Corticosteroids improve pain and symptoms over the short-term in knee OA

Study Type: Meta analysis
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Ten randomized controlled trials were included in this meta-analysis to evaluate the efficacy of intra-articular corticosteroid injections compared to placebo for the management of knee osteoarthritis. A dichotomous outcome of symptom improvement, defined as the most important patient-oriented outcome, and pain outcome were evaluated. Corticosteroid injections resulted Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: New Zealand Accident Rehabilitation and Compensation Insurance Corporation
Conflicts: None disclosed
Why was this study needed now?
Knee osteoarthritis is a prevalent cause of disability in adults and places a significant burden on both the healthcare system and society. Conservative management options are recommended as a first-line of treatment prior to total knee arthroplasty. Intra-articular corticosteroid injections are a treatment that has shown promise in early clinical trials. A synthesis of available literature was needed to provide an estimate of efficacy in comparison to placebo injections.
What was the principal research question?
Does the use of intra-articular corticosteroid injections improve symptoms and relieve pain in comparison to placebo injections?
Data Source: Medline, Cochrane Central Register of Controlled Trials, and EMBASE were searched to identify relevant papers published up to 2003. The references lists of included papers were additionally searched.
Index Terms: Index terms included both MeSH terms and non-MeSH terms. MeSH terms included triamcinolone; prednisolone; prednisone; hydrocortisone; adrenal cortex hormones; osteoarthritis; knee; injections, intra-articular; and randomized controlled trials. Non-MeSH terms included injections; randomized controlled trial; and corticosteroid and steroid.
Study Selection: Eligibility criteria included: 1) a randomized placebo-controlled trial design, and 2) assessed the efficacy of intra-articular corticosteroids for knee osteoarthritis. Ten randomized controlled trials were selected for final inclusion.
Data Extraction: Data extraction was conducted independently by two authors, with discrepancies resolved through discussion and consensus. Quality assessment of the included trials was conducted by two independent authors using the Jadad scoring system. Symptom improvement was defined as the most important patient-oriented outcome and was assessed as a dichotomous outcome (ie. number of patients with decreased pain, number of patients with subjective improvement, number of patients with distinct improvement, etc.)
Data Synthesis: Relative risks (RR) and the number needed to treat (NNT) were calculated using review manager 4.1. Heterogeneity was assessed using the I-squared statistic.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.