Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis
Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences
Epidemiology | Health Services Administration | Health Services Research | Hormones, Hormone Substitutes, and Hormone Antagonists | Musculoskeletal Diseases | Rheumatology | Therapeutics
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
J Rheumatol. 2018 Jun 15. pii: jrheum.171385. doi: 10.3899/jrheum.171385. [Epub ahead of print] Link to article on publisher's site
The Journal of rheumatology
Liu, Shao-Hsien; Dube, Catherine E.; Eaton, Charles B.; Driban, Jeffrey B.; McAlindon, Timothy E.; and Lapane, Kate L., "Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis" (2018). Quantitative Health Sciences Publications and Presentations. 1204.