Corticosteroid injections for the treatment of osteoarthritis present a wide spectrum of effects ranging from detrimental to disease‐modifying: A systematic review of preclinical evidence by the ESSKA Orthobiologic Initiative

Abstract

PurposeAim of this systematic review of preclinical evidence was to determine the effects of intra‐articular corticosteroid (CS) injections in joints affected by osteoarthritis (OA).MethodsA systematic review was performed on animal studies evaluating intra‐articular CS injections for OA joints. The search was performed on PubMed, Cochrane, and Web of Science databases. A synthesis of the results was performed investigating CS effects by evaluating studies comparing CS with control groups. Morphological, histological, immunohistochemistry evaluations, clinical outcomes, biomarkers and imaging results were evaluated. The risk of bias was assessed according to the Systematic Review Centre for Laboratory Animal Experimentation's tool.ResultsThirty‐two articles analysing CS effects in OA animal models were included (1079 joints), 18 studies on small and 14 on large animals. CS injections showed overall positive effects in at least one of the outcomes in 68% of the studies, while 16% reported a deleterious effect. CS improved cartilage and synovial outcomes in 68% and 60% of the studies, but detrimental effects were documented in 11% and 20% of the studies, respectively. Clinical parameters evaluated in terms of pain, lameness or joint swelling improved in 63% of the studies but deteriorated in 13%. Evidence is limited on imaging and biomarkers results, as well as on the best CS type, dose, formulation and injection protocol. The risk of bias assessment revealed a 28% low and an 18% high risk of bias.ConclusionIntra‐articular CS injections induced a wide range of results on OA joints in experimental animal models, from disease‐modifying and positive effects on pain and joint function at short‐term evaluation to the lack of benefit or even negative effects. This underlines the need to identify more specific indications and treatment modalities to avoid possible detrimental effects while maximising the anti‐inflammatory properties and the benefits of intra‐articular CS in OA joints.Level of EvidenceLevel II.

Intra‐articular corticosteroids for the treatment of osteoarthritis: A systematic review and meta‐analysis on the comparison of different molecules and doses

“…CS act directly on nuclear steroid receptors, interrupting the inflammatory and immune OA cascade at several levels, thereby reducing pro‐inflammatory and pain mediators [ 26 , 52 ]. The benefits observed in animal models and in the clinical setting have led to the widespread use of CS injections in clinical practice, and this approach has been shown to provide pain relief and joint function improvement in OA joints [ 4 , 5 , 31 , 42 , 43 , 47 ]. Scientific societies and healthcare organizations endorsed the use of CS injections as part of a comprehensive treatment plan for OA.…”