Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France.
Caen Normandie University, UMR-S 1075-Mobilités: Vieillissement, Pathologie, Santé COMETE, Caen, France, Rheumatology Department, CHU Caen, Caen, France, and Université de Lorraine, EA 4360, APEMAC, Nancy, France.
Arthritis Rheumatol. 2022 Aug;74(8):1343-1351. doi: 10.1002/art.42118. Epub 2022 Jun 22.
Recent findings have demonstrated that intraarticular (IA) glucocorticoid injections can be deleterious for knees with osteoarthritis (OA). This study was undertaken to assess, in a real-life setting, the risk of knee OA progression in patients who received IA glucocorticoid injections over a 5-year follow-up period.
We used marginal structural modeling with inverse probability of treatment weighting to determine the causal association between IA glucocorticoid injections and the 5-year risk of disease progression in patients with symptomatic knee OA from the Knee and Hip Osteoarthritis Long-term Assessment cohort. OA progression was defined as an incident total knee replacement (TKR) and/or radiographic worsening (Kellgren/Lawrence [K/L] grade or joint space narrowing [JSN]). We also examined these outcomes in knees that received IA hyaluronan (IAHA) injections.
Among the 564 patients with knee OA included in the study sample, 51 (9.0%) and 99 (17.5%) received IA glucocorticoid or IAHA injections, respectively, and 414 (63.1%) did not receive any injection during follow-up. Compared to untreated knees, those treated with IA glucocorticoid injections had a similar risk of incident TKR (hazard ratio [HR] 0.92 [95% confidence interval (95% CI) 0.20, 4.14]; P = 0.91) or K/L grade worsening (HR 1.33 [95% CI 0.64, 2.79]; P = 0.44). IAHA injections had no effect on the risk of TKR (HR 0.81 [95% CI 0.14, 4.63]; P = 0.81) or K/L grade worsening (HR 1.36 [95% CI 0.85, 2.17]; P = 0.20). Similar results were obtained for JSN, and when TKR and radiographic outcomes were combined.
In this study, IA glucocorticoid injections for symptomatic knee OA did not significantly increase the 5-year risk of incident TKR or radiographic worsening. These findings should be interpreted cautiously and replicated in other cohorts.
最近的研究结果表明，关节内（IA）糖皮质激素注射对骨关节炎（OA）的膝关节可能有害。本研究旨在评估在膝关节 OA 患者中，在 5 年随访期间接受 IA 糖皮质激素注射后的膝关节 OA 进展风险。
我们使用边缘结构模型和逆概率治疗加权来确定 IA 糖皮质激素注射与膝关节 OA 患者 5 年疾病进展风险之间的因果关系，这些患者来自膝关节和髋关节 OA 长期评估队列。OA 进展定义为全膝关节置换术（TKR）和/或放射学恶化（Kellgren/Lawrence [K/L] 分级或关节间隙狭窄 [JSN]）。我们还检查了接受 IA 透明质酸（IAHA）注射的膝关节的这些结果。
在研究样本的 564 例膝关节 OA 患者中，51 例（9.0%）和 99 例（17.5%）分别接受了 IA 糖皮质激素或 IAHA 注射，414 例（63.1%）在随访期间未接受任何注射。与未治疗的膝关节相比，接受 IA 糖皮质激素注射的膝关节发生 TKR 的风险相似（风险比 [HR] 0.92 [95%置信区间（95%CI）0.20，4.14]；P = 0.91）或 K/L 分级恶化（HR 1.33 [95%CI 0.64，2.79]；P = 0.44）。IAHA 注射对 TKR 风险没有影响（HR 0.81 [95%CI 0.14，4.63]；P = 0.81）或 K/L 分级恶化（HR 1.36 [95%CI 0.85，2.17]；P = 0.20）。当 JSN 以及 TKR 和放射学结果相结合时，也得到了相似的结果。
在这项研究中，关节内糖皮质激素注射治疗膝关节 OA 症状并未显著增加 5 年内发生 TKR 或放射学恶化的风险。这些发现应谨慎解释，并在其他队列中复制。
