Erasmus MC Medical University Center Rotterdam, Department of General Practice, The Netherlands.
Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, OX3 7LD, UK; Arthritis Research UK Centre of Excellence for Sports, Exercise and Osteoarthritis, University of Oxford, OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
Osteoarthritis Cartilage. 2016 Jul;24(7):1143-52. doi: 10.1016/j.joca.2016.01.983. Epub 2016 Feb 2.
To evaluate the efficacy of intra-articular (IA) glucocorticoids for knee or hip osteoarthritis (OA) in specific subgroups of patients with severe pain and inflammatory signs using individual patient data (IPD) from existing trials.
Randomized trials evaluating one or more IA glucocorticoid preparation in patients with knee or hip OA, published from 1995 up to June 2012 were selected from the literature. IPD obtained from original trials included patient and disease characteristics and outcomes measured. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). The subgroup factors assessed included severe pain (≥70 points, 0-100 scale) and signs of inflammation (dichotomized in present or not) at baseline. Multilevel regression analyses were applied to estimate the magnitude of the effects in the subgroups with the individuals nested within each study.
Seven out of 43 published randomized clinical trials (n = 620) were included. Patients with severe baseline pain had a significantly larger reduction in short-term pain, but not in mid- and long-term pain, compared to those with less severe pain at baseline (Mean Difference 13.91; 95% Confidence Interval 1.50-26.31) when receiving IA glucocorticoid injection compared to placebo. No statistical significant interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo and to tidal irrigation at all follow-up points.
This IPD meta-analysis demonstrates that patients with severe knee pain at baseline derive more benefit from IA glucocorticoid injection at short-term follow-up than those with less severe pain at baseline.
使用现有试验的个体患者数据（IPD），评估关节内（IA）糖皮质激素治疗严重疼痛和炎症体征的膝或髋骨关节炎（OA）患者的疗效。
从文献中选择了评估一种或多种 IA 糖皮质激素制剂在膝或髋 OA 患者中的使用的随机试验。从原始试验中获得的 IPD 包括患者和疾病特征以及测量的结果。主要结局是短期随访（最长 4 周）时的疼痛严重程度。评估的亚组因素包括基线时的严重疼痛（≥70 分，0-100 分）和炎症体征（分为存在或不存在）。应用多水平回归分析估计亚组中个体内嵌套的个体的效应大小。
纳入了 7 项已发表的随机临床试验中的 43 项（n=620）。与基线疼痛较轻的患者相比，基线时疼痛严重的患者在接受 IA 糖皮质激素注射治疗时，短期疼痛明显减轻，但中、长期疼痛减轻不明显（平均差异 13.91；95%置信区间 1.50-26.31），与安慰剂相比。与安慰剂和潮汐灌洗相比，在所有随访点均未发现炎症体征与 IA 糖皮质激素注射之间的统计学显著交互作用。
这项 IPD 荟萃分析表明，基线时膝痛严重的患者在短期随访时从 IA 糖皮质激素注射中获益更多，而基线时疼痛较轻的患者获益较少。
