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Revisión sistemática

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Efficacy of intra-articular corticosteroid injections in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Revista Joint bone spine
Año 2021
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Este artículo incluye 23 Estudios primarios 23 Estudios primarios (23 referencias)

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Revisión sistemática

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The Impact of Excluding Patients with End-Stage Knee Disease in Intra-Articular Hyaluronic Acid Trials: A Systematic Review and Meta-Analysis

Revista Advances in Therapy
Año 2019
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 20 Estudios primarios 20 Estudios primarios (20 referencias)

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Introduction: The Kellgren–Lawrence (K–L) grade is the most commonly used measure of radiographic disease severity in knee osteoarthritis (OA). Studies suggest that intra-articular hyaluronic acid (IA-HA) should only be considered in cases of early stage knee OA. The purpose of this review was to determine if trials administering IA-HA in early-moderate knee OA patients demonstrated greater pain relief than studies that also included patients with end-stage disease. Methods: We conducted a systematic search of the literature to identify randomized controlled trials (RCT) comparing IA-HA with saline injections and that diagnosed disease severity using the K–L grade criteria. The primary outcome was mean change in pain from baseline at 4–13 weeks and 22–27 weeks. Safety was evaluated on the total number of participants experiencing a treatment-related adverse event (AE). Results: Twenty RCTs were included. In the early-moderate OA subgroup, the mean change in pain scores was statistically significant favoring IA-HA from baseline to 4–13 weeks [SMD = − 0.30, 95% CI − 0.44 to − 0.15, p < 0.0001] and within 22–27 weeks [SMD = − 0.27, 95% CI − 0.39 to − 0.16, p < 0.00001]. No significant differences were observed in the late OA subgroup. IA-HA was associated with a significantly greater risk of treatment-related AEs relative to saline in the late OA subgroup [RR = 1.76, 95% CI 1.16–2.67, p = 0.008]. Conclusion: IA-HA provides significant pain relief compared to saline for patients with early-moderate knee OA, compared to cohorts including patients with end-stage OA (KL grade 4), with no increase in the risk of treatment-related AEs, up to 6 months. Patients with end-stage disease had lower levels of pain relief and may be diluting study results if included in the treatment cohort. Funding: Ferring Pharmaceuticals. © 2018, The Author(s).

Revisión sistemática

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Comparison of intra-articular hyaluronic acid and methylprednisolone for pain management in knee osteoarthritis: A meta-analysis of randomized controlled trials.

Autores Ran J , Yang X , Ren Z , Wang J , Dong H
Revista International journal of surgery (London, England)
Año 2018
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Este artículo incluye 5 Estudios primarios 5 Estudios primarios (5 referencias)

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OBJECTIVE: We performed a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of intra-articular methylprednisolone and hyaluronic acid (HA) in term of pain reduction and improvements of knee function in patients with knee osteoarthritis (OA). MATERIALS AND METHODS: The PubMed, EMBASE, ScienceDirect, and Cochrane Library databases were systematically searched for literature up to January 2018. RCTs involving HA and methylprednisolone in knee OA were included. Two independent reviewers performed independent data abstraction. The I RESULTS: Five RCTs with 1004 patients were included in the meta-analysis. The present meta-analysis indicated that there were no significant differences in terms of WOMAC pain, physical function and stiffness at 4 week, 12 weeks and 26 weeks between HA and methylprednisolone groups. No increased risk of adverse events were identified in both groups. CONCLUSION: Both HA and methylprednisolone injections were effective therapies for patients with knee OA. Methylprednisolone showed comparable efficacy in reducing pain and improving functional recovery to HA. And no significant difference was found in long-term of follow-up in terms of adverse effects.

Revisión sistemática

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Mixed Treatment Comparisons for Nonsurgical Treatment of Knee Osteoarthritis: A Network Meta-analysis.

Revista The Journal of the American Academy of Orthopaedic Surgeons
Año 2018
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Este artículo incluye 52 Estudios primarios 54 Estudios primarios (52 referencias)

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INTRODUCTION: Knee osteoarthritis (KOA) is a significant health problem with lifetime risk of development estimated to be 45%. Effective nonsurgical treatments are needed for the management of symptoms. METHODS: We designed a network meta-analysis to determine clinically relevant effectiveness of nonsteroidal anti-inflammatory drugs, acetaminophen, intra-articular (IA) corticosteroids, IA platelet-rich plasma, and IA hyaluronic acid compared with each other as well as with oral and IA placebos. We used PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to perform a systematic search of KOA treatments with no date limits and last search on October 7, 2015. Article inclusion criteria considered the following: target population, randomized controlled study design, English language, human subjects, treatments and outcomes of interest, ≥30 patients per group, and consistent follow-up. Using the best available evidence, two abstractors independently extracted pain and function data at or near the most common follow-up time. RESULTS: For pain, all active treatments showed significance over oral placebo, with IA corticosteroids having the largest magnitude of effect and significant difference only over IA placebo. For function, no IA treatments showed significance compared with either placebo, and naproxen was the only treatment showing clinical significance compared with oral placebo. Cumulative probabilities showed naproxen to be the most effective individual treatment, and when combined with IA corticosteroids, it is the most probable to improve pain and function. DISCUSSION: Naproxen ranked most effective among conservative treatments of KOA and should be considered when treating pain and function because of its relative safety and low cost. The best available evidence was analyzed, but there were instances of inconsistency in the design and duration among articles, potentially affecting uniform data inclusion.

Revisión sistemática

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Systematic clinical evidence review of NASHA (Durolane hyaluronic acid) for the treatment of knee osteoarthritis.

Revista Open access rheumatology : research and reviews
Año 2018
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 11 Estudios primarios 11 Estudios primarios (11 referencias)

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BACKGROUND: Pain and limitations in joint mobility associated with knee osteoarthritis (OA) are clinically challenging to manage, and advanced progression of disease can often lead to total knee arthroplasty. Intra-articular injection of hyaluronic acid (HA), also referred to as viscosupplementation, is a non-surgical treatment approach for OA, the effectiveness of which may depend on the HA composition, and the length of time over which it resides in the joint. One of the available options for such therapies includes NASHA (Durolane HA), a non-animal, biofermentation-derived product, which is manufactured using a process that stabilizes the HA molecules to slow down their rate of degradation and produce a unique formulation with a terminal half-life of ~1 month. The objectives of the current review were to assess, in patients with OA of the knee, the efficacy and safety of intra-articular treatment with NASHA relative to control (saline) injections, other HA products, and other injectables (corticosteroids, platelet-rich plasma, mesenchymal stem cells). METHODS: This systematic evidence review examines patient outcomes following NASHA treatment as described in published data from studies conducted in subjects with knee OA. A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant literature search strategy yielded 11 eligible clinical studies with a variety of comparator arms. Outcomes assessed at various time points following intra-articular treatment included measures of pain, function, quality of life, and incidence of treatment-related adverse events (AEs). RESULTS: The available evidence reported for the clinical studies assessed demonstrates sustained and effective relief of knee OA symptoms following a single injection of NASHA. In addition, an excellent biocompatibility profile is observed for NASHA as an intra-articular therapy for OA, as reflected by the low rate of AEs associated with treatment. CONCLUSION: Treatment with NASHA is an effective and safe single-injection procedure, which can be beneficial in the clinical management of knee OA.

Revisión sistemática

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Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review.

Revista Seminars in arthritis and rheumatism
Año 2018
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Este artículo incluye 17 Estudios primarios 17 Estudios primarios (17 referencias)

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INTRODUCTION: Hyaluronic acid (HA) is a commonly prescribed intra-articular (IA) therapy for knee osteoarthritis (OA). While a single series of IA-HA has been well studied, the efficacy and safety of repeated courses of IA-HA injection therapy in knee OA patients have not been evaluated as frequently. METHODS: A literature search was conducted using MEDLINE, EMBASE and PubMed databases. The primary outcome measure was knee pain reduction after each treatment course and/or last reported follow-up visit. Secondary outcomes were treatment-related adverse events (AEs) and serious adverse events (SAEs). RESULTS: A total of 17 articles (7 RCTs and 10 cohort studies) met the pre-defined inclusion criteria. Of the RCTs, six were double-blind with two trials including open label extension studies, and one was single-blind. Studies ranged from investigating a single reinjection cycle to four repeat injection cycles. Eleven studies evaluated one reinjection, five studies evaluated ≥2 repeated courses of IA-HA, and one study allowed either one or two repeated courses. All studies reported pain reduction from baseline in the IA-HA treatment group throughout the initial treatment cycle, and either sustained or further reduced pain throughout the repeated courses of treatment. The study with the longest follow-up repeated IA-HA injection every 6 months for 25 months. Pain decreased after the first course and continued to decrease until the end of the study, with an approximate 55% reduction in pain compared to baseline. Common AEs were joint swelling and arthralgia; there were no reported SAEs. All repeated courses were well tolerated, and the number of documented AEs and SAEs was similar to the primary injection regimens. CONCLUSION: Repeated courses of IA-HA injections are an effective and safe treatment for knee OA. Repeat courses were demonstrated to maintain or further improve pain reduction while introducing no increased safety risk.

Revisión sistemática

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Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: A systematic review and meta-analysis.

Autores Tian K , Cheng H , Zhang J , Chen K
Revista Medicine
Año 2018
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 4 Estudios primarios 4 Estudios primarios (4 referencias)

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BACKGROUND: To evaluate the efficacy and safety of intra-articular methylprednisolone for reducing pain in patients with knee osteoarthritis. METHODS: We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11), and the Cochrane Library (1900-2017.11) for randomized clinical trials comparing the use of methylprednisolone to treat knee osteoarthritis. The primary outcomes are Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and WOMAC function scores. Each outcome was combined and calculated using the statistical software STATA 12.0. Fixed/random effect model was adopted based on the heterogeneity tested by I statistic. RESULTS: A total of 739 patients were analyzed across 4 randomized controlled trials (RCTs). The present meta-analysis revealed that there were significant differences between groups regarding the WOMAC pain scores at 4 weeks (WMD = -1.384, 95% CI: -1.975 to -0.793, P = .000), 12 weeks (WMD = -1.587, 95% CI: -2.489 to -0.685, P = .001), and 24 weeks (WMD = -1.563, 95% CI: -2.245 to -0.881, P = .000). Significant differences were identified in terms of physical function at 4 weeks (WMD = -7.925, 95% CI: -13.359 to -2.491, P = .004), 12 weeks (WMD = -7.314, 95% CI: -13.308 to -1.320, P = .117), and 24 weeks (WMD = -6.484, 95% CI: -11.256 to -1.711, P = .008). CONCLUSION: Intra-articular methylprednisolone injection was associated with an improved pain relief and physical function in patients with knee osteoarthritis. Additionally, no severe adverse effects were observed. Due to the limited quality of the evidence currently available, higher quality RCTs were required.

Revisión sistemática

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The efficacy of multiple versus single hyaluronic acid injections: A systematic review and meta-analysis

Revista BMC musculoskeletal disorders
Año 2017
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 30 Estudios primarios 30 Estudios primarios (30 referencias)

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Background: Intra-articular hyaluronic acid (IA-HA) is a common therapy used to treat knee pain and suppress knee inflammation in knee osteoarthritis (OA), typically prescribed in regimens ranging from a single injection to 5 weekly injections given once weekly. We conducted a systematic review to determine the efficacy of IA-HA, with subgroup analyses to explore the differences in knee pain and adverse events (AEs) across different dosing regimens. Methods: We conducted a systematic search of the literature to identify studies evaluating IA-HA for the management of knee OA compared to IA-saline. Primary outcome measure was the mean knee pain score at 13 Weeks (3 months) or 26 weeks (6 months). Secondary outcome was the number of treatment-related AEs and treatment-related serious adverse events (SAEs). We evaluated differences in levels of pain and AEs/SAEs between dosing regimens compared to IA-Saline. Results: Thirty articles were included. Overall, IA-HA injections were associated with less knee pain compared to IA-Saline injections for all dosing regimens. 2-4 injections of IA-HA vs. IA-Saline produced the largest effect size at both 3-months and 6-months (Standard mean difference [SMD] = -0.76; -0.98 to -0.53, 95% CI, P < 0.00001, and SMD = -0.36; -0.63 to -0.09 95% CI, P = 0.008, respectively). Additionally, single injection studies yielded a non-significant treatment effect at 3 and 6 months, while ≥5 5 injections demonstrated a significant improvement in pain only at 6 months. Five or more injections of IA-HA were associated with a higher risk of treatment-related AEs compared to IA-Saline (Risk ratio [RR] = 1.67; 1.09 to 2.56 95% CI, p = 0.02), which was a result not seen within the 1 and 2-4 injection subgroups. Conclusion: Overall, 2-4 and ≥5 injection regimens provided pain relief over IA-Saline, while single injection did not. Intra-articular injections of HA used in a 2-4 injection treatment regimen provided the greatest benefit when compared to IA-Saline with respect to pain improvement in patients with knee OA, and was generally deemed safe with few to no treatment-related AEs reported across studies. Future research is needed to directly compare these treatment regimens. © 2017 The Author(s).

Revisión sistemática

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Eficacia de 3 inyecciones semanales en comparación con 5 inyecciones semanales de hialuronato de sodio intra-articular en el alivio del dolor de la osteoartritis de rodilla o 3 inyecciones semanales de otros productos de hialuronano: una revisión sistemática y metanálisis.

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Revista Archives of Physical Medicine & Rehabilitation
Año 2017
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Este artículo incluye 24 Estudios primarios 24 Estudios primarios (24 referencias)

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Objetivo Investigar si el número de inyecciones de ácido hialurónico (HA) en un tratamiento con hialuronato de sodio (Hyalgan) altera la efectividad en la reducción del dolor de la osteoartritis de rodilla (OA). Fuentes de datos Las bases de datos electrónicas, incluyendo PubMed y Embase, se registraron desde enero de 1980 hasta noviembre de 2015. Selección del estudio Se incluyeron estudios clínicos que evaluaron la eficacia de un curso de 3 o 5 inyecciones intraarticulares semanales de Hyalgan para tratar el dolor de OA de rodilla. También incluimos estudios clínicos evaluando la efectividad de un curso de 3 semanas de otros tratamientos de HA aprobados por la Administración de Alimentos y Medicamentos (FDA) sobre el dolor de OA en la rodilla. Se identificaron veinticuatro estudios, que incluyeron 2168 participantes del estudio en 30 cohortes tratadas. Extracción de datos Se determinaron los tamaños de efecto para los estudios seleccionados mediante la extracción de las puntuaciones de dolor de OA de rodilla antes y después de HA o tratamientos de control. Las meta-regresiones fueron implementadas para determinar si el número de inyecciones semanales en un curso de terapia de Hyalgan modificó los resultados. Síntesis de datos La estimación agrupada para el alivio del dolor basal fue de -31,4 (SE, 5,46, intervalo de confianza del 95% [IC], -45,5 a -17,4) con un ciclo de 3 semanas de Hyalgan y -32,2 (SE, 5,25; CI, -45,6 a -18,7) con un curso de 5 semanas de Hyalgan. Los hallazgos del metanálisis indican un alivio del dolor de OA de la rodilla con un curso de Hyalgan de 3 semanas es similar al de un curso de Hyalgan de 5 semanas (p = 0,916). La estimación agrupada para el alivio del dolor basal con un curso de 3 semanas de otros productos de HA fue -29,4 (SE, 4,98; IC del 95%, -42,2 a -16,6), indicando también alivio del dolor con un curso de 3 semanas de Hyalgan Similar a la de un curso de 3 semanas de otros productos de HA (P = 0,696). Conclusiones No hubo diferencias estadísticas entre la reducción en el dolor de OA de rodilla con un curso de 3 semanas de Hyalgan en comparación con la reducción en el dolor de OA de rodilla con un curso de 5 semanas de Hyalgan o un curso de 3 semanas de otros productos de HA. Estos hallazgos demuestran que el alivio comparable del dolor de OA de rodilla se logra con un curso de 3 semanas de Hyalgan y los 2 grupos de control.

Revisión sistemática

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Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis.

Revista International Journal of Surgery
Año 2017
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Este artículo incluye 12 Estudios primarios 12 Estudios primarios (12 referencias)

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OBJECTIVE: A meta analysis to compare efficacy and safety of intraarticular hyaluronic acid (HA) and intraarticular corticosteroids (CS) in patients with knee osteoarthritis. METHOD: Potential studies were searched from the electronic databases included PubMed, Embase, web of science and the Cochrane Library up to August 2016. High quality randomized controlled trials (RCTs) were selected based on inclusion criteria. RevMan 5.3 were used for the meta-analysis. RESULTS: 12 RCTs containing 1794 patients meet the inclusion criteria. Visual analog scale (VAS) score in CS group decrease more than HA group up to 1 month (p = 0.03) and it shows equal efficacy at 3 months (p = 0.29); HA is more effective than CS at 6 months (p = 0.006). To Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, there is no significant difference for two groups at 3 months (p = 0.29); HA shows greater relative effect than CS at 6 months (p = 0.005). No significant difference is found on proportion of rescue medication use after initiation of treatment (p = 0.58) and proportion of withdrawal for knee pain (p = 0.54). HA and CS exhibit equal efficacy on improvement of active range of knee flexion at 3 months (p = 0.73) and 6 months (p = 0.43). More topical adverse effects occurred in intraarticular HA group when compared with intraarticular CS group. CONCLUSION: Intraarticular CS is more effective on pain relief than intraarticular HA in short term (up to 1 month), while HA is more effective in long term (up to 6 months). Two therapies benefit similarly for knee function improvement. Both two methods are relatively safe, but intraarticular HA causes more topical adverse effects compared with intraarticular CS.