Intra-Articular Corticosteroid Injections to Manage Trapeziometacarpal Osteoarthritis—a Systematic Review

Fowler, Andrew; Swindells, Mark G.; Burke, F. D.

doi:10.1007/s11552-015-9778-3

Cited by 32 publications

(20 citation statements)

References 33 publications

(113 reference statements)

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“…The existing evidence base suggests that a majority of patients who present with painful base of thumb osteoarthritis avoid surgical intervention 4 21 22. However, it remains unclear as to which specific non-surgical interventions add value due to the significant methodological problems with the studies that have been carried out in this area 6 7 23. As a result, it is likely that the non-operative management of base of thumb osteoarthritis is highly variable, much as the surgical management appears to be 24.…”

Section: Discussionmentioning

confidence: 99%

Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis

et al. 2019

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ObjectiveTo evaluate the effectiveness of injection-based therapy in base of thumb osteoarthritis.DesignSystematic review and meta-analysis.Data sourcesMEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO were searched from inception to 22 May 2018.Study selectionRandomised controlled trials (RCTs) and non-RCTs of adults with base of thumb osteoarthritis investigating an injection-based intervention with any comparator/s.Data extraction and analysisData were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random-effects model for short-term and medium-term follow-up.ResultsIn total, 9 RCTs involving 504 patients were identified for inclusion. All compared different injection-based therapies with each other, no studies compared an injection-based therapy with a non-injection-based intervention. Twenty injection-based intervention groups were present within these nine trials, consisting of hyaluronic acid (n=9), corticosteroid (n=7), saline placebo (n=3) and dextrose (n=1). Limited meta-analysis was possible due to the heterogeneity in the injections and outcomes used, as well as incomplete outcome data. Meta-analysis of two RCTs (92 patients) demonstrated reduced Visual Analogue Scale pain on activity with corticosteroid versus hyaluronic acid (mean difference (MD) −1.32, 95% CI −2.23 to −0.41) in the medium term, but no differences in other measures of pain or function in the short term and medium term. Overall, the available evidence does not suggest that any of the commonly used injection therapies are superior to placebo, one another or a non-injection-based comparator.ConclusionCurrent evidence is equivocal regarding the use of injection therapy in base of thumb osteoarthritis, both in terms of which injection-based therapy is the most effective and in terms of whether any injection-based therapy is more effective than other non-injection-based interventions. Given limited understanding of both the short-term and long-term effects, there is a need for a large, methodologically robust RCT investigating the commonly used injection therapies and comparing them with other therapeutic options and placebo.PROSPERO registration numberCRD42018095384.

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Section: Discussionmentioning

confidence: 99%

Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis

et al. 2019

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“…Despite the high prevalence of TMJ OA, in the literature there are a limited number of controlled studies comparing the efficacy of i.a. HA vs steroid and the results are often controversial [ 10 ]. The great heterogeneity of the clinical trials makes the definitive considerations difficult: indeed, the studies differ for methodology and protocol design, outcome measures, treatment (different formulations of HA and schedules) and times of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Corticosteroid injections are a mainstay of therapy in OA, especially for patients with pain refractory to oral treatments, although their use is limited by their potential adverse effects [ 8 , 9 ]. Into the TMJ, steroid injections can lead to significant short-term benefits, such as pain relief and improved function, particularly from 1 to 3 months post-administration [ 10 ]. HA, that belongs to the glycosaminoglycan family, is the main component of the cartilage matrix in normal joints and it’s responsible of lubrification, shock absorption and visco-elastic properties of synovial fluid (SF).…”

Section: Introductionmentioning

confidence: 99%

Can hybrid hyaluronic acid represent a valid approach to treat rizoarthrosis? A retrospective comparative study

Tenti

Pascarelli

Giannotti

et al. 2017

BMC Musculoskelet Disord

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BackgroundOsteoarthritis (OA) of the trapeziometacarpal joint (TMJ) is a disabling condition with a significant impact on quality of life. The optimal management of hand OA requires a combination of non-pharmacological and pharmacological treatments that include intra-articular (i.a.) therapy. EULAR experts recommend corticosteroid injections in TMJ OA and underline the usefulness of hyaluronic acid (HA). The aim of this study was the assessment of the efficacy and tolerability of i.a. injections of a hybrid formulation of HA (Sinovial H-L®) in comparison to triamcinolone in patients with TMJ OA.MethodsThis 6-months observational comparative study, retrospective analyzed the medical records of 100 patients with monolateral or bilateral TMJ OA, treated with two injections of Sinovial H-L® (Sinovial H-L Group) or of triamcinolone acetonide (Triamcinolone Group). Clinical assessments were recorded at the time of the first and second injection and after one, 3 and 6 months.The primary outcomes were the change in global pain on a Visual Analogue Scale (VAS) and in hand function evaluated by the Functional Index for Hand OA (FIHOA) from baseline to month 6. Secondary outcomes were the improvement of the duration of morning stiffness, Health Assessment Questionnaire (HAQ) and the Medical Outcomes Study 36-Item Short Form (SF-36). The comparison between the two groups of treatment were performed with the Wilcoxon rank-sum test for continuous variables and with chi-square or Fisher exact test for categorical variables. Statistical significance was set at p < 0.05.ResultsBoth therapies provided effective pain relief and joint function improvement, but the benefits achieved were statistically significantly superior in the Sinovial H-L Group than the Triamcinolone Group after one month (p < 0.01) from the beginning of the therapy and during the 6-months follow-up (p < 0.001). Furthermore, Sinovial H-L® was associated with a significant decrease in the duration of morning stiffness and with a significant improvement in the HAQ score and physical component summary (PCS)-SF-36.ConclusionsOur results suggested that the hybrid formulation of HA may be more effective than triamcinolone in pain relief and joint function improvement with a rapid and persistent effect, resulting a valid alternative to steroid in the management of TMJ OA.Trial registrationClinicalTrials.gov, date of registration: June 14, 2017, NCT03200886. The present trial was retrospectively registered.

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“…The results regarding strength measures are interesting yet have been seen elsewhere: in prior BJA treatment studies, it is often the case that those studies that combine pain and strength measures often find conflicting results. 40,41 Though exceptions exist, patients generally seek relief of pain over restoration of strength when undergoing treatment for BJA, and thus pain relief is cited as proof of a favorable outcome.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Disease-Specific Questionnaire for Basal Joint Arthritis

et al. 2016

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The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is the most commonly used instrument to assess outcomes of basal joint arthritis (BJA). However, the DASH is subject to influence by the entire upper extremity. This study aims to develop and validate a disease-specific questionnaire for BJA that would be more sensitive to changes in thumb function and pain, and correlate better with objective and subjective metrics. The thumb disability examination (TDX) was developed and 80 patients presenting with BJA at one of the two hospital-based hand clinics were enrolled in the validation study. At enrollment, subjects were given the TDX, DASH, and visual analog pain scale with activity (A-VAS) surveys. The strength was assessed. Patients receiving corticosteroid injection were seen for follow-up at 6 weeks and those who underwent surgery were seen between 3 and 6 months postoperatively. Both the groups were given the TDX, DASH, and A-VAS scales at follow-up. In total, 65 subjects were included in the analysis. Average TDX completion time was 134.3 seconds. The TDX correlated more strongly with A-VAS scores at baseline than the DASH, but less strongly with tip-pinch measures. The TDX was more responsive to injection and surgical treatments for BJA than the DASH, yielding a larger effect size and standardized response mean, and was the only instrument to significantly correlate with changes in A-VAS. The TDX is a reliable instrument for assessing BJA treatment outcomes. It bears less of a burden on patients, is more responsive to symptomatic changes, and correlates better with most objective and subjective measures than the DASH. II, diagnostic.

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Intra-Articular Corticosteroid Injections to Manage Trapeziometacarpal Osteoarthritis—a Systematic Review

Cited by 32 publications

References 33 publications

Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis

Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis

Can hybrid hyaluronic acid represent a valid approach to treat rizoarthrosis? A retrospective comparative study

Development and Validation of a Disease-Specific Questionnaire for Basal Joint Arthritis

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