Title
Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis
UMMS Affiliation
Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences
Publication Date
2018-06-15
Document Type
Article
Disciplines
Epidemiology | Health Services Administration | Health Services Research | Hormones, Hormone Substitutes, and Hormone Antagonists | Musculoskeletal Diseases | Rheumatology | Therapeutics
Abstract
OBJECTIVE: We examined the longterm effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA).
METHODS: Using Osteoarthritis Initiative data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injections (n = 412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect on symptoms of newly initiated injection use compared to nonusers over 2 years of followup.
RESULTS: Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. About 18.9% had additional injection use after initiation, but switching between injection types was common. Compared to nonusers, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points, 95% CI 0.82-1.66), stiffness (yearly worsening: 0.30 points, 95% CI 0.10-0.49), and physical functioning (yearly worsening: 2.62 points, 95% CI 0.94-4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50, 95% CI -0.11 to 1.11; stiffness: -0.07, 95% CI -0.38 to 0.24; and functioning: 0.49, 95% CI -1.34 to 2.32).
CONCLUSION: Although intraarticular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptom relief over 2 years of followup for persons with knee OA.
DOI of Published Version
10.3899/jrheum.171385
Source
J Rheumatol. 2018 Jun 15. pii: jrheum.171385. doi: 10.3899/jrheum.171385. [Epub ahead of print] Link to article on publisher's site
Journal/Book/Conference Title
The Journal of rheumatology
PubMed ID
29907665
Related Resources
Repository Citation
Liu S, Dube CE, Eaton CB, Driban JB, McAlindon TE, Lapane KL. (2018). Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis. Population and Quantitative Health Sciences Publications. https://doi.org/10.3899/jrheum.171385. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1204