Is injection therapy effective for base of thumb osteoarthritis?

  • Riley N & al.
  • BMJ Open
  • 11 Sep 2019

  • 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 current 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 whether any injection-based therapy is more effective than other non-injection-based interventions.
  • Large randomised controlled trials (RCTs) are required to investigate the commonly used injection therapies and compare them with other therapeutic options and placebo.

Why this matters

  • Base of thumb osteoarthritis is a common condition associated with pain, dysfunction, and disability.
  • Findings suggest that the majority of patients with painful base of thumb osteoarthritis avoid surgical intervention. However, it remains unclear as to which specific non-surgical interventions add value.

Study design

  • Meta-analysis of 9 RCTs involving 504 patients evaluated the efficacy of injection-based therapy in base of thumb osteoarthritis.
  • Outcome: patient-reported pain and function (tip pinch strength and grip strength).
  • Funding: BMA’s Doris Hillier Arthritis and Rheumatism grant.

Key results

  • The study involved total 20 injection-based intervention groups (hyaluronic acid [n=9], corticosteroid [n=7], saline placebo [n=3] and dextrose [n=1]).
  • Two RCTs (n=92) demonstrated reduced Visual Analogue Scale pain on activity with corticosteroid vs hyaluronic acid (mean difference, −1.32; 95% CI, −2.23 to −0.41; P=.005) in the medium term.
  • No difference in hand function was observed in the short and medium-term.
  • No adverse events were found for any trial interventions.

Limitations

  • Meta-analysis included small and single-centre studies.
  • Lack of sufficient outcome data.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit