Tian Kewei, Cheng Huiguang, Zhang Jiangtao, Chen Ke
Department of Hip Injury and Disease, Orthopedic Hospital of Henan Province, Luoyang City Joint Surgery Hospital Hip Joint Ward, Xi' an Hong Hui Hospital , Xi' an Department of Knee Injury and Disease, Orthopedic Hospital of Henan Province, Luoyang City, China.
Medicine (Baltimore). 2018 Apr;97(15):e0240. doi: 10.1097/MD.0000000000010240.
To evaluate the efficacy and safety of intra-articular methylprednisolone for reducing pain in patients with knee osteoarthritis.
We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11), and the Cochrane Library (1900-2017.11) for randomized clinical trials comparing the use of methylprednisolone to treat knee osteoarthritis. The primary outcomes are Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and WOMAC function scores. Each outcome was combined and calculated using the statistical software STATA 12.0. Fixed/random effect model was adopted based on the heterogeneity tested by I statistic.
A total of 739 patients were analyzed across 4 randomized controlled trials (RCTs). The present meta-analysis revealed that there were significant differences between groups regarding the WOMAC pain scores at 4 weeks (WMD = -1.384, 95% CI: -1.975 to -0.793, P = .000), 12 weeks (WMD = -1.587, 95% CI: -2.489 to -0.685, P = .001), and 24 weeks (WMD = -1.563, 95% CI: -2.245 to -0.881, P = .000). Significant differences were identified in terms of physical function at 4 weeks (WMD = -7.925, 95% CI: -13.359 to -2.491, P = .004), 12 weeks (WMD = -7.314, 95% CI: -13.308 to -1.320, P = .117), and 24 weeks (WMD = -6.484, 95% CI: -11.256 to -1.711, P = .008).
Intra-articular methylprednisolone injection was associated with an improved pain relief and physical function in patients with knee osteoarthritis. Additionally, no severe adverse effects were observed. Due to the limited quality of the evidence currently available, higher quality RCTs were required.
评估关节腔内注射甲泼尼龙减轻膝关节骨关节炎患者疼痛的疗效和安全性。
我们对Medline（1966 - 2017.11）、PubMed（1966 - 2017.11）、Embase（1980 - 2017.11）、ScienceDirect（1985 - 2017.11）和Cochrane图书馆（1900 - 2017.11）进行电子检索，以查找比较使用甲泼尼龙治疗膝关节骨关节炎的随机临床试验。主要结局指标为西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛评分及WOMAC功能评分。使用统计软件STATA 12.0对每个结局进行合并和计算。根据I统计量检验的异质性采用固定/随机效应模型。
4项随机对照试验（RCT）共纳入739例患者。本荟萃分析显示，在4周时（加权均数差[WMD] = -1.384，95%置信区间[CI]：-1.975至-0.793，P = 0.000）、12周时（WMD = -1.587，95% CI：-2.489至-0.685，P = 0.001）和24周时（WMD = -1.563，95% CI：-2.245至-0.881，P = 0.000），两组间WOMAC疼痛评分存在显著差异。在4周时（WMD = -7.925，95% CI：-13.359至-2.491，P = 0.004）、12周时（WMD = -7.314，95% CI：-13.308至-1.320，P = 0.117）和24周时（WMD = -6.484，95% CI：-11.256至-1.711，P = 0.008），身体功能方面存在显著差异。
关节腔内注射甲泼尼龙可改善膝关节骨关节炎患者的疼痛缓解情况及身体功能。此外，未观察到严重不良反应。由于现有证据质量有限，需要更高质量的随机对照试验。
