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

Najm, Aurélie; Alunno, Alessia; Gwinnutt, James M; Wéill, Catherine; Bérenbaum, Francis

doi:10.1016/j.jbspin.2021.105198

Cited by 35 publications

(11 citation statements)

References 32 publications

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“…Although diclofenac 150 mg is consistently reported to statistically significantly reduce pain several NSAIDs evaluated within the same systematic reviews were no better than placebo 11,58 . Similarly, IA corticosteroids may be no more efficacious than placebo for the treatment of OA 59,60 . IA corticosteroids or PO NSAIDs were the most commonly active comparators to IA NSAIDS in the human IA NSAID efficacy studies.…”

Section: Discussionmentioning

confidence: 98%

“…11,58 Similarly, IA corticosteroids may be no more efficacious than placebo for the treatment of OA. 59,60 IA corticosteroids or PO NSAIDs were the most commonly active comparators to IA NSAIDS in the human IA NSAID efficacy studies. Therefore, without an internal placebo control in these trials, despite demonstrating IA NSAIDs have similar efficacy to PO NSAIDs or IA corticosteroids, all therapies may have been no better than placebo.…”

Section: Summary Of Human Studiesmentioning

confidence: 99%

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Pharmacokinetics, safety and efficacy of intra‐articular non‐steroidal anti‐inflammatory drug injections for the treatment of osteoarthritis: A narrative review

Selig

Kress

Horton

et al. 2022

Clinical Pharmacy Therapeu

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What is known and Objective Osteoarthritis (OA) is a common cause of joint disease and activity limitation in adults. Common therapies to treat OA‐related pain are oral and topical non‐steroidal anti‐inflammatory drugs (NSAIDs) and intra‐articular (IA) corticosteroids. However, prolonged courses of oral NSAIDs are associated with systemic adverse effects and repeat IA corticosteroid injections may cause cartilage degeneration. IA NSAIDs may be an alternative therapy possibly minimizing systemic side effects while maintaining efficacy. Therefore, we sought to summarize the pharmacokinetics, safety and efficacy of IA NSAIDs to help providers make a more informed decision on the use of IA NSAIDs. Methods We searched the National Library of Medicine Database with terms “intraarticular and nsaid”, yielding 1032 results. Only traditional formulations of NSAIDs were considered for inclusion. Animal studies were included if animals were healthy or if the method of arthritis induction was a reasonable model of osteoarthritis. Human studies were included if humans were healthy or if the primary disease studied was osteoarthritis of a large joint. Of 1032 results, 31 research articles met the inclusion criteria and were summarized in this review. Results and Discussion We found that single doses of IA NSAIDs provided far less total systemic and synovial exposure compared to a one week course of oral NSAIDs, but maximum concentrations to the synovium with IA administration were much higher. IA NSAIDs had an excellent safety profile in small animals, large animals and humans, although these injections were associated with non‐specific cartilage inflammation in healthy animals. In animal models, IA NSAIDs had similar efficacy to PO NSAIDs in treating OA‐related pain. In humans, IA NSAIDs had similar efficacy to PO NSAIDS and IA corticosteroids in treating OA‐related pain; however, many trials did not have a placebo control and outcome measures were heterogeneous. What is new and Conclusion Overall, single doses of IA NSAIDs appear safe and efficacious across animals and humans. The optimal use of IA NSAIDs is still to be determined and further research is needed. However IA NSAIDs may be an additional beneficial therapy to treat OA‐related pain. Potential uses may be to augment IA corticosteroids injections, to interrupt multiple IA corticosteroid injections or as an alternative in patients that are high risk for corticosteroid‐related adverse events.

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Section: Discussionmentioning

confidence: 98%

Section: Summary Of Human Studiesmentioning

confidence: 99%

Pharmacokinetics, safety and efficacy of intra‐articular non‐steroidal anti‐inflammatory drug injections for the treatment of osteoarthritis: A narrative review

Selig

Kress

Horton

et al. 2022

Clinical Pharmacy Therapeu

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“…Intra‐articular (IA) injections of long‐acting preparations of corticosteroids (methylprednisolone acetate, triamcinolone acetonide and triamcinolone hexacetonide) in humans with OA have been shown to have a short‐term benefit in alleviation of pain compared to placebo (Najm et al . 2021 ). Methylprednisolone acetate is licensed for IA use in the dog for inflammatory conditions (Depo‐medrone V; Zoetis), therefore its use in OA (typically considered a non‐inflammatory condition, although now understood to have an inflammatory component) under the licence is debatable (Sokolove & Lepus 2013 ).…”

Section: Pharmaceutical Treatments Of Canine Oamentioning

confidence: 99%

Advances in the pharmaceutical treatment options for canine osteoarthritis

Pye

Bruniges

Peffers

et al. 2022

J of Small Animal Practice

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Canine osteoarthritis is a significant cause of pain in many dogs and can therefore compromise animal welfare. As the understanding of the biology and pain mechanisms underpinning osteoarthritis grows, so do the number of treatments available to manage it. Over the last decade, there have been a number of advances in the pharmaceutical treatment options available for dogs with osteoarthritis, as well as an increasing number of clinical trials investigating the efficacy of pre‐existing treatments. This review aims to examine the current evidence behind pharmaceutical treatment options for canine osteoarthritis, including non‐steroidal anti‐inflammatory drugs, piprants, monoclonal antibodies, adjunctive analgesics, structure modifying osteoarthritis drugs and regenerative therapies.

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“…Это важный факт, указывающий на целесообразность применения ВСИ ГК как средства первой линии для локальной терапии ОА -учитывая низкую стоимость (в сравнении с препаратами ГлК) и удобство применения (однократное введение) этого метода. Полученные нами данные хорошо согласуются с многочисленными сравнениями лечебного потенциала ВСИ ГК и ВСИ ГлК, которые демонстрируют однозначное преимущество препаратов ГлК спустя 6 и более месяцев после проведенного курса [5,16].…”

Section: рис 3 динамика функциональных нарушений (по чрш)unclassified

“…Согласно результатам недавно опубликованного метаанализа, проведенного A. Najm и соавт. [5], включавшего данные 15 рандомизированных контролируемых исследований (РКИ) при ОА КС, эффективность ВСИ ГК в первые 6 недель после манипуляции превосходила действие ВСИ препаратов гиалуроновой кислоты (ГлК), нестероидных противовоспалительных препаратов (НПВП) и физиотерапии. Стандартизированное различие средних (SMD) составило для ВСИ ГК в отношении снижения боли -0.61 (95%-й доверительный интервал (ДИ): -1,25; 0,03), в отношении уменьшения функциональных нарушений --1,02 (95% ДИ: -2,14; 0,10).…”

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Evaluation of the effectiveness of intra-articular injections of glucocorticoids in knee synovitis in patients with rheumatic diseases in real clinical practice

Karateev¹,

Нестеренко²,

Bialik³

et al. 2022

Naučno-praktičeskaâ revmatologiâ

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Intra-articular injections of glucocorticoids are widely used in the complex therapy of rheumatic diseases (RD). However, there is insufficient data on their effectiveness and safety in real clinical practice.The aim of the study – to evaluate the effectiveness of intra-articular injections of glucocorticoids in rheumatic diseases in real clinical practice.Material and methods. The study group consisted of 290 patients with RD, mainly osteoarthritis (OA) and rheumatoid arthritis (RA) (69.0% – women; age – 55.6±12.6 years), who underwent intra-articular injections of glucocorticoids in the knee joint. Indications for intra-articular injections of glucocorticoids were determined by the attending physicians. The control group consisted of 112 patients with OA (71.4% – women; age 59.3±14.6 years) who underwent a course of intra-articular injections of hyaluronic acid. The result of treatment was evaluated in 2 weeks, 1 and 3 months according to a telephone survey.Result. After 2 weeks, 1 month and 3 months after the intra-articular injections of glucocorticoids, the severity of pain during movement decreased (numerical rating scale (NRS) 0–10; Me [25%; 75%]) from 6.0 [4.0; 8.0] to 1,0 [0; 2,0], 2,0 [1,0; 4,0] and 2.5 [1.0; 4.0] respectively (p<0.001). After 3 months, the number of patients with no pain or mild pain (<4 NRS) was 63.8%, with complete/almost complete absence of pain (≤1 NRS) – 30.3%. The effect of intraarticular injections of glucocorticoids was higher in RA than in OA: pain dynamics after 3 months –4.0 [–2.0; –6.0] and –2.0 [–1.0; –5.0] respectively (p=0.003). In OA, the effect of intra-articular injections of glucocorticoids and of hyaluronic acid did not differ: the dynamics of pain after 3 months was –2.0 [–1.0; –5.0] and –3.0 [–1.0; –5.0] respectively (p=0.869). No serious adverse reactions were noted at intra-articular injections of glucocorticoids.Conclusions. Intra-articular injections of glucocorticoids are an effective and fairly safe method of short-term treatment of synovitis in rheumatic diseases.

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

Cited by 35 publications

References 32 publications

Pharmacokinetics, safety and efficacy of intra‐articular non‐steroidal anti‐inflammatory drug injections for the treatment of osteoarthritis: A narrative review

Pharmacokinetics, safety and efficacy of intra‐articular non‐steroidal anti‐inflammatory drug injections for the treatment of osteoarthritis: A narrative review

Advances in the pharmaceutical treatment options for canine osteoarthritis

Evaluation of the effectiveness of intra-articular injections of glucocorticoids in knee synovitis in patients with rheumatic diseases in real clinical practice

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