Article Text
Abstract
Objective To summarise the evidence on intra-articular therapies (IAT) to inform the 2020 EULAR recommendations.
Methods An 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.
Results Of 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.
Conclusions This 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.
- arthritis
- glucocorticoids
- osteoarthritis
- therapeutics
Data availability statement
Data are available upon reasonable request to the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available upon reasonable request to the corresponding author.
Supplementary materials
Supplementary Data
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Footnotes
Twitter @sdlcrodriguez, @raul_cast_morei, @ElenaNikiUK, @carmona_loreto
Contributors SCR-G, RC-M, LC, JU, and EN contributed to the conception and study design. SCR-G and RC-M performed study selection and data collection. SCR-G, RC-M, LC, JU, and EN analysed the data. SCR-G, RC-M, LC, JU, EN, TWON, MD, MB, HP, IMP, VV, LT, WUK, MADA, FB, EN, IP, and JdlT contributed to the interpretation of the data. SR-G and RC-M wrote the first version of the manuscript and LC revised it critically. All authors read and approved the final manuscript.
Funding This study was supported by a EULAR Task force grant CL109.
Competing interests SCR-G reports grants from The Spanish Rheumatology Foundation during the conduct of the study, and personal fees from Roche, Sanofi, MSD, UCB-Pharma, Bristol-Myers-Squibb and Novartis and non-financial support from Lilly, Pfizer, Sanofi, MSD, Abbvie, UCB-Pharma, outside the submitted work. MD has received personal fees for advisory boards from Grunenthal, Mallinckrodt and Pfizer, and author royalties from UpToDate, and was an investigator in an AstraZeneca-funded, non-drug study (the ‘Sons of Gout’ study), unrelated to this work. LT has received speakers fee from AbbVie, Janssen, Roche, Novartis, Pfizer, MSD, BMS and GE. FB reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Serono, MSD, Nordic, Novartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica, 4P Pharma, outside the submitted work. LC declares that her institute receives grants for studies and research courses from Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA.
Provenance and peer review Not commissioned; externally peer reviewed.