Corticosteroid injections for osteoarthritis of the knee: meta-analysis

Abstract

Objectives: To determine the efficacy of intra-articular corticosteroid injections for osteoarthritis of the knee and to identify numbers needed to treat.

Data sources: Cochrane controlled trials register, Medline (1966 to 2003), Embase (1980 to 2003), hand searches, and contact with authors.

Inclusion criteria: Randomised controlled trial in which the efficacy of intra-articular corticosteroid injections for osteoarthritis of the knee could be ascertained.

Results: In high quality studies, the pooled relative risk for improvement in symptoms of osteoarthritis of the knee at 16-24 weeks after intra-articular corticosteroid injections was 2.09 (95% confidence interval 1.2 to 3.7) and the number needed to treat was 4.4. The pooled relative risk for improvement up to two weeks after injections was 1.66 (1.37 to 2.0). The numbers needed to treat to get one improvement in the statistically significant studies was 1.3 to 3.5 patients.

Conclusion: Evidence supports short term (up to two weeks) improvement in symptoms of osteoarthritis of the knee after intra-articular corticosteroid injection. Significant improvement was also shown in the only methodologically sound studies addressing longer term response (16-24 weeks). A dose equivalent to 50 mg of prednisone may be needed to show benefit at 16-24 weeks.

Figures

Fig 1

Summary of search results

Fig 2

Improvements up to two weeks after steroid injection in knee

Fig 3

Improvements at 16-24 weeks after high dose steroid injection in knee for two high quality studies

Fig 4

Visual analogue scale for pain up to two weeks after steroid injection in knee

Fig 5

Funnel plot for corticosteroids compared with placebo