What is the evidence for corticosteroid injections in the treatment of osteoarthritis of the knee?
AMSTAR Rating
Summary
Patient Population:
1767 participants (27 trials) with knee osteoarthritis
Intervention:
Triamcinolone acetonide, cortivazol, celestone, and hydrocortisone tertiary-butylacetate were used.
Comparison:
IA corticosteroid was evaluated vs. placebo, hyaluronan/hylan, joint lavage or another corticosteroid
Outcome:
Pain (1-13 weeks)
- Intra-articular steroid found to improve pain by 1.0 out of 10 on VAS compared to control (SMD -0.40, 95% CI -0.58 to -0.22) (NNT = 8)
Pain (26 weeks)
- No evidence of benefit
Function (1-6 weeks)
- Intra-articular steroid found to improve function on WOMAC by 0.7 units compared to control (SMD -0.33, 95% CI -0.56 to -0.09) (NNT = 10)
Function (13-26 weeks)
- No evidence of benefit
Quality of Life
- No evidence of benefit (SMD -0.01, 95% CI -0.30 to 0.28)
Joint space Narrowing
- No evidence of benefit (SMD -0.02, 95% CI -0.49 to 0.46)
Side effects
- Patients receiving corticosteroid 11% less likely to experience adverse effects.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| AAOS (2013) | Inconclusive |
| NICE (2014) | Adjunct |
| ACR (2019) | Strongly recommended |
| OARSI (2019) | Conditional Recommendation (Level 1A) |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Pain (VAS)
1-13 weeks
26 weeks
Function (WOMAC)
1-6 weeks
13-26 weeks
Quality of Life
1-26 weeks
Relevant Clinical Info
NNT = 8 to provide BENEFIT a 1-point improvement in pain on 10-point scale (up to 13 weeks)
Patients receiving intra-articular corticosteroid had an improvement in pain by 2.8 points on a 10 point scale, compared to patients receiving placebo who improve 1.8 points on a 10 point scale.
Is this clinically important?
Participant Information
the sample size was 1767
their were 27 studies used.
