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Intra-articular and soft tissue injections, a systematic review of relative efficacy of various corticosteroids

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Abstract

The comparative efficacy of various Corticosteroid (CS) injections commonly used to treat musculoskeletal conditions has not been systematically studied. Our objective is to synthesize data about comparative efficacy of various CS used for intra-articular and periarticular soft tissue injections. Online databases were searched including MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effectiveness, and bibliographies of studies till November 2013. We included all randomized controlled trials comparing two CS for intra-articular and periarticular injections, selected according to Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology. Seven good quality trials were selected for qualitative data synthesis. Two trials comparing triamcinolone hexacetonide (TH) and methylprednisolone (MP) for knee arthritis suggested faster pain relief with TH for rheumatoid arthritis (RA) at day 7 (p < 0.05) and osteoarthritis (OA) at week 3 (visual analogue scale, 33 mm vs 14 mm, p < 0.01) but a similar long-term efficacy. One trial suggested faster pain relief with MP compared to triamcinolone acetonide (TA) for rotator cuff tendonitis at 2 weeks (percentage of patients improving 92 % vs. 50 %; p = 0.02) but similar long-term efficacy, while another trial suggested no difference between TA and MP for knee OA. Two trials for knee arthritis suggested a substantially better efficacy for TH than TA (response rate at 24 months 77 % vs 39 %; p = 0.001) and betamethasone (BM) at day 42 (p < 0.01). There is paucity of data regarding comparative efficacy of various CS injections. Limited number of studies favored TH over other CS (TA, MP, BM).

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Conflict of interest

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Funding

This project received an educational grant of USD 4500 from American Regent toward OHSU rheumatology fellowship fund. Funding source had no effect on data collection, data synthesis, and analysis.

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  1. Division of Arthritis and Rheumatic Diseases, Mail Code OP09, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA

    Neha Garg, Lisa Perry & Atul Deodhar

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  1. Neha Garg
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  2. Lisa Perry
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Correspondence to Neha Garg.

Appendixes

Appendixes

Appendix 1A

Table 5 Database: Ovid MEDLINE(R) and Ovid OLDMEDLINE(R) <1946 to November Week 1 2013>
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Appendix 1B

Table 6 Database: EBM Reviews—Cochrane Central Register of Controlled Trials <October 2013>
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Appendix 1C

Table 7 Database: EBM Reviews—Cochrane Database of Systematic Reviews <2005 to October 2013>
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Appendix 1D

Table 8 Database: EBM Reviews—Database of Abstracts of Reviews of Effects <4th Quarter 2013>
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Appendix 2A

Table 9 Excluded studies and reasons for exclusion
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Appendix 2B

Table 10 Bibliography of studies not available for full text review
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Garg, N., Perry, L. & Deodhar, A. Intra-articular and soft tissue injections, a systematic review of relative efficacy of various corticosteroids. Clin Rheumatol 33, 1695–1706 (2014). https://doi.org/10.1007/s10067-014-2572-8

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