- This meta-analysis found that the effect of multiple intra-articular corticosteroid (IACS) injections on pain relief in patients with osteoarthritis (OA) did not appear statistically different from that of the comparator.
- There was some evidence of potentially detrimental effects of multiple IACS injections.
Why this matters
- Efficacy and safety of multiple IACS injections reflecting recommended best practice are yet to be assessed.
- Data from studies with more pragmatic designs will better inform clinical practice.
- 6 randomised controlled trials (RCTs) were included for efficacy assessment and 16 studies (14 RCTs; 2 observational studies) for safety assessment.
- Funding: None.
- Multiple IACS injections appeared more effective in reducing pain than the comparator (standard mean difference [SMD], −0.47; 95% CI, 0.62-0.31). However, there was considerable heterogeneity (I2=92.6%).
- In the subgroup analysis according to varying time points at 6, 12, 26, 52 and 106 weeks, apart from pain reduction at 26 months (SMD, −0.55; 95% CI, −1.06 to −0.05), no difference was seen between IACS and comparator.
- One RCT showed that regular IACS injections given every 3 months for 2 years caused greater cartilage volume loss vs saline injection (mean change in cartilage loss, −0.21 mm vs −0.10 mm).
- One cohort study revealed that multiple IACS injections were associated with worsening of joint space narrowing (HR, 3.02; 95% CI, 2.25-4.05) and increased risk of joint replacement (HR, 2.54; 95% CI, 1.81-3.57).
- Minor local adverse events were similar in both groups.
- Heterogeneity among RCTs.