Duloxetine Combined With Intra-articular Injection of Corticosteroid and Hyaluronic Acid Reduces Pain in the Treatment of Knee Osteoarthritis Patients

Inclusion Criteria: * Participants meet American College of Rheumatology clinical and radiographic criteria for the diagnosis of knee osteoarthritis with knee pain \[ pain for ≥14 days of each month for ≥3 months before study entry, with a mean score ≥4 on the 24-h average pain score (0-10) using the average of daily ratings before the trial\] * Body mass index \< 40 kg/m2 * Radiographic criteria included Kellgren-Lawrence grade Ⅱ-III * Knee stability, no deformity, no lumbar spondylosis with radiculopathy. * Good cognition, and the ability to understand the study protocol and the agreement to participate. Exclusion Criteria: * Inflammatory arthritis, autoimmune disorder, septic arthritis, or any other concomitant disease (such as liver and kidney disease) * Those who prior synovial fluid analysis indicative of a diagnosis other than osteoarthritis * Participants with contraindications to duloxetine (currently using monoamine oxidase inhibitors, poorly controlled angle-closure glaucoma), previous exposure to duloxetine, combined with other drugs acting on the central nervous system (such as benzodiazepines) and allergic to any of the medications used in this study. * With metabolic diseases or anticoagulation therapy * Participants who had received invasive treatments to the knee during the past 6 months; joint replacement of the knee at any time or current infection in the affected limb.