Intra-articular Therapies for Hand Osteoarthritis: A Systematic Review and Network Meta-analysis.

Objective: Intra-articular injection therapy for hand osteoarthritis has inconclusive evidence regarding the effectiveness of different regimens. A systematic review and network meta-analysis of randomized controlled trials was conducted to examine the effectiveness of different injectants.

Design: The PubMed, Cochrane Library, Embase, ClinicalKey, and Scopus databases were searched for studies from inception to July 15, 2023. Randomized controlled trials that applied intra-articular injection to hand osteoarthritis patients were included, and the outcomes of pain scores and functional scales were assessed.

Results: Fourteen randomized controlled trials with 674 patients met the inclusion criteria; 11 randomized controlled trials were included in the network meta-analysis. Intra-articular injected platelet-rich plasma and dextrose significantly improved pain scores (mean difference = -4.03, 95% confidence interval = -6.51 to -1.56 for platelet-rich plasma; mean difference = -1.06, 95% confidence interval = -2.1 to -0.02 for dextrose) and hand function (standard mean difference = -0.93, 95% confidence interval = -1.81 to -0.05 for platelet-rich plasma; standard mean difference = -0.84, 95% confidence interval = -1.58 to -0.09 for dextrose) in the long-term (≥6 mos after treatment completion). The ranking probabilities revealed the highest effectiveness of platelet-rich plasma, followed by dextrose. No major adverse effects were reported.

Conclusions: Intra-articular injected platelet-rich plasma and dextrose can be recommended for treating hand osteoarthritis.