Is it possible to predict which patients are most likely to benefit from intra-articular corticosteroid injections? A systematic review.

Florence Shekleton*, Richard L Donovan, Vikki Wylde, Michael R Whitehouse

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

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Intra-articular corticosteroid injections (IACIs) can reduce osteoarthritis-related pain, with differing levels of response across patient groups. This systematic review investigates what is known about the positive and negative predictors of outcomes in patients with osteoarthritis who undergo IACIs.

We systematically searched the Medline, Embase and Cochrane databases to May 2023 for studies that evaluated patients undergoing IACIs for osteoarthritis and reported on predictors of outcomes in these patients.

Eight studies were included. Two were placebo-controlled trials, six were observational studies. Due to the heterogeneity of outcomes and variables between the studies, it was not possible to pool the results for formal meta-analysis. Higher baseline pain, older age, higher BMI, lower range of movement, higher Kellgren-Lawrence radiographic score, joint effusion and aspiration were shown to be predictors of a positive response to IACIs in some of the included studies. However, other studies showed no difference in response with these variables, or a negative correlation with response. Sex, smoking, mental health status, hypertension/ischaemic heart disease, diabetes mellitus, duration of symptoms, and socioeconomic status did not demonstrate any correlation with the prediction of positive or negative outcomes after IACIs.

Several patient features have been identified as positive predictors of outcomes following IACIs. However, this systematic review has identified inconsistent and variable findings across the existing literature. Further research with standardisation of IACI administration and outcome measures is required to facilitate further analysis of the reliability and significance of predictive factors for response to IACIs.
Original languageEnglish
Article numbere15005
Number of pages10
JournalInternational Journal of Rheumatic Diseases
Issue number1
Early online date7 Jan 2024
Publication statusPublished - 19 Jan 2024

Bibliographical note

Funding Information:
This study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (BRC-1215-20011). The views expressed are those of the author 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.

Publisher Copyright:
© 2024 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.


  • Osteoarthritis
  • Injections, Intra-Articular
  • Steroids
  • Systematic review
  • Correlation of Data


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