PURPOSE: The purpose of this study was to quantify and compare the clinical relevance of the different intra-articular corticosteroids (CS) effects in vivo for osteoarthritis (OA) treatment.
METHODS: The search was conducted on PubMed, Cochrane, and Web of Science in October 2023. The PRISMA guidelines were used. Inclusion criteria: animal or human randomized controlled trials (RCTs), English language and no time limitation, on the comparison of different intra-articular CS for OA treatment. The articles' quality was assessed using the Cochrane RoB2 and GRADE guidelines for human RCTs, and SYRCLE's tool for animal RCTs.
RESULTS: Eighteen RCTs were selected (16 human and 2 animal studies), including 1577 patients (1837 joints) and 31 animals (51 joints). The CS used were triamcinolone (14 human and 2 animal studies), methylprednisolone (7 human and 1 animal study), betamethasone (3 human studies) and dexamethasone (1 human study). All studies addressed knee OA except for three human and one animal study. A meta-analysis was performed on the comparison of methylprednisolone and triamcinolone in humans with knee OA analysing VAS pain at very short- (≤2 weeks), short- (>2 and ≤4 weeks), mid- (>4 and ≤8 weeks), long- (>8 and ≤ 12 weeks), and very long-term (>12 and ≤24 weeks). Triamcinolone showed better post-injection values compared to methylprednisolone at very short-term (p = 0.028). No difference in terms of VAS improvement was observed at any follow-up.
CONCLUSIONS: The available preclinical and clinical literature provides limited evidence on the comparison of different CS, hindering the possibility of determining the best CS approach in terms of molecule and dose for the intra-articular injection of OA joints.
LEVEL OF EVIDENCE: Level I.
La eficacia comparativa de diferentes inyecciones de corticosteroides (CS) comúnmente utilizados para tratar enfermedades del sistema osteomuscular no se ha estudiado sistemáticamente. Nuestro objetivo es sintetizar datos sobre eficacia comparativa de diversos CS utilizado para intra-articular y las inyecciones de tejidos blandos periarticulares. Bases de datos en línea se incluyen MEDLINE, el Registro Cochrane Central de Ensayos Controlados, Base de Datos Cochrane de Revisiones Sistemáticas, y base de datos de resúmenes de revisiones de efectividad, y bibliografías de los estudios hasta noviembre de 2013. Se incluyeron todos los ensayos controlados aleatorios que compararon dos CS para intraarticular e inyecciones periarticulares, seleccionados de acuerdo con informes Preferred Artículos para revisiones sistemáticas y meta-análisis metodología. Se seleccionaron siete ensayos de buena calidad para la síntesis de datos cualitativos. Dos ensayos que compararon hexacetónido triamcinolona (TH) y metilprednisolona (MP) para la artritis de rodilla sugirieron un alivio del dolor más rápido con TH para la artritis reumatoide (AR) en el día 7 (p <0,05) y la osteoartritis (OA) en la semana 3 (escala analógica visual, 33 mm vs 14 mm, p <0,01), pero una eficacia similar a largo plazo. Un ensayo indicó el alivio del dolor más rápido con MP en comparación con triamcinolona (TA) para la tendinitis del manguito rotador a las 2 semanas (porcentaje de pacientes mejora de 92% frente a 50%; p = 0,02), pero similar eficacia a largo plazo, mientras que otro ensayo indicó ninguna diferencia entre la AT y MP para la OA de rodilla. Dos ensayos para la artritis de rodilla sugirieron un sustancialmente mejor eficacia para TH de TA (tasa de respuesta a los 24 meses 77% vs 39%; p = 0,001) y la betametasona (BM) en el día 42 (p <0,01). Hay escasez de datos sobre eficacia comparativa de diferentes inyecciones CS. Número limitado de estudios favoreció TH sobre otra CS (TA, MP, BM).
The purpose of this study was to quantify and compare the clinical relevance of the different intra-articular corticosteroids (CS) effects in vivo for osteoarthritis (OA) treatment.
METHODS:
The search was conducted on PubMed, Cochrane, and Web of Science in October 2023. The PRISMA guidelines were used. Inclusion criteria: animal or human randomized controlled trials (RCTs), English language and no time limitation, on the comparison of different intra-articular CS for OA treatment. The articles' quality was assessed using the Cochrane RoB2 and GRADE guidelines for human RCTs, and SYRCLE's tool for animal RCTs.
RESULTS:
Eighteen RCTs were selected (16 human and 2 animal studies), including 1577 patients (1837 joints) and 31 animals (51 joints). The CS used were triamcinolone (14 human and 2 animal studies), methylprednisolone (7 human and 1 animal study), betamethasone (3 human studies) and dexamethasone (1 human study). All studies addressed knee OA except for three human and one animal study. A meta-analysis was performed on the comparison of methylprednisolone and triamcinolone in humans with knee OA analysing VAS pain at very short- (≤2 weeks), short- (>2 and ≤4 weeks), mid- (>4 and ≤8 weeks), long- (>8 and ≤ 12 weeks), and very long-term (>12 and ≤24 weeks). Triamcinolone showed better post-injection values compared to methylprednisolone at very short-term (p = 0.028). No difference in terms of VAS improvement was observed at any follow-up.
CONCLUSIONS:
The available preclinical and clinical literature provides limited evidence on the comparison of different CS, hindering the possibility of determining the best CS approach in terms of molecule and dose for the intra-articular injection of OA joints.
LEVEL OF EVIDENCE:
Level I.
Pregunta de la revisión sistemática»Revisión sistemática de intervenciones
