OBJECTIVE: To evaluate the efficacy of intra--articular (IA) glucocorticoid for knee or hip osteoarthritis (OA) in specific subgroups of patients according to the baseline severity of pain and inflammatory signs using individual patient data (IPD) from existing trials. Furthermore, this study aims to assess if a baseline pain cut-off was associated with clinically important effectiveness of IA glucocorticoid. This is an update of an IA glucocorticoid IPD meta-analysis by the OA Trial Bank.
METHOD: Randomized trials evaluating one or more IA glucocorticoid preparations in hip and knee OA, published to May 2018 were selected. IPD of patient and disease characteristics and outcome measures were acquired. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). Potential interaction effect of severe pain (≥70 points, 0-100 scale) and signs of inflammation at baseline were studied using a two-stage approach with general liner model followed by random effects model. Analysis of trend was conducted, assessing if a baseline pain cut-off was associated with the threshold for clinically important treatment effect of IA glucocorticoid compared to placebo.
RESULTS: Four out of 16 eligible randomized clinical trials (n = 641) were combined with the existing OA Trial Bank studies (n = 620), yielding 1261 participants from eleven studies. Participants with severe baseline pain compared to those with less severe pain had greater pain reduction at mid-term (around 12 weeks) (mean reduction: -6.90 (95%CI -10.91; -2.90)), but not at short- and long-term. No interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo at all follow-up time-points. Analysis of trend demonstrated treatment response to IA glucocorticoid from baseline pain levels >50 (0-100 scale) and above.
CONCLUSION: This updated IPD meta-analysis demonstrated that participants with severe pain compared to those with less severe pain at baseline experienced significantly more pain relief with IA glucocorticoid compared with placebo at mid-term.
Purpose. The aim of this current review was to confirm the efficacy of intra-articular steroid therapy (IAST) for patients with hip osteoarthritis (OA) and discuss the duration and influential factors of IAST. Methods. Online databases (Medline, EMBASE, and Web of Science) were searched from inception to May 2019. Both randomized controlled trials (RCTs) and noncontrolled trials assessing the efficacy of hip IAST on pain were included. Common demographics data were extracted using a standardized form. Quality was assessed on the basis of Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. Results. 12 trials met the inclusion criteria. According to data from individual trials, IAST had significant efficacy on hip OA in both immediate and delay pain reduction, which persisted up to 12 weeks after IAST. The influences of the baseline severity of hip OA or synovitis and injection dose or volume on the clinical outcome of IAST were still controversial. The IAST appeared to be well tolerant by most of the participants. Conclusion. IAST was proved to be an efficacious therapy in both immediate and delay pain reduction for hip OA patients within 12 weeks. The longer follow-up data of efficacy and safety and potentially influential factors are still unclear and needed further confirmation.
OBJETIVO: Las directrices internacionales recomiendan inyecciones intra-articulares de esteroides (IASI) en el manejo de la osteoartritis de cadera (OA), aunque estas recomendaciones se extrapolan principalmente a partir de estudios de OA de rodilla. El objetivo de esta revisión sistemática fue evaluar la eficacia de IASI sobre el dolor en la OA de cadera. MÉTODOS: Se realizaron búsquedas en Mayo de 2015 en MEDLINE, EMBASE, AMED, CINAHL Plus, Web of Science y el Registro Central Cochrane de Ensayos Controlados. Se incluyeron Ensayos Controlados Aleatorios (ECAs) que evaluaron la eficacia del IASI de cadera en el dolor. Los datos pre-especificados se extrajeron utilizando un formulario estandarizado. La calidad fue evaluada usando la puntuación de Jadad. Resultados: Cinco ensayos cumplieron los criterios de inclusión. Todos tenían un pequeño número de participantes (≤101). Todos los estudios informaron alguna reducción en el dolor a las 3-4 semanas después de la inyección en comparación con el control. Basándose en los datos de ensayos individuales, el tamaño del efecto del tratamiento fue grande una semana después de la inyección pero disminuyó a partir de entonces. Se informó una reducción significativa del efecto (tamaño de efecto moderado) en dos ensayos hasta 8 semanas después del IASI. Los resultados combinados de dos ensayos (n = 90) mostraron un aumento en la probabilidad de cumplir los criterios de respuesta a las 8 semanas post-IASI, el cociente de probabilidades 7,8 (confianza del 95% Intervalo (CI): 2,7-22,8). El número necesario para tratar para lograr un respondedor OMERACT-OARSI a las 8 semanas después de la inyección fue de 2,4 (IC del 95%: 1,7-4,2). La IASI de cadera parece ser generalmente bien tolerada. CONCLUSIONES: La IASI de cadera puede ser eficaz en la reducción del dolor a corto plazo en aquellos con OA de cadera aunque la calidad de la evidencia fue relativamente pobre. Se requieren más ensayos grandes y metodológicamente rigurosos para verificar si los corticosteroides intra-articulares son beneficiosos y por cuánto tiempo.
OBJECTIVE: To evaluate the efficacy of intra-articular (IA) glucocorticoids for knee or hip osteoarthritis (OA) in specific subgroups of patients with severe pain and inflammatory signs using individual patient data (IPD) from existing trials.
DESIGN: Randomized trials evaluating one or more IA glucocorticoid preparation in patients with knee or hip OA, published from 1995 up to June 2012 were selected from the literature. IPD obtained from original trials included patient and disease characteristics and outcomes measured. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). The subgroup factors assessed included severe pain (≥70 points, 0-100 scale) and signs of inflammation (dichotomized in present or not) at baseline. Multilevel regression analyses were applied to estimate the magnitude of the effects in the subgroups with the individuals nested within each study.
RESULTS: Seven out of 43 published randomized clinical trials (n = 620) were included. Patients with severe baseline pain had a significantly larger reduction in short-term pain, but not in mid- and long-term pain, compared to those with less severe pain at baseline (Mean Difference 13.91; 95% Confidence Interval 1.50-26.31) when receiving IA glucocorticoid injection compared to placebo. No statistical significant interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo and to tidal irrigation at all follow-up points.
CONCLUSIONS: This IPD meta-analysis demonstrates that patients with severe knee pain at baseline derive more benefit from IA glucocorticoid injection at short-term follow-up than those with less severe pain at baseline.
OBJETIVOS: Variaciones en el grado de alivio del dolor informado por los pacientes con osteoartritis después de inyecciones intraarticulares de corticosteroides son bien reconocidos pero las razones de esto no son ampliamente entendidas y factores que podrían predecir variaciones en la respuesta no han sido objeto de revisión sistemática. Nos propusimos realizar una revisión sistemática de la literatura en relación con los predictores de la reducción del dolor después de inyecciones intraarticulares de corticosteroides en pacientes con artrosis de rodilla y cadera.
MÉTODOS: Se realizaron búsquedas en Medline, EMBASE, Web of Knowledge y la búsqueda MeSH de PubMed, la última búsqueda se realizó en agosto de 2012. Los términos de búsqueda incluyeron artrosis de rodilla, artrosis de cadera, términos corticosteroides y productos relacionados, y la inyección intra-articular. Los trabajos fueron seleccionados y revisados por 2 colaboradores. Para la inclusión, se requieren papeles para describir estudios en los que los pacientes con osteoartritis de la rodilla o cadera recibieron la inyección de corticosteroides intraarticular como una intervención, contienen claros indicadores de medidas de resultado relacionadas con el dolor y contener el análisis en relación con predictores de la respuesta clínica al tratamiento.
RESULTADOS: Veintiún estudios cumplieron los criterios de inclusión de un total de 54 artículos revisados en su totalidad. Ocho de ellos relacionados con la artrosis de cadera y 13 en relación con OA de rodilla. No hay factores que fueron investigados como posibles factores predictivos de respuesta, incluyendo la evidencia radiográfica de grado y clínica o ecográfica de la inflamación o hipertrofia sinovial fueron apoyados por pruebas sólidas. El estudio también identificó que varios predictores potenciales plausibles no habían sido estudiados hasta la fecha.
CONCLUSIONES: La investigación previa no ha identificado predictores confiables de respuesta a las inyecciones de corticosteroides IA, una intervención ampliamente practicada en la OA de rodilla y cadera. Se requieren estudios adicionales si esta pregunta se responde.
To evaluate the efficacy of intra--articular (IA) glucocorticoid for knee or hip osteoarthritis (OA) in specific subgroups of patients according to the baseline severity of pain and inflammatory signs using individual patient data (IPD) from existing trials. Furthermore, this study aims to assess if a baseline pain cut-off was associated with clinically important effectiveness of IA glucocorticoid. This is an update of an IA glucocorticoid IPD meta-analysis by the OA Trial Bank.
METHOD:
Randomized trials evaluating one or more IA glucocorticoid preparations in hip and knee OA, published to May 2018 were selected. IPD of patient and disease characteristics and outcome measures were acquired. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). Potential interaction effect of severe pain (≥70 points, 0-100 scale) and signs of inflammation at baseline were studied using a two-stage approach with general liner model followed by random effects model. Analysis of trend was conducted, assessing if a baseline pain cut-off was associated with the threshold for clinically important treatment effect of IA glucocorticoid compared to placebo.
RESULTS:
Four out of 16 eligible randomized clinical trials (n = 641) were combined with the existing OA Trial Bank studies (n = 620), yielding 1261 participants from eleven studies. Participants with severe baseline pain compared to those with less severe pain had greater pain reduction at mid-term (around 12 weeks) (mean reduction: -6.90 (95%CI -10.91; -2.90)), but not at short- and long-term. No interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo at all follow-up time-points. Analysis of trend demonstrated treatment response to IA glucocorticoid from baseline pain levels >50 (0-100 scale) and above.
CONCLUSION:
This updated IPD meta-analysis demonstrated that participants with severe pain compared to those with less severe pain at baseline experienced significantly more pain relief with IA glucocorticoid compared with placebo at mid-term.
Pregunta de la revisión sistemática»Revisión sistemática de intervenciones
