Jones Katherine, Bruce Julie, Lewis Thomas L, Nolan Ciaran N, Munteanu Shannon E, Menz Hylton B, Backhouse Michael R
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Warwick, UK.
University Hospitals Coventry and Warwick, NHS Trust, Coventry, UK.
Rheumatol Adv Pract. 2025 Mar 11;9(2):rkaf030. doi: 10.1093/rap/rkaf030. eCollection 2025.
Intra-articular corticosteroid injections are commonly used in the management of foot and ankle OA. Although current clinical guidelines advocate the judicious use of corticosteroid injection as an adjunct therapy, none of these recommendations are specific to the foot and ankle. Therefore, the aim of this review is to examine the effectiveness of intra-articular corticosteroid injections in people with foot or ankle OA.
Four databases (Cumulative Index to Nursing and Allied Health Literature [CINAHL], MEDLINE, EMBASE and CENTRAL) and one clinical trial register (International Clinical Trials Registry Platform [ICTRP]) were searched from inception to June 2024 for randomized control trials (RCTs) and quasi-RCTs evaluating corticosteroid injection in the treatment of foot or ankle OA on pre-specified outcomes: pain, function, quality of life, safety (adverse events) and/or cost-effectiveness. Two independent reviewers conducted record screening, data extraction (Cochrane data extraction tool) and assessment of methodological quality (Cochrane Risk of Bias tool [RoB 2.0]).
From 1711 citations, two RCTs (57 participants, 49% males) were identified. There were no differences in pain or function over 8 weeks after a single injection of intra-articular corticosteroid compared with prolotherapy for treatment of first metatarsal joint OA. Pain and function significantly improved in people having three corticosteroid injections combined with hyaluronic acid compared with corticosteroid injections alone for treatment of post-traumatic subtalar OA. Methodological quality was graded as some concerns in both trials.
There is insufficient evidence to guide the use of intra-articular corticosteroid injections for OA of the foot or ankle. Future robust research is needed to provide reliable evidence for this commonly performed treatment.
关节内注射皮质类固醇常用于足踝骨关节炎的治疗。尽管当前临床指南提倡谨慎使用皮质类固醇注射作为辅助治疗，但这些建议均未针对足踝部。因此，本综述的目的是研究关节内注射皮质类固醇对足踝骨关节炎患者的有效性。
检索了四个数据库（护理及相关健康文献累积索引[CINAHL]、医学文献数据库[MEDLINE]、荷兰医学文摘数据库[EMBASE]和考克兰对照试验中心注册库[CENTRAL]）以及一个临床试验注册库（国际临床试验注册平台[ICTRP]），检索时间从建库至2024年6月，以查找评估皮质类固醇注射治疗足踝骨关节炎在预先设定结局（疼痛、功能、生活质量、安全性[不良事件]和/或成本效益）方面的随机对照试验（RCT）和半随机对照试验（quasi-RCT）。两名独立评审员进行记录筛选、数据提取（考克兰数据提取工具）和方法学质量评估（考克兰偏倚风险工具[RoB 2.0]）。
从1711篇文献中，确定了两项RCT（57名参与者，49%为男性）。对于第一跖趾关节骨关节炎的治疗，单次关节内注射皮质类固醇与注射增生疗法相比，8周内疼痛或功能无差异。对于创伤后距下关节骨关节炎的治疗，与单独注射皮质类固醇相比，三次皮质类固醇注射联合透明质酸可使疼痛和功能显著改善。两项试验的方法学质量均被评为存在一些问题。
尚无足够证据指导关节内注射皮质类固醇用于足踝骨关节炎的治疗。未来需要进行有力的研究，为这种常见治疗方法提供可靠证据。
