Intra-articular hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis: A meta-analysis

Abstract

The aim of the present study was to evaluate the therapeutic effect of intra-articular hyaluronic acid (HA) in comparison to corticosteroids (CS) for knee osteoarthritis (OA). The data sources included PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and hand searched reviews. Randomized controlled trials that reported the effects of intra-articular HA and CS in the treatment of knee OA were selected based on specific inclusion criteria. A meta-analysis was performed for the visual analog scale (VAS), Lequesne index, Knee Society Clinical Rating System (KSS), maximum flexion and adverse events of knee OA. Sensitivity analysis was also conducted to avoid bias. The seven eligible trials included 583 participants and the majority of the trials were of high quality. After one month, the mean difference in the VAS was 1.66 [95% confidence interval (CI); -0.90, 4.23), indicating equal efficacy for HA and CS. However, after three months, the mean difference was -12.58 (95% CI; -17.76, -7.40), while after six months, the difference was -9.01 (95% CI; -12.62, -5.40), favoring HA. For the additional indicators, including the Lequesne index, the KSS, maximum flexion and adverse events, no statistically significant differences were observed between the two treatment approaches for knee OA. Therefore, the results of the meta-analysis highlight a therapeutic trajectory for intra-articular HA in knee OA pain, as compared with CS, over six months post-intervention. After one month, the two approaches exhibited equal efficacy; however, in the long term, HA was found to have an enhanced effect. No statistically significant difference was observed in the adverse events caused by the two interventions. Further investigation and understanding into the trend observed in the present study may aid clinicians in the treatment of knee OA.

Keywords: corticosteroids; hyaluronic acid; intra-articular; knee; meta-analysis; osteoarthritis.

Figure 1

Summary of the search results and the selection procedure for inclusion.

Figure 2

Forest plot diagram showing the VAS of knee OA. VAS, visual analog score; SD, standard deviation; CI, confidence interval; OA, osteoarthritis.

Figure 3

Forest plot diagram showing the Lequesne index of knee OA. SD, standard deviation; CI, confidence interval; OA, osteoarthritis.

Figure 4

Forest plot diagram showing the KSS of knee OA. SD, standard deviation; CI, confidence interval; KSS, Knee Society Clinical Rating Score; OA, osteoarthritis.

Figure 5

Forest plot diagram showing the maximum flexion of knee OA. SD, standard deviation; CI, confidence interval; OA, osteoarthritis.

Figure 6

Forest plot diagram showing the adverse events of knee OA. SD, standard deviation; CI, confidence interval; OA, osteoarthritis.

Figure 7

Funnel plot showing the publication bias of the subgroups with regard to VAS at the different time periods. VAS, visual analog score. SE, standard error; MD, mean difference.