Department of Medicine, Co-Director Joint Preservation and Arthritis Center, NYU Grossman School of Medicine, New York, NY, USA.
Departments of Medicine and Biochemistry & Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY, USA.
Osteoarthritis Cartilage. 2021 Jan;29(1):8-16. doi: 10.1016/j.joca.2020.09.001. Epub 2020 Sep 7.
Intra-articular (IA) injections of glucocorticoids (GCs) have been shown to decrease pain, increase mobility, and improve quality of life in patients with osteoarthritis (OA) of the knee. Concerns about cartilage loss with IA GCs have prompted reconsideration of their use in knee OA. This review has three objectives: 1) critically review the clinical, molecular, and structural effects of IA GCs in knee OA; 2) provide a design for a clinical trial aimed at improving our understanding of the long-term consequences of IA GCs; and 3) provide practical guidance on the use of IA GCs in patients with knee OA based on current information.
A narrative review of current literature on the use of IA GCs for OA of the knee.
Important questions remain to be fully answered with respect to IA GCs, including long-term effects on all aspects of the structural and molecular environment of the knee, and identification of factors that can reliably predict a positive or negative response to IA GCs.
While awaiting results from an appropriately designed study, several provisional statements regarding IA GCs can be put forward: 1) IA GCs appear to be a relatively safe option that is effective in specific patients with symptomatic knee OA; 2) there is no definitive evidence that IA GCs accelerate joint deterioration to an important extent or hastens the requirement for knee replacement; and 3) there are few contraindications to IA GCs and injection-associated complications are rare when IA GCs are delivered with proper technique.
关节内（IA）注射糖皮质激素（GCs）已被证明可减轻膝关节骨关节炎（OA）患者的疼痛，增加活动度，并改善生活质量。IA GCs 可能导致软骨丢失，这促使人们重新考虑其在膝 OA 中的应用。本次综述有三个目的：1）批判性地评价 IA GCs 在膝 OA 中的临床、分子和结构影响；2）为旨在提高我们对 IA GCs 长期后果的理解的临床试验提供设计；3）根据当前信息，为膝 OA 患者使用 IA GCs 提供实用指南。
对 IA GCs 治疗膝 OA 的当前文献进行叙述性综述。
IA GCs 的长期影响（包括对膝关节结构和分子环境的所有方面的影响）以及确定可可靠预测 IA GCs 阳性或阴性反应的因素等重要问题仍有待充分解答。
在等待经过精心设计的研究结果的同时，可以就 IA GCs 提出一些暂定声明：1）IA GCs 似乎是一种相对安全的选择，对有症状的膝 OA 特定患者有效；2）没有明确的证据表明 IA GCs 会在很大程度上加速关节恶化或加速膝关节置换的需求；3）IA GCs 的禁忌症很少，当以适当的技术进行 IA GCs 注射时，与注射相关的并发症很少见。
