I think that this is clearly an interesting topic for discussion and consideration of the current evidence.
The commentary article by Dr John Orchard (below) is clearly very strong and well articulated, but these formats — whilst making their best efforts to be evidence informed — are inherently biased!
The central systematic review to which John’s commentary refers is also below. There is a focus on studies that have administered/compared the effects of multiple steroid injections over a defined short time course, which could be argued is different from the argument that the commentary (don’t deliver any corticosteroid injection (CSI) to knees with OA) is presenting.
The review findings do add weight to the argument that short term benefits from injections are commonly observed, but that beyond the 6 – 8 week time point, placebo or other injectables (e.g. Hyaluronic acid) are of possibly superior effect to corticosteroid.
I think it is important for some consideration of these level 1 findings, and on our approaches to managing this painful condition. With a suffering patient in front of you seeking assistance, it may be challenging to deny them something that can ease their short term symptoms, but perhaps these data may shift the discussion away from steroid and result in a different approach being offered?
Effects of recurrent intra articular corticosteroid injections for osteoarthritis at 3 months and beyond a systematic review and meta analysis in comparison to other injectables
PDF, 3 MB
DownloadPay attention to the evidence in the longer term intraarticular corticosteroid injections offer only harm for knee osteoarthritis
PDF, 120 KB
DownloadWould you like to get involved in this discussion? To do so, complete the form below for the attention of Dr Simon Lack.
References
Osteoarthritis Research Society International:
- J.W. Orchard. School of Public Health, Sports Medicine at Sydney University, Cnr Western Ave and Physics Rd, University of Sydney, NSW 2006, Australia.
- R.L. Donovan, T.A. Edwards, A. Judge, A.W. Blom, S.K. Kunutsor, M.R. Whitehouse. Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK, National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
