Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2024 Nov;32(11):2725-2745. doi: 10.1002/ksa.12242. Epub 2024 May 30.
PURPOSE: Aim of this systematic review of preclinical evidence was to determine the effects of intra-articular corticosteroid (CS) injections in joints affected by osteoarthritis (OA). METHODS: A systematic review was performed on animal studies evaluating intra-articular CS injections for OA joints. The search was performed on PubMed, Cochrane, and Web of Science databases. A synthesis of the results was performed investigating CS effects by evaluating studies comparing CS with control groups. Morphological, histological, immunohistochemistry evaluations, clinical outcomes, biomarkers and imaging results were evaluated. The risk of bias was assessed according to the Systematic Review Centre for Laboratory Animal Experimentation's tool. RESULTS: Thirty-two articles analysing CS effects in OA animal models were included (1079 joints), 18 studies on small and 14 on large animals. CS injections showed overall positive effects in at least one of the outcomes in 68% of the studies, while 16% reported a deleterious effect. CS improved cartilage and synovial outcomes in 68% and 60% of the studies, but detrimental effects were documented in 11% and 20% of the studies, respectively. Clinical parameters evaluated in terms of pain, lameness or joint swelling improved in 63% of the studies but deteriorated in 13%. Evidence is limited on imaging and biomarkers results, as well as on the best CS type, dose, formulation and injection protocol. The risk of bias assessment revealed a 28% low and an 18% high risk of bias. CONCLUSION: Intra-articular CS injections induced a wide range of results on OA joints in experimental animal models, from disease-modifying and positive effects on pain and joint function at short-term evaluation to the lack of benefit or even negative effects. This underlines the need to identify more specific indications and treatment modalities to avoid possible detrimental effects while maximising the anti-inflammatory properties and the benefits of intra-articular CS in OA joints. LEVEL OF EVIDENCE: Level II.
目的:本系统综述的目的是确定关节内皮质类固醇(CS)注射对骨关节炎(OA)关节的影响。
方法:对评估关节内 CS 注射治疗 OA 关节的动物研究进行了系统综述。在 PubMed、Cochrane 和 Web of Science 数据库中进行了检索。通过比较 CS 组与对照组的研究,对 CS 效果进行综合评估。评估了形态学、组织学、免疫组织化学评价、临床结果、生物标志物和影像学结果。根据系统评价中心对实验室动物实验的工具评估了偏倚风险。
结果:共纳入 32 篇分析 OA 动物模型中 CS 作用的文章(1079 个关节),18 篇为小型动物研究,14 篇为大型动物研究。CS 注射在 68%的研究中至少在一种结果中显示出总体积极作用,而 16%的研究报告了有害作用。CS 改善了 68%的研究中的软骨和滑膜结果,但在 11%和 20%的研究中分别记录了有害作用。在疼痛、跛行或关节肿胀方面评估的临床参数在 63%的研究中得到改善,但在 13%的研究中恶化。关于影像学和生物标志物结果以及最佳 CS 类型、剂量、配方和注射方案的证据有限。偏倚风险评估显示,低风险为 28%,高风险为 18%。
结论:关节内 CS 注射在实验性 OA 关节中产生了广泛的结果,从短期评估的疾病修饰和对疼痛和关节功能的积极影响到缺乏益处甚至负面影响。这强调了需要确定更具体的适应证和治疗方式,以避免可能的有害影响,同时最大限度地发挥 OA 关节内 CS 的抗炎特性和益处。
证据等级:二级。
Cochrane Database Syst Rev. 2015-10-22
Cochrane Database Syst Rev. 2015-10-17
Cochrane Database Syst Rev. 2005-4-18
Cochrane Database Syst Rev. 2006-4-19
Knee Surg Sports Traumatol Arthrosc. 2021-12