Intra-articular injections in thumb osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Abstract

Objectives: The objective was to assess the efficacy of intra-articular injections of corticosteroids or hyaluronic acid in thumb osteoarthritis.

Methods: A systematic review of the literature was performed until August 2014. All controlled trials reporting the efficacy on pain, functional capacity and pulp pinch force of hyaluronic acid or corticosteroids in thumb osteoarthritis were selected. Pooled standardized response means (SRMs) were assessed by meta-analysis.

Results: Six trials were included and contributed to 3 meta-analyses (hyaluronic acid versus placebo, corticosteroids vs. placebo and hyaluronic acid vs. corticosteroids). Among the 428 patients included, 169 were treated with hyaluronic acid, 147 with corticosteroids and 74 with placebo. Versus placebo at week 12, hyaluronic acid (2 trials, 148 patients) lead to better functional capacity (SRM -1.14 [-1.69; -0.60]) with no difference on pain; corticosteroids (2 trials, 164 patients) lead to no difference on pain or function. When comparing hyaluronic acid vs. corticosteroids (4 trials, 304 patients), no difference was evidenced until week 12. At week 24, pain was significantly lower in the corticosteroids group (SRM 1.44 [0.14; 2.74]) and pulp pinch force higher in the hyaluronic acid group (SRM -0.75 [-3.87; -1.97]).

Conclusion: This meta-analysis shows great heterogeneity. Hyaluronic acid may be useful to increase functional capacity and corticosteroids to decrease pain in thumb osteoarthritis at week 24.

Keywords: Corticosteroids; Functional capacity; Hyaluronic acid; Intra-articular injection; Pain; Thumb osteoarthritis.