Are multiple intra-articular corticosteroid injections effective for osteoarthritis pain?

  • Ayub S & al.
  • Rheumatology (Oxford)
  • 12 Jan 2021

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Study design

  • 6 randomised controlled trials (RCTs) were included for efficacy assessment and 16 studies (14 RCTs; 2 observational studies) for safety assessment.
  • Funding: None.

Key results

  • 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.

Limitations

  • Heterogeneity among RCTs.