, future research could produce more robust, generalizable, and theoretically meaningful findings.
FUNDING
This research did not receive any external influenced by emotional and psychosocial factors.
Nevertheless, the findings of this study provide REFERENCES