关节内注射肉毒毒素治疗关节疼痛的有效性和安全性：系统回顾和荟萃分析。

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine Pub Date : 2025-02-01 DOI:10.1016/j.rehab.2024.101877

Mathieu Gagnière , Camille Daste , Raphaël Campagna , Jean-Luc Drapé , Antoine Feydy , Henri Guerini , Marie-Martine Lefèvre-Colau , François Rannou , Christelle Nguyen

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引用次数: 0

摘要

背景：在各种关节疼痛动物模型中进行的研究表明，关节内A型肉毒毒素（BoNT-A）具有抗伤害性作用。在人体中进行的随机对照试验（RCTs）显示了潜在的影响，但结果却截然不同。目的：评价关节内BoNT-A治疗关节疼痛的疗效和安全性。方法：我们对随机对照试验进行了系统回顾，比较了关节内BoNT-A与其他干预措施在短期（6个月）内对关节疼痛患者疼痛和活动限制的影响及其不良反应。我们在适当的时候进行了荟萃分析。检索了MEDLINE、EMBASE、ClinicalTrials.gov、CINHAL和ICTRP数据库，检索时间为2023年7月9日。两名独立的审稿人选择了符合条件的研究，并以标准化的方式提取数据。定量合成结果用标准化平均差（SMD）（95%置信区间）表示。结果：我们纳入了14项随机对照试验：437名参与者接受关节内注射BoNT-A， 551名参与者接受另一种干预。总体而言，7项随机对照试验（549名参与者）比较了关节内BoNT-A与膝关节关节内治疗：疼痛的短期、中期和长期SMD分别为-0.35（-0.82至0.12）、-0.27（-0.61至0.08）和-0.43(-1.12至0.26)，活动受限的SMD分别为-0.44（-0.96至0.07）、-0.24（-0.63至0.15）和-0.42（-1.26至0.42）。两项肩部随机对照试验（68名受试者）和一项拇指基底随机对照试验（60名受试者）显示短期疼痛减轻。轻微不良事件并不罕见，但没有报道与关节内BoNT-A相关的严重不良事件。结论：关节内BoNT-A可以在短期内减轻中小型关节（如拇指底和肩部）的关节疼痛，但对于大型关节（如膝关节）则没有效果。注册：PROSPERO: CRD42021290157(首次提交日期：2021年11月8日；注册日期：2021年12月8日)。

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Efficacy and safety of intra-articular botulinum toxin injection therapy for joint pain: A systematic review and meta-analysis

Background

Studies conducted in various animal models of joint pain showed an anti-nociceptive effect of intra-articular botulinum toxin type A (BoNT-A). Randomized controlled trials (RCTs) in humans suggest a potential effect but results are disparate.

Objectives

To assess the efficacy and safety of intra-articular BoNT-A for the treatment of joint pain.

Methods

We conducted a systematic review of RCTs comparing the effects of intra-articular BoNT-A to other interventions on pain and activity limitations in the short (<3 months), intermediate (3–6 months) and long term (> 6 months), and their adverse effects, in people with joint pain. We performed a meta-analysis when appropriate. MEDLINE, EMBASE, ClinicalTrials.gov, CINHAL and ICTRP databases were searched from inception to July 9, 2023. Two independent reviewers selected eligible studies and extracted data in a standardized manner. The results of quantitative synthesis were expressed as the standardized mean difference (SMD) (95 % confidence interval).

Results

We included 14 RCTs: 437 participants received an intra-articular injection of BoNT-A and 551 received another intervention. Overall, 7 RCTs (549 participants) compared intra-articular BoNT-A with an intra-articular treatment in the knee: short-, intermediate-, and long-term SMD were -0.35 (-0.82 to 0.12), -0.27 (-0.61 to 0.08), and -0.43 (-1.12 to 0.26) for pain and -0.44 (-0.96 to 0.07), -0.24 (-0.63 to 0.15) and -0.42 (-1.26 to 0.42) for activity limitations, respectively. Two RCTs (68 participants) in the shoulder and 1 RCT (60 participants) in the base-of-thumb showed reduced pain in the short term. Minor adverse events were not rare, but no serious adverse events related to intra-articular BoNT-A were reported.

Conclusions

Intra-articular BoNT-A may reduce joint pain in the short term for small and medium-sized joints (ie, base-of-thumb and shoulder), but not for large joints (ie, knee).

Registration

PROSPERO: CRD42021290157 (Date of first submission: 8 November 2021; Date of registration: 8 December 2021).

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来源期刊

Annals of Physical and Rehabilitation Medicine Medicine-Rehabilitation

CiteScore

7.80

自引率

4.30%

发文量

136

审稿时长

34 days

期刊介绍： Annals of Physical and Rehabilitation Medicine covers all areas of Rehabilitation and Physical Medicine; such as: methods of evaluation of motor, sensory, cognitive and visceral impairments; acute and chronic musculoskeletal disorders and pain; disabilities in adult and children ; processes of rehabilitation in orthopaedic, rhumatological, neurological, cardiovascular, pulmonary and urological diseases.