Interventions for osteoarthritis pain: A systematic review with network meta-analysis of existing Cochrane reviews

Geir Smedslund; Ingvild Kjeken; Frauke Musial; Joseph Sexton; Nina Østerås

doi:10.1016/j.ocarto.2022.100242

Interventions for osteoarthritis pain: A systematic review with network meta-analysis of existing Cochrane reviews

Osteoarthr Cartil Open. 2022 Feb 15;4(2):100242. doi: 10.1016/j.ocarto.2022.100242. eCollection 2022 Jun.

Authors

Geir Smedslund¹, Ingvild Kjeken¹, Frauke Musial², Joseph Sexton³, Nina Østerås¹

Affiliations

¹ Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.
² National Research Center in Complementary and Alternative Medicine, NAFKAM, Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University, Norway.
³ Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.

Abstract

Objective: To conduct a network meta-analysis comparing all treatments for osteoarthritis (OA) pain in the Cochrane Library.

Design: The Cochrane Library and Epistemonikos were searched for randomized controlled trials (RCTs) about treatments for hip and knee OA. We constructed 17 broad categories, comprising drug treatments, exercise, surgery, herbs, orthotics, passive treatments, regenerative medicine, diet/weight loss, combined treatments, and controls. In addition to a full network analysis, we compared the direct/indirect effects, and studies with shorter-/longer follow-up. CINeMA software was used for assessing confidence in network meta-analysis estimates.

Results: We included 35 systematic reviews including 445 RCTs. There were 153 treatments for OA. In total, 491 comparisons were related to knee OA, less on hip OA, and only nine on hand OA. Six treatment categories showed clinically significant effects favoring treatment over control on pain. "Diet/weight loss" and "Surgery" had effect sizes close to zero. The network as a whole was not coherent. Of 136 treatment comparisons, none were rated as high confidence, six as moderate, 13 as low, and 117 as very low.

Conclusions: Direct comparison of different available treatment options for OA is desirable, however not currently feasible in practice, due to heterogeneous study populations and lack of clear descriptions of control interventions. We found that many treatments were effective, but since the network as a whole was not coherent and lacked high confidence in the treatment comparisons, we could not produce a ranking of effects.

Keywords: ACR, American College of Rheumatology; CINeMA, Confidence In the results of Network Meta-Analysis; DJW, Chinese Duhuo Jisheng Wan; EULAR, European Alliance of Associations for Rheumatology; Interventions; NMAs, Network meta-analyses; NSAIDs, nonsteroidal anti-inflammatory drugs; Network meta-analysis; Non-pharmacological; OA, Osteoarthritis; OARSI, Osteoarthritis Research Society International; Osteoarthritis; PRP, platelet-rich plasma; Pain; Pharmacological; QoL, Quality of Life; RoB, Cochrane risk of bias; SKI 306X, Extract from a mixture of Clematis mandshurica, Trichosanthes kirilowii and Prunella vulgaris; TENS, Transcutaneous nerve stimulation; WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index.

Publication types

Review