title: Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis.
abstract: OBJECTIVE
  A meta analysis to compare efficacy and safety of intraarticular hyaluronic acid (HA) and intraarticular corticosteroids (CS) in patients with knee osteoarthritis.
  
  
  METHODS
  Potential studies were searched from the electronic databases included PubMed, Embase, web of science and the Cochrane Library up to August 2016. High quality randomized controlled trials (RCTs) were selected based on inclusion criteria. RevMan 5.3 were used for the meta-analysis.
  
  
  RESULTS
  12 RCTs containing 1794 patients meet the inclusion criteria. Visual analog scale (VAS) score in CS group decrease more than HA group up to 1 month (p = 0.03) and it shows equal efficacy at 3 months (p = 0.29); HA is more effective than CS at 6 months (p = 0.006). To Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, there is no significant difference for two groups at 3 months (p = 0.29); HA shows greater relative effect than CS at 6 months (p = 0.005). No significant difference is found on proportion of rescue medication use after initiation of treatment (p = 0.58) and proportion of withdrawal for knee pain (p = 0.54). HA and CS exhibit equal efficacy on improvement of active range of knee flexion at 3 months (p = 0.73) and 6 months (p = 0.43). More topical adverse effects occurred in intraarticular HA group when compared with intraarticular CS group.
  
  
  CONCLUSIONS
  Intraarticular CS is more effective on pain relief than intraarticular HA in short term (up to 1 month), while HA is more effective in long term (up to 6 months). Two therapies benefit similarly for knee function improvement. Both two methods are relatively safe, but intraarticular HA causes more topical adverse effects compared with intraarticular CS.
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China; Tianjin Medical University, Tianjin, 300070, People's Republic of China. Electronic address: 2010021204@tmu.edu.cn.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: He
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China; Tianjin Medical University, Tianjin, 300070, People's Republic of China. Electronic address: doctorkmj@tmu.edu.cn.
authors.forename: Ming-Jie
authors.initials: MJ
authors.lastname: Kuang
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China; Tianjin Medical University, Tianjin, 300070, People's Republic of China. Electronic address: zhaoj_91@163.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. Electronic address: sunleigys@163.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Sun
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. Electronic address: 578794146@qq.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Lu
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. Electronic address: 337533607@qq.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. Electronic address: mbiomechanics@126.com.
authors.forename: Jian-Xiong
authors.initials: JX
authors.lastname: Ma
authors.affiliation: Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China; Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, People's Republic of China. Electronic address: maxinlong432@sina.com.
authors.forename: Xin-Long
authors.initials: XL
authors.lastname: Ma
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects; D059352:Musculoskeletal Pain / Q000188:drug therapy* / Q000209:etiology; D020370:Osteoarthritis, Knee / Q000150:complications / Q000188:drug therapy*; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D000305:Adrenal Cortex Hormones; D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: Corticosteroids; Intraarticular hyaluronic acid; Knee osteoarthritis; Meta-analysis