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 - Publisher Copyright: ©

PY - 2021

Y1 - 2021

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

KW - glucocorticoids

KW - osteoarthritis

KW - therapeutics

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 - Review

C2 - 34103406

AN - SCOPUS:85106950848

VL - 7

SP - 1

EP - 20

JO - RMD Open

JF - RMD Open

SN - 2056-5933

IS - 2

M1 - 001658

ER -