Abstract
Objective
Intra-articular corticosteroid injections (IACIs) provide temporary symptom relief in osteoarthritis (OA). This meta-analysis investigated the effects of recurrent IACIs at three months and beyond.
Design
We searched Medline, Embase and Cochrane from inception to January 2021 for randomised controlled trials (RCTs) of patients with OA who received recurrent IACIs compared with other injectables, placebo or no treatment (primary outcomes: pain, function). Mean differences (MDs) with 95% confidence intervals were reported.
Results
Ten RCTs were included (eight knee OA (n=763), two trapeziometacarpal OA (n=121)). Patients received between 2 and 8 injections, varying by trial. Trials compared recurrent IACIs with hyaluronic acid (HA), platelet-rich plasma (PRP), saline or orgotein (follow-up 3-24 months). Greater improvements in pain, function and QoL at 3-24 months were noted for the comparators than with IACIs, with comparators demonstrating an equal or superior effect, or the intervention effect attenuating over follow-up. Recurrent IACIs demonstrated no benefits in pain or function over placebo at 12-24 months. No serious adverse events were recorded. No studies reported on time-to-future interventions, risk of future prosthetic joint infection or other adverse events associated with subsequent joint replacement.
Conclusions
Recurrent IACIs often provide inferior (or non-superior) symptom relief compared with other injectables (including placebo). Other injectables (HA, PRP) often yielded greater improvements in pain and function up to 24 months post-injection. Existing RCTs on recurrent IACIs lack sufficient follow-up data to assess disease progression, time-to-future interventions and complications following these.
Intra-articular corticosteroid injections (IACIs) provide temporary symptom relief in osteoarthritis (OA). This meta-analysis investigated the effects of recurrent IACIs at three months and beyond.
Design
We searched Medline, Embase and Cochrane from inception to January 2021 for randomised controlled trials (RCTs) of patients with OA who received recurrent IACIs compared with other injectables, placebo or no treatment (primary outcomes: pain, function). Mean differences (MDs) with 95% confidence intervals were reported.
Results
Ten RCTs were included (eight knee OA (n=763), two trapeziometacarpal OA (n=121)). Patients received between 2 and 8 injections, varying by trial. Trials compared recurrent IACIs with hyaluronic acid (HA), platelet-rich plasma (PRP), saline or orgotein (follow-up 3-24 months). Greater improvements in pain, function and QoL at 3-24 months were noted for the comparators than with IACIs, with comparators demonstrating an equal or superior effect, or the intervention effect attenuating over follow-up. Recurrent IACIs demonstrated no benefits in pain or function over placebo at 12-24 months. No serious adverse events were recorded. No studies reported on time-to-future interventions, risk of future prosthetic joint infection or other adverse events associated with subsequent joint replacement.
Conclusions
Recurrent IACIs often provide inferior (or non-superior) symptom relief compared with other injectables (including placebo). Other injectables (HA, PRP) often yielded greater improvements in pain and function up to 24 months post-injection. Existing RCTs on recurrent IACIs lack sufficient follow-up data to assess disease progression, time-to-future interventions and complications following these.
| Original language | English |
|---|---|
| Pages (from-to) | 1658-1669 |
| Number of pages | 12 |
| Journal | Osteoarthritis and Cartilage |
| Volume | 30 |
| Issue number | 12 |
| Early online date | 12 Sept 2022 |
| DOIs | |
| Publication status | E-pub ahead of print - 12 Sept 2022 |
Bibliographical note
Funding Information:This study is funded by the National Institute for Health Research (NIHR) [Health Technology Assessment (Grant reference number NIHR129011)]. The study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in considering the study design or in the collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the article for publication.
Funding Information:
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol for the submitted work. AJ, AWB and MRW disclose financial activities, outside the remit of the submitted work (AJ: personal fees; AWB: research grants; MRW: research grants, lecturing, textbook royalties); no other relationships or activities that could appear to have influenced the submitted work.
Publisher Copyright:
© 2022 The Author(s)
Keywords
- osteoarthritis
- injections, intra-articular
- steroids
- patient reported outcome measures
- systematic review
- meta-analysis