Intra-articular corticosteroids: Systematic review of effects of multiple injections and different doses

IF 0.8 4区农林科学 Q3 VETERINARY SCIENCES

Equine Veterinary Education Pub Date : 2025-01-28 DOI:10.1111/eve.14098

P. K. A. Tokawa, R. Y. A. Baccarin, G. M. Zanotto

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引用次数: 0

Abstract

Background

Corticosteroids are commonly used for intra-articular (IA) treatment of osteoarthritis (OA); however, controversy exists regarding its use as a multiple-injection treatment and for appropriate dosing.

Objectives

This systematic review collected and critically appraised evidence regarding the effects of (1) multiple injections protocols for OA treatment in horses and humans; (2) different doses of corticosteroids for treating OA in horses and humans; (3) different doses of corticosteroids in challenged joint tissues/cells in vitro.

Study design

Systematic review.

Methods

Titles published up to June 2022 generated by searches in PubMed, CAB and the Web of Science were screened using general inclusion criteria. Each question (multiple treatments; different doses in vivo and in vitro) had further inclusion requirements. The risk of bias was assessed according to the study design. Horses were the species of interest but human studies were also considered.

Results

Of 6417 titles generated by the systematic search, only nine met all inclusion criteria for question 1, one was included for question 2 and 11 for question 3. Most studies showed unclear/high risk of bias. Multiple-injection protocols showed better symptom-modifying changes at first injections with decreasing improvements over time or for shorter follow-ups in both humans and horses. Disease-modifying changes improved over shorter follow-ups; however, at longer periods, negative effects were seen. Determining the dose effect of different doses of corticosteroids was challenging as only one in vivo study met the inclusion criteria. In vitro, lower doses appeared to be safer for articular tissues.

Main limitations

Lack of studies meeting inclusion criteria.

Conclusions

No benefits but drawbacks of multiple IA injections in the long term were found in this review. Results regarding the dose of corticosteroids in OA joints were poorly available in vivo and support the use of lower doses. In vitro, studies pointed out that lower doses might be safer for joint tissues.

Abstract Image

查看原文本刊更多论文

关节内皮质类固醇：多次注射和不同剂量效果的系统评价

皮质类固醇通常用于骨关节炎（OA）的关节内（IA）治疗；然而，关于其作为多次注射治疗和适当剂量的使用存在争议。本系统综述收集并批判性评价了以下证据：(1)多种注射方案对马和人OA治疗的影响；(2)不同剂量的皮质类固醇治疗马和人的骨关节炎；(3)不同剂量皮质类固醇对体外损伤关节组织/细胞的影响。研究设计系统评价。方法使用一般纳入标准筛选PubMed、CAB和Web of Science检索到的2022年6月前发表的论文。每个问题（多重治疗；体内和体外不同剂量）都有进一步的纳入要求。根据研究设计评估偏倚风险。马是人们感兴趣的物种，但也考虑了对人类的研究。结果在系统检索产生的6417个标题中，只有9个标题符合问题1的全部收录标准，1个标题符合问题2的收录标准，11个标题符合问题3的收录标准。大多数研究显示不明确/高偏倚风险。多次注射方案在首次注射时表现出更好的症状改善变化，随着时间的推移或较短的随访，人类和马的改善逐渐减少。在较短的随访中，疾病改善变化有所改善；然而，在较长的时间内，负面影响就会显现出来。确定不同剂量皮质类固醇的剂量效应具有挑战性，因为只有一项体内研究符合纳入标准。在体外实验中，较低剂量对关节组织似乎更安全。主要限制缺乏符合纳入标准的研究。结论：本综述没有发现长期多次注射IA的益处，但有缺点。关于骨性关节炎关节中皮质类固醇剂量的体内研究结果很少，支持使用较低剂量。体外研究指出，较低的剂量可能对关节组织更安全。

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

Equine Veterinary Education 农林科学-兽医学

CiteScore

2.40

自引率

22.20%

发文量

132

审稿时长

18-36 weeks

期刊介绍： Equine Veterinary Education (EVE) is the official journal of post-graduate education of both the British Equine Veterinary Association (BEVA) and the American Association of Equine Practitioners (AAEP). Equine Veterinary Education is a monthly, peer-reviewed, subscription-based journal, integrating clinical research papers, review articles and case reports from international sources, covering all aspects of medicine and surgery relating to equids. These papers facilitate the dissemination and implementation of new ideas and techniques relating to clinical veterinary practice, with the ultimate aim of promoting best practice. New developments are placed in perspective, encompassing new concepts and peer commentary. The target audience is veterinarians primarily engaged in the practise of equine medicine and surgery. The educational value of a submitted article is one of the most important criteria that are assessed when deciding whether to accept it for publication. Articles do not necessarily need to contain original or novel information but we welcome submission of this material. The educational value of an article may relate to articles published with it (e.g. a Case Report may not have direct educational value but an associated Clinical Commentary or Review Article published alongside it will enhance the educational value).