Is injection therapy effective for base of thumb osteoarthritis?

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

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • 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.


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