Abstract：
OBJECTIVE: To quantify the clinical relevance of intra-articular corticosteroid effects compared to placebo for the injective treatment of knee osteoarthritis (OA).
METHODS: The PubMed, Cochrane Library and Web of Science databases were searched on May 3, 2023. This study was conducted in accordance with the PRISMA guidelines. The inclusion criteria were randomized controlled trials (RCTs), published in English, with no time limitation regarding publication date, comparing intra-articular corticosteroids and placebo injections for knee OA. The effects were quantified at short- (≤6 weeks), mid- (>6 weeks and ≤3 months), and long-term (≥6 months) follow-ups. The minimal clinically important difference (MCID) for the outcomes (visual analogue scale for pain - VAS: 1.4, Western Ontario and McMaster University Osteoarthritis Index - WOMAC: 9) was used to interpret the clinical improvement provided by intra-articular corticosteroid injections compared to placebo. The quality of each article was assessed using the Cochrane RoB 2 tool and the GRADE guidelines.
RESULTS: Among the 1030 articles retrieved, 11 RCTs (842 patients) were included. A comparison of the two groups revealed statistically significant differences in the improvement of VAS and WOMAC scores in terms of the mean difference (MD); this difference was in favour of corticosteroids at short-term (p < 0.001, MD = -1.6 and p < 0.001, MD = -9.9, respectively) and mid-term follow-ups (p = 0.001, mean MD = -1.3 and p = 0.005, MD = -4.9, respectively). No difference was observed at the long-term follow-up. The MDs between the improvements in the two groups reached the MCID values for the VAS and WOMAC only at the short-term follow-up. The RoB 2 tool and the GRADE evaluations showed the presence of risk of bias and limited quality of evidence.
CONCLUSIONS: This systematic review and meta-analysis demonstrated that intra-articular corticosteroid injections offer clinically perceivable pain relief and functional improvement higher than the placebo effect only at short-term follow-up in patients affected by knee OA, with benefits losing clinical relevance already after 6 weeks. These results, together with the low number and the limited quality of the RCTs comparing this treatment with placebo, question the indication for the use of corticosteroid injections in clinical practice for the treatment of knee OA.
METHODS: Level I.
METHODS: The PubMed, Cochrane Library and Web of Science databases were searched on May 3, 2023. This study was conducted in accordance with the PRISMA guidelines. The inclusion criteria were randomized controlled trials (RCTs), published in English, with no time limitation regarding publication date, comparing intra-articular corticosteroids and placebo injections for knee OA. The effects were quantified at short- (≤6 weeks), mid- (>6 weeks and ≤3 months), and long-term (≥6 months) follow-ups. The minimal clinically important difference (MCID) for the outcomes (visual analogue scale for pain - VAS: 1.4, Western Ontario and McMaster University Osteoarthritis Index - WOMAC: 9) was used to interpret the clinical improvement provided by intra-articular corticosteroid injections compared to placebo. The quality of each article was assessed using the Cochrane RoB 2 tool and the GRADE guidelines.
RESULTS: Among the 1030 articles retrieved, 11 RCTs (842 patients) were included. A comparison of the two groups revealed statistically significant differences in the improvement of VAS and WOMAC scores in terms of the mean difference (MD); this difference was in favour of corticosteroids at short-term (p < 0.001, MD = -1.6 and p < 0.001, MD = -9.9, respectively) and mid-term follow-ups (p = 0.001, mean MD = -1.3 and p = 0.005, MD = -4.9, respectively). No difference was observed at the long-term follow-up. The MDs between the improvements in the two groups reached the MCID values for the VAS and WOMAC only at the short-term follow-up. The RoB 2 tool and the GRADE evaluations showed the presence of risk of bias and limited quality of evidence.
CONCLUSIONS: This systematic review and meta-analysis demonstrated that intra-articular corticosteroid injections offer clinically perceivable pain relief and functional improvement higher than the placebo effect only at short-term follow-up in patients affected by knee OA, with benefits losing clinical relevance already after 6 weeks. These results, together with the low number and the limited quality of the RCTs comparing this treatment with placebo, question the indication for the use of corticosteroid injections in clinical practice for the treatment of knee OA.
METHODS: Level I.
摘要：
目的：量化与安慰剂相比，关节内皮质类固醇作用与注射治疗膝骨关节炎（OA）的临床相关性。
方法：PubMed，Cochrane图书馆和WebofScience数据库于2023年5月3日进行了搜索。这项研究是根据PRISMA指南进行的。纳入标准为随机对照试验(RCTs),以英文出版,发布日期没有时间限制，比较关节内注射糖皮质激素和安慰剂治疗膝关节OA。在短期（≤6周）量化效果，中期（>6周且≤3个月），和长期（≥6个月）随访。结果的最小临床重要差异（MCID）（疼痛的视觉模拟评分-VAS：1.4，西安大略省和麦克马斯特大学骨关节炎指数-WOMAC：9）用于解释关节内皮质类固醇注射提供的临床改善与安慰剂相比。使用CochraneRoB2工具和GRADE指南评估每篇文章的质量。
结果：在检索到的1030篇文章中，纳入11项RCTs（842例患者）。两组的比较显示，在平均差异（MD）方面，VAS和WOMAC评分的改善具有统计学意义；这种差异在短期（分别为p<0.001，MD=-1.6和p<0.001，MD=-9.9）和中期随访（p=0.001，平均MD=-1.3和p=0.005，MD=-4.9）时有利于皮质类固醇。在长期随访中没有观察到差异。两组改善之间的MD仅在短期随访中达到VAS和WOMAC的MCID值。RoB2工具和GRADE评估显示存在偏倚风险和证据质量有限。
结论：本系统综述和荟萃分析表明，关节内注射皮质类固醇激素仅在短期随访中对膝关节OA患者的临床可察觉的疼痛缓解和功能改善高于安慰剂效果。6周后，益处已经失去临床相关性。这些结果,再加上与安慰剂相比，RCT的数量少，质量有限，质疑在临床实践中使用皮质类固醇注射剂治疗膝关节OA的适应症。
方法：一级
方法：PubMed，Cochrane图书馆和WebofScience数据库于2023年5月3日进行了搜索。这项研究是根据PRISMA指南进行的。纳入标准为随机对照试验(RCTs),以英文出版,发布日期没有时间限制，比较关节内注射糖皮质激素和安慰剂治疗膝关节OA。在短期（≤6周）量化效果，中期（>6周且≤3个月），和长期（≥6个月）随访。结果的最小临床重要差异（MCID）（疼痛的视觉模拟评分-VAS：1.4，西安大略省和麦克马斯特大学骨关节炎指数-WOMAC：9）用于解释关节内皮质类固醇注射提供的临床改善与安慰剂相比。使用CochraneRoB2工具和GRADE指南评估每篇文章的质量。
结果：在检索到的1030篇文章中，纳入11项RCTs（842例患者）。两组的比较显示，在平均差异（MD）方面，VAS和WOMAC评分的改善具有统计学意义；这种差异在短期（分别为p<0.001，MD=-1.6和p<0.001，MD=-9.9）和中期随访（p=0.001，平均MD=-1.3和p=0.005，MD=-4.9）时有利于皮质类固醇。在长期随访中没有观察到差异。两组改善之间的MD仅在短期随访中达到VAS和WOMAC的MCID值。RoB2工具和GRADE评估显示存在偏倚风险和证据质量有限。
结论：本系统综述和荟萃分析表明，关节内注射皮质类固醇激素仅在短期随访中对膝关节OA患者的临床可察觉的疼痛缓解和功能改善高于安慰剂效果。6周后，益处已经失去临床相关性。这些结果,再加上与安慰剂相比，RCT的数量少，质量有限，质疑在临床实践中使用皮质类固醇注射剂治疗膝关节OA的适应症。
方法：一级
