Injections de corticoïdes, acide hyaluronique et plasma riche en plaquettes dans l’arthrose : où en sommes-nous ?

Abstract

Because the intra-articular administration of a drug offers many advantages over the systemic route, corticosteroids or hyaluronic acid intra-articular injections are routinely used in the management of osteoarthritis, and recommended in the recent guidelines of the French Society of Rheumatology for the management of knee osteoarthritis. Nevertheless, international guidelines are not unanimous as to their use in the knee, hip or hand osteoarthritis. This discrepancy is explained by the results of meta-analyses of randomized controlled trials, showing a modest effect size and a disputable clinical relevance. Indeed, clinical trials do not take into account the contextual effect associated with the intra-articular procedure. This effect contributes to the greater placebo effect observed with intra-articular therapies than with oral or transdermal treatments, and the difficulty in demonstrating a clinically relevant effect of intra-articular drugs. Intra-articular injections have an advantageous safety profile compared to other therapies available for the management of osteoarthritis pain. The long-term tolerance of intra-articular corticosteroids remains uncertain, as they have been associated with accelerated structural progression, especially if they are repeated multiple times. Finally, the efficacy of platelet-rich plasma is debated. The literature on this topic is particularly heterogeneous, and randomized controlled trials of good methodological quality are warranted to determine their efficacy and tolerance in the short and long term.