TY - JOUR
T1 - Efficacy and safety of intra-articular therapies in rheumatic and musculoskeletal diseases
T2 - an overview of systematic reviews
AU - Rodriguez-García, Sebastián Cruz
AU - Castellanos-Moreira, Raul
AU - Uson, Jacqueline
AU - Naredo, Esperanza
AU - O'Neill, Terence W
AU - Doherty, Michael
AU - Boesen, Mikael
AU - Pandit, Hemant
AU - Möller Parera, Ingrid
AU - Vardanyan, Valentina
AU - Terslev, Lene
AU - Kampen, Will Uwe
AU - D'Agostino, Maria Antonieta
AU - Berenbaum, Francis
AU - Nikiphorou, Elena
AU - Pitsillidou, Irene
AU - de la Torre-Aboki, Jenny
AU - Carmona, Loreto
N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
COPECARE
PY - 2021/6
Y1 - 2021/6
N2 - 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.
AB - 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.
KW - Arthritis, Rheumatoid
KW - Bias
KW - Humans
KW - Injections, Intra-Articular
KW - Osteoarthritis, Knee/drug therapy
KW - Systematic Reviews as Topic
KW - therapeutics
KW - arthritis
KW - osteoarthritis
KW - glucocorticoids
UR - http://www.scopus.com/inward/record.url?scp=85106950848&partnerID=8YFLogxK
U2 - 10.1136/rmdopen-2021-001658
DO - 10.1136/rmdopen-2021-001658
M3 - Journal article
C2 - 34103406
SN - 2056-5933
VL - 7
JO - RMD Open
JF - RMD Open
IS - 2
M1 - 001658
ER -