Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis.
Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis.
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DOI：
10.3899/jrheum.171385
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Lapane KL
中科院分区：
文献类型：
--
作者：
Liu SH;Dubé CE;Eaton CB;Driban JB;McAlindon TE;Lapane KL
我们研究了皮质类固醇或透明质酸注射在缓解膝骨关节炎（OA）患者症状方面的长期有效性。使用骨关节炎倡议（OAI）的数据，采用新用户设计来识别开始使用皮质类固醇或透明质酸注射的参与者（n=412）。使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）测量膝关节症状（疼痛、僵硬、功能）。我们使用调整时变混杂因素的边际结构模型来估计新开始注射与非注射者在两年随访期间对症状的影响。在412名开始注射的参与者中，77.2%使用皮质类固醇注射，22.8%使用透明质酸注射。大约18.9%的患者在启动后使用了额外的注射，但在注射类型之间切换很常见。与非使用者相比，在边际结构模型调整潜在混杂因素后，平均而言，开始皮质类固醇注射的参与者经历了疼痛（年加重：1.24点；95%可信区间[95% CI]: 0.82至1.66）、僵硬（年加重：0.30点；95% CI: 0.10至0.49）和身体功能（年加重：2.62点；95% CI: 0.94至4.29）的恶化。开始注射透明质酸的参与者没有表现出WOMAC亚量表的改善（疼痛：0.50,95% CI: - 0.11至1.11，僵硬：- 0.07,95% CI: - 0.38至0.24，功能：0.49,95% CI: - 1.34至2.32）。尽管在短期临床试验中，关节内注射可能支持减轻症状的有效性，但在两年的随访中，皮质类固醇或透明质酸注射似乎并没有提供持续的症状缓解。
We examined the long-term effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA). Using Osteoarthritis Initiative (OAI) data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injection use (n=412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect of newly initiated injection use compared to non-users on symptoms over two years of follow-up. Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. Approximately 18.9% had additional injections use after initiation, but switching between injection types was common. Compared to non-users, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points; 95% confidence interval [95% CI]: 0.82 to 1.66), stiffness (yearly worsening: 0.30 points; 95% CI: 0.10 to 0.49), and physical functioning (yearly worsening: 2.62 points; 95% CI: 0.94 to 4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50; 95% CI: −0.11 to 1.11, stiffness: −0.07; 95% CI: −0.38 to 0.24, and functioning: 0.49; 95% CI: −1.34 to 2.32). Although intra-articular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptoms relief over two years of follow-up for persons with knee OA.
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