Intra-articular and soft tissue injections, a systematic review of relative efficacy of various corticosteroids

Neha Garg, Lisa Perry, Atulya (Atul) Deodhar

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

The comparative efficacy of various Corticosteroid (CS) injections commonly used to treat musculoskeletal conditions has not been systematically studied. Our objective is to synthesize data about comparative efficacy of various CS used for intra-articular and periarticular soft tissue injections. Online databases were searched including MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effectiveness, and bibliographies of studies till November 2013. We included all randomized controlled trials comparing two CS for intra-articular and periarticular injections, selected according to Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology. Seven good quality trials were selected for qualitative data synthesis. Two trials comparing triamcinolone hexacetonide (TH) and methylprednisolone (MP) for knee arthritis suggested faster pain relief with TH for rheumatoid arthritis (RA) at day 7 (p <0.05) and osteoarthritis (OA) at week 3 (visual analogue scale, 33 mm vs 14 mm, p <0.01) but a similar long-term efficacy. One trial suggested faster pain relief with MP compared to triamcinolone acetonide (TA) for rotator cuff tendonitis at 2 weeks (percentage of patients improving 92 % vs. 50 %; p = 0.02) but similar long-term efficacy, while another trial suggested no difference between TA and MP for knee OA. Two trials for knee arthritis suggested a substantially better efficacy for TH than TA (response rate at 24 months 77 % vs 39 %; p = 0.001) and betamethasone (BM) at day 42 (p <0.01). There is paucity of data regarding comparative efficacy of various CS injections. Limited number of studies favored TH over other CS (TA, MP, BM).

Original languageEnglish (US)
Pages (from-to)1695-1706
Number of pages12
JournalClinical Rheumatology
Volume33
Issue number12
DOIs
StatePublished - Nov 14 2014

Fingerprint

Triamcinolone Acetonide
Methylprednisolone
Adrenal Cortex Hormones
Joints
Injections
Betamethasone
Databases
Arthritis
Knee
Pain
Intra-Articular Injections
Tendinopathy
Rotator Cuff
Knee Osteoarthritis
Bibliography
Visual Analog Scale
MEDLINE
Osteoarthritis
Meta-Analysis
Rheumatoid Arthritis

Keywords

  • Corticosteroid
  • Injections
  • Intra-articular
  • Periarticular
  • Systematic review

ASJC Scopus subject areas

  • Rheumatology
  • Medicine(all)

Cite this

Intra-articular and soft tissue injections, a systematic review of relative efficacy of various corticosteroids. / Garg, Neha; Perry, Lisa; Deodhar, Atulya (Atul).

In: Clinical Rheumatology, Vol. 33, No. 12, 14.11.2014, p. 1695-1706.

Research output: Contribution to journalArticle

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