Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis
Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis
复制标题
DOI：
10.1007/s00167-018-5071-7
复制
发表时间：
2019-06-01
影响因子：
3.8
通讯作者：
Bhandari, Mohit
中科院分区：
文献类型：
--
作者：
Smith, Christopher;Patel, Rahil;Bhandari, Mohit
目的关节内注射皮质类固醇（CS）和透明质酸（HA）已分别证实对膝关节骨关节炎（OA）的疗效;然而，这两种治疗方法都受到症状缓解轨迹的限制。CS和HA在膝关节OA的管理相结合，可以提供改善的症状缓解的患者谁是候选人的关节内therapy.Methods电子数据库Medline，EMBASE和科克伦图书馆被用来识别相关的出版物。纳入了随机对照试验（RCT），评价了CS和HA联合关节内注射与HA单独注射的比较。符合荟萃分析条件的结局为WOMAC疼痛、WOMAC总评分、OMERACT-OARSI应答率和治疗相关不良事件。标准化均值差（SMD）计算连续的结果，使用逆方差法和随机效应模型。使用Mantel-Haenszel方法和随机效应模型计算二分结局的比值比（OR）。使用I-2统计量评估异质性。结果纳入了8项试验（n = 751例患者）。2-4周时WOMAC疼痛评分的降低有利于CS和HA联合治疗组，优于HA单药治疗组[SMD 0.60，95% CI（0.23，0.97）; p = 0.002，I-2 = 75%]。24-26周和52周WOMAC疼痛评分的长期改善也有利于CS和HA联合组{[SMD 0.25，95% CI（0.09，0.41）; p = 0.002，I-2 = 0%]和[SMD 0.39，95% CI（0.01，0.77）; p = 0.05，I-2 = 0%]}。WOMAC总分，OMERACT-OARSI应答率，或治疗相关的不良事件没有显着差异。结论CS和HA联合关节内注射导致疼痛减少在2-4，2 - 4 -26和52周相比，HA单独注射。
Purpose Intra-articular injections of corticosteroid (CS) and hyaluronic acid (HA) have individually demonstrated efficacy for knee osteoarthritis (OA); however, both treatments are limited by the trajectory of symptom relief. The combination of CS and HA in the management of knee OA may provide improved symptomatic relief for patients who are candidates for intra-articular therapies.Methods Electronic databases Medline, EMBASE and Cochrane Library were used to identify relevant publications. Randomized controlled trials (RCT) that evaluated intra-articular injections of combined CS and HA in comparison to HA alone were included. Outcomes eligible for meta-analysis were WOMAC pain, WOMAC total, OMERACT-OARSI responder rate, and treatment-related adverse events. Standardized mean differences (SMD) were calculated for continuous outcomes using an inverse variance method and a random-effects model. Odds ratios (OR) were calculated for dichotomous outcomes using the Mantel-Haenszel method and a random-effects model. Heterogeneity was assessed using the I-2 statistic.Results Eight trials (n = 751 patients) were included. Reduction in WOMAC pain scores at 2-4 weeks favoured the combined CS and HA group compared to HA alone [SMD 0.60, 95% CI (0.23, 0.97); p = 0.002, I-2 = 75%]. Longer term improvements at 24-26 and 52 weeks WOMAC pain scores also favoured the combined CS and HA group {[SMD 0.25, 95% CI (0.09, 0.41); p = 0.002, I-2 = 0%] and [SMD 0.39, 95% CI (0.01, 0.77); p = 0.05, I-2 = 0%]} compared to HA alone, respectively. There were no significant differences in WOMAC total scores, OMERACT-OARSI responder rate, or treatment-related adverse events.Conclusion Combined intra-articular injections of CS and HA led to reductions in pain at 2-4, 24-26 and 52 weeks compared to HA injections alone.