Evidence and recommendations for use of intra-articular injections for knee osteoarthritis.
Pharmacological treatments are widely recommended in international guidelines for management of osteoarthritis (OA). However, the use of intra-articular (IA) therapies of diverse active drugs remains controversial. We critically reviewed studies of the efficacy and safety of IA injections of corticosteroids (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and botulinum toxin A (BTA) and evidence-based international recommendations for their use in treating knee OA. The process of article selection was unsystematic. Articles were selected on the basis of authors' expertise, self-knowledge, and reflective practice. Only studies assessing knee OA were included. IA CS and HA injections were conditionally to fully recommended for treating knee OA. No recommendations have been formulated for IA PRP or BTA. The evidence remains inconsistent and controversial for the use of IA therapies for knee OA. The characteristics of and selection criteria for the OA population that would likely benefit from these therapies need to be identified. Accurately phenotyping and selecting patients is mandatory in future randomized controlled trials. Therefore, efficacy and safety meta-analyses should be performed, as should qualitative and sensitivity analyses of published trial results.
Université Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, PRES Sorbonne Paris Cité, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Paris, France. Electronic address: christelle.nguyen2@aphp.fr.
Christelle
C
Nguyen
Université Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, PRES Sorbonne Paris Cité, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France.
Marie-Martine
MM
Lefèvre-Colau
Université Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, PRES Sorbonne Paris Cité, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France.
Serge
S
Poiraudeau
Université Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, PRES Sorbonne Paris Cité, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Paris, France.
François
F
Rannou
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular / Q000592:standards; D007719:Knee Joint / Q000187:drug effects; D009465:Neuromuscular Agents / Q000008:administration & dosage; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D018579:Patient Selection; D053657:Platelet-Rich Plasma; D017410:Practice Guidelines as Topic; D055675:Viscosupplements / Q000008:administration & dosage
D000305:Adrenal Cortex Hormones; D009465:Neuromuscular Agents; D055675:Viscosupplements; D006820:Hyaluronic Acid; D019274:Botulinum Toxins, Type A
Botulinum toxin A; Corticosteroids; Evidence-based medicine; Hyaluronic acid; Intra-articular injections; Osteoarthritis; Platelet-rich plasma