Bannuru Raveendhara R, Natov Nikola S, Obadan Isi E, Price Lori L, Schmid Christopher H, McAlindon Timothy E
Tufts University School of Medicine, Boston, MA, USA.
Arthritis Rheum. 2009 Dec 15;61(12):1704-11. doi: 10.1002/art.24925.
To compare the efficacy of intraarticular hyaluronic acid with corticosteroids for knee osteoarthritis (OA).
Our data sources were Medline, EMBASE, CINAHL, BIOSIS, and the Cochrane database, as well as hand- searched reviews, manuscripts, and supplements. For unpublished data we used author contacts. Randomized trials that reported effects of intraarticular hyaluronic acid versus corticosteroids on knee OA were selected based on inclusion criteria. Two reviewers extracted data independently. Using a random-effects model, we computed effect sizes for pain change from baseline at 2, 4, 8, 12, and 26 weeks. We also performed multivariate analyses accounting for within and between-study covariance. We performed sensitivity analyses for trials that reported intent-to-treat (ITT) analysis and blinding, and directly compared Hyalgan with methylprednisolone.
The 7 eligible trials included 606 participants. Five reported ITT analyses. At week 2 the effect size was -0.39 (95% confidence interval [95% CI], -0.65, -0.12) favoring corticosteroids; at week 4 it was -0.01 (95% CI -0.23, 0.21) suggesting equal efficacy. At week 8 the effect size was 0.22 (95% CI -0.05, 0.49) favoring hyaluronic acid, and at week 12 it was 0.35 (95% CI 0.03, 0.66) favoring hyaluronic acid. At week 26 the effect size was 0.39 (95% CI 0.18, 0.59), favoring hyaluronic acid. The multivariate analyses and sensitivity analyses generated consistent results.
From baseline to week 4, intraarticular corticosteroids appear to be relatively more effective for pain than intraarticular hyaluronic acid. By week 4, the 2 approaches have equal efficacy, but beyond week 8, hyaluronic acid has greater efficacy. Understanding this trend is useful to clinicians when treating knee OA.
比较关节腔内注射透明质酸与皮质类固醇治疗膝关节骨关节炎（OA）的疗效。
我们的数据来源包括医学期刊数据库（Medline）、荷兰医学文摘数据库（EMBASE）、护理及健康领域数据库（CINAHL）、生物学文摘数据库（BIOSIS）和考克兰数据库，以及手工检索的综述、手稿和增刊。对于未发表的数据，我们通过联系作者获取。根据纳入标准，选择报告关节腔内注射透明质酸与皮质类固醇对膝关节OA影响的随机试验。两名评价者独立提取数据。使用随机效应模型，我们计算了在第2、4、8、12和26周时疼痛相对于基线变化的效应量。我们还进行了多变量分析，考虑了研究内和研究间的协方差。我们对报告意向性分析（ITT）和盲法的试验进行了敏感性分析，并直接比较了玻璃酸钠与甲基强的松龙。
7项符合条件的试验纳入了606名参与者。5项报告了ITT分析。在第2周时，效应量为-0.39（95%置信区间[95%CI]，-0.65，-0.12），表明皮质类固醇更有效；在第4周时，效应量为-0.01（95%CI -0.23，0.21），表明两者疗效相当。在第8周时，效应量为0.22（95%CI -0.05，0.49），表明透明质酸更有效；在第12周时，效应量为0.35（95%CI 0.03，0.66），表明透明质酸更有效。在第26周时，效应量为0.39（95%CI 0.18，0.59），表明透明质酸更有效。多变量分析和敏感性分析得出了一致的结果。
从基线到第4周，关节腔内注射皮质类固醇在缓解疼痛方面似乎比关节腔内注射透明质酸更有效。到第4周时，两种方法疗效相当，但在第8周之后，透明质酸的疗效更佳。了解这一趋势对治疗膝关节OA的临床医生很有帮助。
