The Effect of Corticosteroid Doses on Pain in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

IF 1.6 Q3 RHEUMATOLOGY

Musculoskeletal Care Pub Date : 2025-06-01 DOI:10.1002/msc.70121

Marc-Antoine Lafrenaye-Dugas, Frédérique Dupuis, Valérie Bélanger, Marie-Michèle Briand

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Abstract

Objective: To evaluate the effect of various doses of intra articular corticosteroid injection (IACI) on pain reduction in knee osteoarthritis when compared with normal saline and perform a between-dose comparison.

Methods: A systematic review with meta-analysis was conducted searching four databases until April 2024. RCTs comparing the effect of IACI with normal saline on pain relief in knee osteoarthritis were included. The different doses were pooled into three categories: low (< 40 mg methylprednisolone equivalent), usual (40 mg), or high dose (> 40 mg). Their effect compared to normal saline was evaluated at very short (VST, 1-3 weeks), short (ST, 4-8 weeks) and middle term (MT, 10-16 weeks). A multivariate analysis carried out the influence of dosage on pain relief, at each time point. The Jadad scale was used to assess risks of bias and GRADE for certainty of evidence.

Results: Eleven studies were included in the meta-analyses (n = 1125 patients). Low dose was significantly superior to normal saline in the VST, but not in the ST (low-quality evidence). No data were available for the MT. The usual dose was significantly superior to normal saline in the ST, but not in the VST and MT (moderate-quality evidence). A high dose was significantly superior to normal saline in the ST and MT (low-quality evidence). Multivariate analysis showed that the dose significantly influenced pain reduction at ST and MT, but not in the VST (low-quality evidence).

Conclusion: The dose of IACI doesn't influence pain reduction in the peak effect, but a higher dose seems to have a more prolonged effect.

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皮质类固醇剂量对膝关节骨关节炎疼痛的影响：一项系统回顾和荟萃分析。

目的：评价不同剂量关节内皮质类固醇注射（IACI）与生理盐水对膝关节骨性关节炎的镇痛效果，并进行剂量间比较。方法：对4个数据库进行系统评价和meta分析，检索至2024年4月。比较IACI与生理盐水对膝关节骨关节炎疼痛缓解效果的随机对照试验被纳入研究。不同剂量分为三类：低剂量（甲基强的松龙当量< 40毫克）、普通剂量（40毫克）或高剂量（40毫克）。在极短期（VST， 1-3周）、短期（ST， 4-8周）和中期（MT， 10-16周）对其与生理盐水的效果进行评估。对各时间点剂量对疼痛缓解的影响进行多变量分析。使用Jadad量表评估偏倚风险和GRADE以确定证据。结果：11项研究被纳入meta分析（n = 1125例患者）。在VST中，低剂量明显优于生理盐水，但在ST中则没有（低质量证据）。没有关于MT的数据。在ST中，常规剂量明显优于生理盐水，但在VST和MT中则没有（中等质量证据）。在ST和MT中，高剂量明显优于生理盐水（低质量证据）。多变量分析显示，剂量显著影响ST和MT的疼痛减轻，但在VST中没有（低质量证据）。结论：IACI的剂量不影响疼痛缓解的峰值效应，但剂量越高，效果越持久。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Musculoskeletal Care RHEUMATOLOGY-

CiteScore

2.30

自引率

7.70%

发文量

期刊介绍： Musculoskeletal Care is a peer-reviewed journal for all health professionals committed to the clinical delivery of high quality care for people with musculoskeletal conditions and providing knowledge to support decision making by professionals, patients and policy makers. This journal publishes papers on original research, applied research, review articles and clinical guidelines. Regular topics include patient education, psychological and social impact, patient experiences of health care, clinical up dates and the effectiveness of therapy.