title: The OA Trial Bank: meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids.
abstract: To evaluate the efficacy of intra-articular (IA) glucocorticoids for knee or hip osteoarthritis (OA) in specific subgroups of patients with severe pain and inflammatory signs using individual patient data (IPD) from existing trials.
  
  
  
  Randomized trials evaluating one or more IA glucocorticoid preparation in patients with knee or hip OA, published from 1995 up to June 2012 were selected from the literature. IPD obtained from original trials included patient and disease characteristics and outcomes measured. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). The subgroup factors assessed included severe pain (≥70 points, 0-100 scale) and signs of inflammation (dichotomized in present or not) at baseline. Multilevel regression analyses were applied to estimate the magnitude of the effects in the subgroups with the individuals nested within each study.
  
  
  
  Seven out of 43 published randomized clinical trials (n = 620) were included. Patients with severe baseline pain had a significantly larger reduction in short-term pain, but not in mid- and long-term pain, compared to those with less severe pain at baseline (Mean Difference 13.91; 95% Confidence Interval 1.50-26.31) when receiving IA glucocorticoid injection compared to placebo. No statistical significant interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo and to tidal irrigation at all follow-up points.
  
  
  
  This IPD meta-analysis demonstrates that patients with severe knee pain at baseline derive more benefit from IA glucocorticoid injection at short-term follow-up than those with less severe pain at baseline.
authors.affiliation: Erasmus MC Medical University Center Rotterdam, Department of General Practice, The Netherlands. Electronic address: m.vanmiddelkoop@erasmusmc.nl.
authors.forename: M
authors.initials: M
authors.lastname: van Middelkoop
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, OX3 7LD, UK; Arthritis Research UK Centre of Excellence for Sports, Exercise and Osteoarthritis, University of Oxford, OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK. Electronic address: nigel.arden@ndorms.ox.ac.uk.
authors.forename: N K
authors.initials: NK
authors.lastname: Arden
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, University of Newcastle, UK. Electronic address: Ismael.Atchia@northumbria-healthcare.nhs.uk.
authors.forename: I
authors.initials: I
authors.lastname: Atchia
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, University of Newcastle, UK. Electronic address: fraser.birrell@newcastle.ac.uk.
authors.forename: F
authors.initials: F
authors.lastname: Birrell
authors.affiliation: UCSD School of Medicine, La Jolla, CA, USA. Electronic address: jeannie.chao@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Chao
authors.affiliation: Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, HCFMUSP, Sao Paulo, Brazil. Electronic address: murezende@uol.com.br.
authors.forename: M U
authors.initials: MU
authors.lastname: Rezende
authors.affiliation: Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Canada. Electronic address: rlambert@ualberta.ca.
authors.forename: R G W
authors.initials: RG
authors.lastname: Lambert
authors.affiliation: Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France. Electronic address: philipperavaud@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Ravaud
authors.affiliation: University Medical Center Utrecht, Department of Rheumatology & Clinical Immunology, Utrecht, The Netherlands. Electronic address: J.W.J.Bijlsma@umcutrecht.nl.
authors.forename: J W
authors.initials: JW
authors.lastname: Bijlsma
authors.affiliation: Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK. Electronic address: Michael.Doherty@nottingham.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: Doherty
authors.affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, UK. Electronic address: k.s.dziedzic@keele.ac.uk.
authors.forename: K S
authors.initials: KS
authors.lastname: Dziedzic
authors.affiliation: Lund University, Department of Orthopaedics, Clinical Sciences Lund, Sweden; Institute of Sports Science and Clinical Biomechanics, Department of Orthopaedics and Traumatology, University of Southern Denmark, Denmark. Electronic address: stefan.lohmander@med.lu.se.
authors.forename: L S
authors.initials: LS
authors.lastname: Lohmander
authors.affiliation: Tufts University, Department of Medicine, Boston, USA. Electronic address: tmcalindon@tuftsmedicalcenter.org.
authors.forename: T E
authors.initials: TE
authors.lastname: McAlindon
authors.affiliation: Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK. Electronic address: Weiya.Zhang@nottingham.ac.uk.
authors.forename: W
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Erasmus MC Medical University Center Rotterdam, Department of General Practice, The Netherlands. Electronic address: s.bierma-zeinstra@erasmusmc.nl.
authors.forename: S M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
mesh_terms: D005938:Glucocorticoids; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint; D015207:Osteoarthritis, Hip; D020370:Osteoarthritis, Knee; D010146:Pain; D016032:Randomized Controlled Trials as Topic
chemical_list: D005938:Glucocorticoids
keywords: Hip; IA glucocorticoid; IPD analysis; Injection; Knee; Osteoarthritis