Table 1

Main characteristics of the SR included

StudyPopulationIntervention and comparatorOutcomesQuality
Knee osteoarthritis
Rutjes et al7IC: RCTs
EC: not stated.
HA vs sham or no interventionPrimary: pain intensity
Secondary: function, SAEs, withdrawal due to AEs
Newberry et al22IC: RCTs, SRs, OS, and CS*
EC: non-English language studies and conference abstracts.
HA vs PBO or other HAPrimary: delay or avoidance of TKR
Secondary: function, QoL, number of AE
Jüni et al23IC: RCT of patients treated with GC either IA or subacromial.
EC: RCT including only patients with inflammatory arthritis
IA GC vs sham, PBO or SOCPrimary: pain and function at 4–6 weeks
Secondary: pain and function at subsequent time points, QoL, JSN, SAEs, withdrawals due to AEs
Ding et al24IC: RCTs reporting ≥1 of the outcomes of interest.
EC: use of PRP or MSC+surgery or lack of a non-cell-based control
MSC vs PBO, HA or IAGCWOMAC, KOOS, VAS, SAEs without a prespecified hierarchyModerate
Bannuru et al4IC: RCTs of patients treated with HA with data on safety outcomes
EC: non-RCT studies
HA vs HA or PBONumber of AEs, SAEs, withdrawals due to AEs without a prespecified hierarchyModerate
Bannuru et al6IC: RCTs with data for ≥1 outcome measure of pain.
EC: studies not including pain outcomes of interest
HA vs IAGCPrimary: pain according to a prespecified hierarchy at different time-pointsModerate
Bannuru et al5IC: RCTs of patients with primary KOA with data on ≥2 interventions of interest and on ≥1 measure of pain, function or stiffness.
EC: not stated
Primary: pain at 3 months according to a prespecified hierarchy
Secondary: function and stiffness at 3 months
Kanchanatawan et al25IC: RCTs of adults with primary KOA with ≥1 of the outcomes of interest and enough data to extract and pool
EC: not stated
PRP vs HA or PBO or shamWOMAC total and subscores, Lequesne score, EuroQol-VAS, IKDC subjective scores, number of AEs without a prespecified hierarchyModerate
Xu et al26IC: RCTs with ≥30 randomised patients, ≥1 month follow-up, quantitative outcome assessment, <20% of dropouts
EC: not stated
PRP vs HA, PBOPain and function (VAS, WOMAC, IKDC, Lequesne) without a prespecified hierarchyModerate
Dai et al27IC: RCTs comparing PRP vs controls for prespecified outcomes
EC: not stated
PRP vs HA or PBOPrimary: WOMAC pain and function scores.
Secondary: WOMAC total score, IKDC, Lequesne, frequency of AE
Arroll and Goodyear-Smith28IC: PBO-controlled RCTs assessing the efficacy of IAGC
EC: not stated
IAGC vs PBOPrimary: improvement of symptoms
Secondary: pain, response to the OA research scale
Shen et al29IC: RCT comparing any PRP vs another IAT with ≥12 w follow-up
EC: studies without IA control group, other PRP or PRP+surgery
PRP vs HA or PBOPrimary: WOMAC pain, function and total at 3, 6, and 12 months
Secondary: number of patients with AEs
Trojian et al30IC: RCTs in English including outcomes of interest at ≥8 and <16 weeks.
EC: studies comparing IA GC or HA vs surgical procedures
OMERACT-OARSI response rates, mean change from baseline in WOMAC pain, stiffness or function, frequency of AE. Without hierarchyModerate
Gallagher et al31IC: RCTs with PBO control, ≥12 m follow-up, data on structural changes
EC: not stated
HA or SOC vs PBO†Primary: changes in JSW or cartilage volume.
Secondary: WOMAC total score, WOMAC pain or VAS pain
Di et al32IC: English-written RCTs
EC: unknown methodology or patients with additional conditions‡
PRP vs HAPrimary: WOMAC, IKDC, KOOS, EQ-VAS, Tegner score.
Secondary: frequency of AE between groups
Trigkilidas and Anand35IC: RCTs with ≥1 outcome measure on pain or function; freely available as full text from specified sources§
EC: non-RCT and language other than English
HA vs PBO or IAGCVAS pain, Lequesne, WOMAC without a prespecified hierarchyLow
Lo et al33IC: Blinded—RCTs comparing HA (≥3 injections) vs PBO with data on pain and 8-week minimum follow-up and drop-out rate of <50%
EC: not stated
HA vs PBOPain according to a prespecified hierarchyLow
Hip osteoarthritis
Ali et al36IC: RCTs, with clinical and functional data with any follow-up
EC: studies on animals and technical notes
PRP vs HAVAS pain, WOMAC total, and HHS without a prespecified hierarchyModerate
McCabe et al38IC: RCTs with patients with HOA (clinical and radiographic)
EC: studies without a control group
IAGC vs PBOPrimary: pain according to a prespecified hierarchy
Secondary: WOMAC function, Lequesne Index, safety profile
Liao et al37IC: RCTs of patients with primary HOA
EC: stated as the opposite to IC
HA vs PBOPrimary: self-reported pain according to a prespecified hierarchy
Secondary: function, OMERACT-OARSI responder index
Medina-Porqueres41IC: English or Spanish-written studies of PRP applied in isolation in ≥1 arm to patients with any grade of HOA as per the ACR criteria
EC: studies including only children or animals; non-OA injuries, OA in other joints or previous surgery
PRP vs IA control (any)Primary: VAS pain, HHS, and WOMAC function.
Secondary: growth factor’s concentration, AE and imaging evaluations
Ye et al42IC: RCTs comparing PRP with HA
EC: studies without a control group, full-text versions or outcomes data
PRP vs HAPrimary: WOMAC total score, VAS pain, and Harris hip score (HHS)
Secondary: n of AE
Leite et al40IC: RCT with ≥1 of the outcomes of interest
EC: RCT comparing HOA vs other sites and HA vs non-IA controls
HA vs IA-injection comparatorsPrimary: pain
Secondary: QoL, OMERACT-OARSI Response, frequency of AEs
Shoulder capsulitis
Sun et al45IC: RCTs comparing IAGC vs no or sham injection or SOC
EC: injection volume >0.10 mL (classified as IAGC+distention)
IAGC vs sham or SOCPrimary: VAS pain
Secondary: passive external rotation, abduction, flexion, internal rotation,and functional scores and frequency of AEs
Buchbinder et al43IC: RCTs of shoulder pain comparing IAGC vs PBO, another intervention or different IAGC dosages
EC: pain duration <3 weeks, RA, polymyalgia rheumatica, and fracture
IAGC vs PBO, other interventionsPain, ROM, function, strength, and return to work or school without a prespecified hierarchyModerate
Lee et al44IC: RCT of capsulitis (confirmed clinically or by US), clearly documenting IC and EC, symptom duration and follow-up >4 weeks
EC: uncontrolled studies
HA vs SOCPain, ROM, and function/disability scores >1 month after administration, frequency of AEs without a prespecified hierarchyModerate
Rheumatoid arthritis
Heuft-Dorenbosch et al46IC: RCTs of RA patients with knee arthritis, enough quality as per the Delphi list. Language restrictions applied¶
EC: not stated
Yttrium synovectomy vs PBO or THKnee circumference, ROM, fixed flexion, pain (Likert scale), subjective change, knee effusion, radiological assessment without prespecified hierarchyModerate
Silvinato and
IC: RCTs of patients with RA and knee arthritis
EC: not stated
MPA vs TA, TH, prednisolonePrimary: flare time at 24 weeks,
Secondary: patient-reported pain and swelling, ROM, frequency of AEs
Saito and Kotake47IC: English or Japanese-written RCTs of patients with RA and knee arthritis including pain assessment
EC: studies with animals or only describing the injection technique
HA vs PBOPrimary: global pain measured with Likert scale at 1 week
Secondary: inflammation measured with Likert scale. Condition of the knee with Likert scale, safety profile
  • *Only data from RCTs were retrieved for the analyses on the present study.

  • †Only data for the HA vs PBO comparison were retrieved.

  • ‡Additional conditions included meniscal tears, inflammatory arthritis, among others.

  • §Free full-texts available from the Warwick University Library or Google Scholar.

  • ¶Articles written in Dutch, English, French, German, or Spanish.

  • AE, adverse events; CS, case series; EC, exclusion criteria; EQ-VAS, Euro Quality of Life – Visual Analogue Scale; freq of AE, frequency of adverse events; GC, glucocorticoids; HA, hyaluronic acid; HHS, Harris Hip Score; HOA, hip osteoarthritis; IA, intra-articular; IAT, intra-articular therapies; IC, inclusion criteria; IKDC, International Knee Documentation Committee; JSN, joint space narrowing; JSW, joint space width; KOA, Knee Osteoarthritis Index; KOOS, Knee injury and Osteoarthritis Outcome Score ; MPA, methylprednisolone acetate; MSC, mesenchymal stem cells; OS, observational studies; PBO, placebo; PRP, platelet-rich plasma; QoL, quality of life; RCT, randomised-controlled trials; ROM, range of motion; SAE, serious adverse events; SoC, standard of care; TA, triamcinolone acetonide; TH, triamcinolone hexacetonide; TKR, total knee replacement; US, ultrasonography; VAS, Visual Analogue Scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.