Question 1. What evidence is available regarding
symptom-modifying and disease-modifying changes after a single IA
injection to treat OA?
Twenty-three articles were included to answer question 1. Of these, 16
focused on humans (12 RCTs, one crossover, one case-control, one
retrospective cohort, and one pilot) (Gaffney et al., 1995; Jones &
Doherty, 1996; Young et al., 2001; Carette et al., 2003; Meenagh et al.,
2004; Heyworth et al., 2008; Chao et al., 2010; Leung et al., 2011;
Yavuz et al., 2012; Gialanella & Bertolinelli, 2013; Lattermann et
al., 2017; Shrestha et al., 2018; Mendes et al., 2019; Okike et al.,
2021; Latourte et al., 2022; Nunes-Tamashiro et al., 2022). Seven
studies included horses as the study subjects (five pre-clinicalin vivo and two RCTs) (Todhunter et al., 1998; Fubini et al.,
2001; Kay et al., 2008; de Grauw et al., 2016; Ekstrand et al., 2019;
Kearney et al., 2021; de Clifford et al., 2021). The risk of bias was
considered unclear/high in most studies, with only four RCTs, one
crossover, and one retrospective pilot study having a low risk of bias
(Figure 3).
Lesions investigated in studies included (in humans) knee OA (ten
studies), anterior cruciate ligament injury (one study), rapidly
destructive hip disease (RDHD) (one study), shoulder adhesive capsulitis
(one study), shoulder rotator cuff tendinopathy (one study), and OA of
the carpometacarpal joint of the thumb (two studies). In horses, there
was lipopolysaccharide-induced joint inflammation of the fetlock/carpus
(five studies), naturally occurring middle carpal joint OA (one study),
and lameness associated with joint pain (responsive to IA block) (one
study). Human studies included 40 to 465 patients, with one study
reporting the number of joints as the experimental unit (757 joints).
This experimental unit was primarily employed in equine investigations
in which sample numbers ranged from 11 to 41 joints. TA was the most
investigated corticosteroid (ten studies; doses were 9–12 mg for horses
and 40–80 mg for humans), followed by TH (five studies; doses of 5–40
mg for humans), MPA (five studies, 0.1 mg/kg for horses and 40–120 mg
for humans), BTM (two studies; 3–6 mg for humans), and DEX (one study;
0.01–3 mg for horses). The specific corticosteroid type employed was
not mentioned in two studies in which authors investigated the effects
of IA corticosteroids in general. Follow-up varied from 48 hours to 6
weeks in equine studies and four weeks to five years in human
investigations.