Intra-articular corticosteroid for knee osteoarthritis

Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intra-articular corticosteroids, there is an ongoing debate about their benefits and safety. This is an update of a Cochrane review first published in 2005. To determin...

Full description

Saved in:
Bibliographic Details
Published in:Cochrane database of systematic reviews 2015-10, Vol.2015 (10), p.CD005328
Main Authors: Jüni, Peter, Hari, Roman, Rutjes, Anne W S, Fischer, Roland, Silletta, Maria G, Reichenbach, Stephan, da Costa, Bruno R
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - administration & dosage
Adrenal Cortex Hormones - adverse effects
Arthralgia - drug therapy
Arthralgia - etiology
Humans
Hyaluronic Acid - administration & dosage
Hyaluronic Acid - adverse effects
Hyaluronic Acid - analogs & derivatives
Hyaluronic Acid - therapeutic use
Injections, Intra-Articular
Osteoarthritis
Osteoarthritis, Knee - drug therapy
Osteoarthritis, Knee - therapy
Pain Measurement
Randomized Controlled Trials as Topic
Rheumatology
Therapeutic Irrigation - methods
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intra-articular corticosteroids, there is an ongoing debate about their benefits and safety. This is an update of a Cochrane review first published in 2005. To determine the benefits and harms of intra-articular corticosteroids compared with sham or no intervention in people with knee osteoarthritis in terms of pain, physical function, quality of life, and safety. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE (from inception to 3 February 2015), checked trial registers, conference proceedings, reference lists, and contacted authors. We included randomised or quasi-randomised controlled trials that compared intra-articular corticosteroids with sham injection or no treatment in people with knee osteoarthritis. We applied no language restrictions. We calculated standardised mean differences (SMDs) and 95% confidence intervals (CI) for pain, function, quality of life, joint space narrowing, and risk ratios (RRs) for safety outcomes. We combined trials using an inverse-variance random-effects meta-analysis. We identified 27 trials (13 new studies) with 1767 participants in this update. We graded the quality of the evidence as 'low' for all outcomes because treatment effect estimates were inconsistent with great variation across trials, pooled estimates were imprecise and did not rule out relevant or irrelevant clinical effects, and because most trials had a high or unclear risk of bias. Intra-articular corticosteroids appeared to be more beneficial in pain reduction than control interventions (SMD -0.40, 95% CI -0.58 to -0.22), which corresponds to a difference in pain scores of 1.0 cm on a 10-cm visual analogue scale between corticosteroids and sham injection and translates into a number needed to treat for an additional beneficial outcome (NNTB) of 8 (95% CI 6 to 13). An I(2) statistic of 68% indicated considerable between-trial heterogeneity. A visual inspection of the funnel plot suggested some asymmetry (asymmetry coefficient -1.21, 95%CI -3.58 to 1.17). When stratifying results according to length of follow-up, benefits were moderate at 1 to 2 weeks after end of treatment (SMD -0.48, 95% CI -0.70 to -0.27), small to moderate at 4 to 6 weeks (SMD -0.41, 95% CI -0.61 to -0.21), small at 13 weeks (SMD -0.22, 95% CI -0.44 to 0.00), and no evidence of an effect at 26 weeks (SMD -0.07
ISSN:1469-493X
1469-493X
DOI:10.1002/14651858.CD005328.pub3