Table 4

Main efficacy outcomes for shoulder capsulitis and rheumatoid arthritis

StudyComparisonFollow-upOutcomesEffect estimateComments
Shoulder capsulitis
Lee et al
HA vs PBO3–6 monthsPain1 RCT—no between-group difference (VAS)
Function1 RCT—no between-group difference (Constant score)
1 RCT—no between-group difference (ROM)
Buchbinder et al43IAGC vs PBO4 weeksPain1 RCT—no between-group difference (VAS) (vs PBO)
6 weeks1 RCT—no between-group difference (VAS) (TA 40 mg vs 10 mg)
4 weeksFunction1 RCT—no between-group difference (ROM)
6 weeks1 RCT—favour higher dose (ROM) (TA 40 mg vs 10 mg)
4 weeksSuccess frequency1 RCT—no between-group difference
Sun et al45IAGC vs PBO4–6 weeksPainMD=1.28 cm (0.75 to 1.82) (VAS), favouring IAGCComparisons with sham or no injection
Passive external rotation and abduction were significantly improved in IAGC-treated patients (vs PBO) at all 3 time-points
12–16 weeksMD=1.00 cm (0.47 to 1.52) (VAS), favouring IAGC
24–26 weeksMD=0.65 cm (0.19 to 1.10), favouring IAGC
4–6 weeksComposite scoresMD=16.62 (11.16 to 22.09), favouring IAGC (SPADI)
12–16 weeksMD=13.46 (8.15 to 18.77), favouring IAGC (SPADI)
24–26 weeksMD=9.91 (2.32 to 17.50), favouring IAGC (SPADI)
4–6 weeksMD=5.30 (–4.38 to 14.98), no difference (ASES)
12–16 weeksMD=12.20 (2.55 to 21.85), favouring IAGC (ASES)
24–26 weeksMD=7.30 (–2.02 to 16.62), no difference (ASES)
12–16 weeksMD=5.70 (–0.59 to 11.99), no difference (Constant score)
4–6 weeksFunctionMD=20.26° (9.70 to 30.83) favouring IAGC (ROM—Int Rotation)
12–16 weeksMD=0.81° (0.18 to 1.44) favouring IAGC (ROM—Int Rotation)
24–26 weeksMD=3.88° (0.51 to 7.25) favouring IAGC (ROM—Int Rotation)
Rheumatoid arthritis
Saito and Kotake47HA vs PBO1 weekPainRR=1.64 (1.14 to 2.35), favouring HAOutcomes were measured with a Likert scale ranging from ‘no improvement’ to ‘marked improvement’
Global InflammationRR=1.61 (1.34 to 1.92), favouring HA
Overall effectivenessRR=1.50 (1.14 to 1.97), favouring HA
Silvinato and Bernardo34MPA vs TH, TA or prednisolone4–24 weeksPain1 RCT—MPA vs TA. No between-group difference (VAS)#Results of the same study at 2 time-points
1 week1 RCT—MPA vs TH vs prednisolone. Favour TH (VAS)#
2–6 weeks1 RCT—MPA vs TH vs prednisolone. No difference (VAS)#
4–24 weeksN° of flares1 RCT—MPA vs TA. No between-group difference
ROM1 RCT—MPA vs TA. No between-group difference
1–6 weeksMorning stiffness1 RCT—MPA vs TH vs prednisolone. No difference
Grip strength1 RCT—MPA vs TH vs prednisolone. No difference
Ritchie articular index1 RCT—MPA vs TH vs prednisolone. No difference
Thermography index1 RCT—MPA vs TH vs prednisolone. No difference
Heuft-Dorenbosch et al46Yttrium synovectomy vs PBO or TH6–12 monthsPain2 RCTs—no between-group differenceNo differences in any other outcome (subjective change, knee effusion, etc)
6 monthsROM1 RCT—favouring yttrium synovectomy (vs PBO)
12 months1 RCT—favouring TA (vs yttrium synovectomy)
12 monthsKnee circumference1 RCT—favouring yttrium (vs PBO)
  • All effect sizes are presented as the point estimate (95% CI) unless otherwise stated.

  • ASES, American Shoulder and Elbow Surgeons score; HA, hyaluronic acid; IAGC, intra-articular glucocorticoids; MD, mean difference; MPA, methylprednisolone acetate; PBO, placebo; RCT, randomised controlled trials; ROM, range of motion; Int Rotation, internal rotation; RR, relative risk; SPADI, Shoulder Pain and Disability Index; TA, triamcinolone acetonide; TH, triamcinolone hexacetonide; VAS, Visual Analogue Scale.