PDF(Pubmed)
Abstract：
UNASSIGNED: Intra-articular corticosteroid injections (IACS) are interventions which provide pain relief in knee osteoarthritis (OA). It remains unclear whether IACS have a deleterious effect on knee cartilage structure.
UNASSIGNED: To estimate the effect of IACS on cartilage structure in patients with knee OA, using joint space width (JSW) (in radiographic studies), and cartilage thickness (in magnetic resonance imaging).
UNASSIGNED: A literature search was performed to identify randomized control trials and observational studies published from inception to June 15, 2022. Studies were included if patients received IACS for knee OA, with a control arm. Given the different metrics used in reporting continuous variable outcomes among studies, pooled estimates for cartilage thickness change were assessed using standardized mean differences (defined as the difference between the means of the groups divided by a within-group standard deviation) to odds ratio transformation. Sensitivity analyses were conducted based on outcome metric, imaging modality, and number of injections.
UNASSIGNED: Six studies (1437 participants) were identified. The estimated effect of IACS on cartilage structure revealed greater odds of cartilage structure worsening (Odds Ratio (OR): 2.01, 95% Confidence Interval (CI): 1.18,3.44). Sensitivity analyses revealed similar trends, with significant results for singular injections with preference to JSW (OR: 2.44, 95%CI: 1.23,4.82), radiographic outcomes with preference to KL grade (OR: 2.03, 95%CI: 1.01,4.10), binary outcomes with preference to KL grade (OR: 2.93, 95%CI: 1.18,7.25) and quantitative measures (Standardized Mean Differences (SMD): -0.34, 95%CI: -0.66, -0.02).
UNASSIGNED: IACS use may contribute to imaging features of knee cartilage loss. Further studies are warranted to investigate the underlying pathogenesis.
UNASSIGNED: To estimate the effect of IACS on cartilage structure in patients with knee OA, using joint space width (JSW) (in radiographic studies), and cartilage thickness (in magnetic resonance imaging).
UNASSIGNED: A literature search was performed to identify randomized control trials and observational studies published from inception to June 15, 2022. Studies were included if patients received IACS for knee OA, with a control arm. Given the different metrics used in reporting continuous variable outcomes among studies, pooled estimates for cartilage thickness change were assessed using standardized mean differences (defined as the difference between the means of the groups divided by a within-group standard deviation) to odds ratio transformation. Sensitivity analyses were conducted based on outcome metric, imaging modality, and number of injections.
UNASSIGNED: Six studies (1437 participants) were identified. The estimated effect of IACS on cartilage structure revealed greater odds of cartilage structure worsening (Odds Ratio (OR): 2.01, 95% Confidence Interval (CI): 1.18,3.44). Sensitivity analyses revealed similar trends, with significant results for singular injections with preference to JSW (OR: 2.44, 95%CI: 1.23,4.82), radiographic outcomes with preference to KL grade (OR: 2.03, 95%CI: 1.01,4.10), binary outcomes with preference to KL grade (OR: 2.93, 95%CI: 1.18,7.25) and quantitative measures (Standardized Mean Differences (SMD): -0.34, 95%CI: -0.66, -0.02).
UNASSIGNED: IACS use may contribute to imaging features of knee cartilage loss. Further studies are warranted to investigate the underlying pathogenesis.
摘要：
关节内皮质类固醇注射(IACS)是在膝骨关节炎(OA)中提供疼痛缓解的干预措施。目前尚不清楚IACS是否对膝关节软骨结构有有害影响。
■为了评估IACS对膝关节OA患者软骨结构的影响，使用关节间隙宽度(JSW)(在射线照相研究中)，和软骨厚度（磁共振成像）。
■进行了文献检索，以确定从开始到2022年6月15日发表的随机对照试验和观察性研究。如果患者接受膝关节OA的IACS，控制臂。考虑到在报告研究中连续变量结果时使用的不同指标，使用标准化平均差值(定义为各组均值之间的差值除以组内标准差)与比值比转换对软骨厚度变化的汇总估计值进行评估.敏感性分析是根据结果指标进行的，成像模式，和注射次数。
■确定了六项研究（1437名参与者）。IACS对软骨结构的估计影响显示软骨结构恶化的可能性更大(赔率比(OR):2.01,95%置信区间(CI):1.18,3.44)。敏感性分析显示出类似的趋势，对于优先于JSW的单一注射，结果显著(OR:2.44,95CI:1.23,4.82)，放射学结果优先于KL等级(OR：2.03，95CI：1.01,4.10)，二元结局优先考虑KL等级(OR:2.93,95CI:1.18,7.25)和定量指标(标准化平均差(SMD):-0.34,95CI:-0.66,-0.02)。
■IACS的使用可能有助于膝关节软骨丢失的成像特征。需要进一步的研究来研究潜在的发病机制。
■为了评估IACS对膝关节OA患者软骨结构的影响，使用关节间隙宽度(JSW)(在射线照相研究中)，和软骨厚度（磁共振成像）。
■进行了文献检索，以确定从开始到2022年6月15日发表的随机对照试验和观察性研究。如果患者接受膝关节OA的IACS，控制臂。考虑到在报告研究中连续变量结果时使用的不同指标，使用标准化平均差值(定义为各组均值之间的差值除以组内标准差)与比值比转换对软骨厚度变化的汇总估计值进行评估.敏感性分析是根据结果指标进行的，成像模式，和注射次数。
■确定了六项研究（1437名参与者）。IACS对软骨结构的估计影响显示软骨结构恶化的可能性更大(赔率比(OR):2.01,95%置信区间(CI):1.18,3.44)。敏感性分析显示出类似的趋势，对于优先于JSW的单一注射，结果显著(OR:2.44,95CI:1.23,4.82)，放射学结果优先于KL等级(OR：2.03，95CI：1.01,4.10)，二元结局优先考虑KL等级(OR:2.93,95CI:1.18,7.25)和定量指标(标准化平均差(SMD):-0.34,95CI:-0.66,-0.02)。
■IACS的使用可能有助于膝关节软骨丢失的成像特征。需要进一步的研究来研究潜在的发病机制。
