Efficacy of intra-articular corticosteroid injections in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

被引:26
|
作者
Najm, Aurelie [1 ]
Alunno, Alessia [2 ]
Gwinnutt, James M. [3 ]
Weill, Catherine [4 ]
Berenbaum, Francis [5 ]
机构
[1] Univ Glasgow, Coll Med Vet & Life Sci, Inst Infect Immun & Inflammat, Glasgow, Lanark, Scotland
[2] Univ Perugia, Dept Med, Rheumatol Unit, Perugia, Italy
[3] Univ Manchester, Fac Biol Med & Hlth, Ctr Musculoskeletal Res, Div Musculoskeletal & Dermatol Sci,Sch Biol Sci,C, Manchester, Lancs, England
[4] Paris Descartes Univ, Bibliotheque Interuniv Sante, Paris, France
[5] Sorbonne Univ, St Antoine Hosp, AP HP, INSERM,CRSA St Antoine,Dept Rheumatol, Paris, France
关键词
Knee osteoarthritis; Systematic literature review; Meta-analysis; Glucocorticoids; Steroids; Intraarticular injections; HYALURONIC-ACID; TRIAMCINOLONE HEXACETONIDE; MICROSPHERE FORMULATION; STEROID INJECTIONS; METHYLPREDNISOLONE; ACETONIDE; HAND; PAIN; HIP;
D O I
10.1016/j.jbspin.2021.105198
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Knee osteoarthritis (OA) is a frequent degenerative disease representing an important health and economic burden. Symptomatic medical treatments available include intra-articular (IA) injections of corticosteroids (GC) but their efficacy and safety profile are debated. Methods: We performed a systematic literature review (SLR) and a meta-analysis (MA) of randomized controlled trials (RCTs) assessing the effect of IA GC injections for knee OA. The effect of the interventions on pain and function was extracted from the single studies and pooled. Standardized mean differences (SMD) are reported. Results: Of 520 studies screened, 23 were included in the SLR and 15 subsequently included in the MA. IA GC showed a trend towards a superior effect compared to control on both pain (SMD & minus;0.61 (95% CI: & minus;1.25, 0.03)) and function (SMD & minus;1.02 (95% CI: & minus;2.14, 0.10)) in short term follow-up (< 6 weeks), while long term follow-up (> 24 weeks) analysis showed a trend towards superiority of controls (IA HA, IA NSAID, physiotherapy) for pain (SMD 0.68 (95% CI: & minus;0.11, 1.47)) and function (SMD 0.88 (95% CI: & minus;0.36, 2.12). There were no differences between interventions in medium term (> 6 weeks & < 24 weeks). Conclusion: In this work, IA GC injections reduced pain and improved function early after administration (< 6 weeks) compared to placebo; while this result was no longer statistically significant with other comparators (IA hyaluronic acid or physiotherapy). Other interventions seem to be more efficient in the long term (> 24 weeks) but this effect was largely driven by single studies with large effect sizes. (c) 2021 Socie & acute;te & acute; franc & cedil; aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.
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页数:8
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