Efficacy and safety of intra-articular therapies in rheumatic and musculoskeletal diseases: an overview of systematic reviews

Abstract

ObjectiveTo summarise the evidence on intra-articular therapies (IAT) to inform the 2020 EULAR recommendations.MethodsAn overview of systematic reviews (SR) including randomised-controlled trials (RCTs) of IAT in adults with arthropathies was performed up to July 2020. Pain, function, and frequency of adverse events were the main efficacy and safety outcomes, respectively. Quality was assessed with the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR)-2 tool.ResultsOf 184 references identified, 16 met the inclusion criteria, and a search of their reference lists identified 16 additional SRs. After quality assessment, 29 were finally included. Of these, 18 focused on knee osteoarthritis (KOA), 6 on hip osteoarthritis (HOA), 3 on shoulder capsulitis (SC), and 3 on rheumatoid arthritis. Overall, hyaluronic acid showed a small effect on pain and function in KOA but not in HOA or shoulder capsulitis. Intra-articular glucocorticoids showed a small effect in pain and function in KOA and function in HOA and SC. Platelet-rich plasma showed benefit in pain and function in KOA but not in HOA. Mesenchymal stem cells behaved similarly. Most SR results were of moderate quality and RCTs included often presented a high risk of bias, mainly due to inadequate blinding and heterogeneous results. All interventions were well tolerated with no clear safety differences.ConclusionsThis overview underlines that most IAT currently used in KOA, HOA, and SC exert small effects and are well tolerated. However, no firm conclusions can be drawn for inflammatory arthritis due to the limited data found.

Intra-articular therapies: patient preferences and professional practices in European countries

“…Many responses might reflect the unclear evidence on these procedures, for which gaining technical experience is usually the goal of training, and not challenging practice by appraising evidence. In a series of systematic reviews on IAT we were able to confirm the existence of potential misconceptions or enlarged risks around IAT, such as the need for asepsis or ultrasound-guided IAT, glucose monitoring in diabetes, and risk of hypertension, among others [21]. Of note, very few studies had been done by rheumatologists, who undertake these IAT most frequently.…”

Bleeding complications in patients on warfarin undergoing joint injection/aspiration: systematic review and meta-analysis

“…Steroid injections in joints are commonly administered for the management of inflammatory or degenerative conditions. [ 1 , 2 ] There is a substantial body of data to support a benefit of intra-articular hyaluronic acid, glucocorticoids, platelet-rich plasma and mesenchymal stem cells in knee and hip osteoarthritis and shoulder capsulitis [ 3 ]. Indeed, of 545 consultations at an urban community general practice, 115 (21.1%) involved a musculoskeletal presentation, of these 17.4% involved the knee in which steroid injections were administered in 33% [ 1 ].…”

Synovial Fluid Regulates the Gene Expression of a Pattern of microRNA via the NF-κB Pathway: An In Vitro Study on Human Osteoarthritic Chondrocytes

“…Otherwise, the observed protective effects of control SF can be attributed to low content of cytokines and other inflammatory mediators, and to a high amount of high-molecular-weight HA [ 60 ]. High-molecular-weight HA has demonstrated to have potent anti-inflammatory effects in synovial fibroblasts, reducing NF-κB activation and IL-1β, IL-6, and TNF-α production [ 61 , 62 , 63 ].…”