MODERATE RECOMMENDATION The Intra-Articular Corticosteroids recommendation has been downgraded one level because of potential risk in accelerating osteoarthritis from injections.
Our search found 18 high (Campos 2017, Cai 2019, Erturk 2016, de Campos 2013, Shrestha 2018, Mendes 2019, Yilmaz 2019, Chao 2010, Raynauld 2003, McAlindon 2017, Henrikson 2015, Neilsen 2018, Riis 2017, Arden 2014, Delgado-Enciso 2019, Smith 2003, Soriano-Maldonado 2016) and 6 moderate quality studies (Conaghan 2018, Langworthy 2019, Gaffney 1995, Yavuz 2012, Yilmaz 2019, Jones 1996) comparing intra-articular corticosteroids to control to treat knee osteoarthritis. Overall pain and function improved with intra-articular corticosteroids; however, it is important to note that such effect lasted only up to 3 months. When we differentiated intra-articular corticosteroids extended versus immediate release (one high, two moderate quality studies) (Bodick 2015, Conaghan 2018 and Langworthy 2019), our analyses demonstrated that, extended release IA steroids can be used over immediate release to improve patient outcomes (Moderate strength recommendation).
Benefits/Harms of Implementation
The AAOS Patient Safety Committee recommends avoiding musculoskeletal corticosteroid injections for two weeks before and one week after COVID vaccine administration.
Outcome Importance
Pain and function improvement through intra-articular therapies for the treatment of knee osteoarthritis may have high impact on symptoms and overall health.
Cost Effectiveness/Resource Utilization
The cost-effectiveness of different intra-articular therapies is still to be determined, in comparison to other treatment strategies and among different intra-articular alternatives.
Acceptability
Currently intra-articular treatments are commonly utilized approach in treating symptomatic knee osteoarthritis, hence there should be no issues implementing this recommendation as it does not influence a major change in clinical practice, and it provides further evidence to support and guide these practices.
Feasibility
These recommendations do not interfere with other interventions or clinical practice therefore it is deemed very feasible in patients with symptomatic knee osteoarthritis.
Future Research
Future research in this area should embrace detailed osteoarthritis characterization including sub-group analyses and osteoarthrosis severity stratification. Furthermore, using clinically relevant outcomes and controls for bias are warranted along with cost-effectiveness analysis
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