A Comprehensive Systematic Review of Intra-Articular Corticosteroids:
Effects of Multiple Injections and Different Doses (Part 2)
Abstract
Background: Corticosteroids are commonly used for
intra-articular (IA) treatment of osteoarthritis (OA) in horses;
however, there is controversy regarding its use as a multiple-injection
treatment and for the appropriate dosing. Objectives: This
systematic review collected and critically appraised the current
evidence regarding the effects of multiple injections and various doses
of corticosteroids for treating osteoarthritis. Study design:
Systematic review. Methods: Titles of published articles up to
June/2022 generated by searches in PubMed, CAB, and the Web of Science
were screened using general inclusion criteria. Each question for
corticosteroid effects (multiple treatments and different doses) had
further inclusion requirements. The risk of bias was assessed according
to the study design. Results: Of 6,417 titles generated by the
systematic search, only nine met all inclusion criteria for
multiple-injection treatments, and 14 were included for screening the
effects of various doses. Most studies showed unclear/high risk of bias.
Multiple-injection protocols showed better symptom-modifying changes at
first injections with decreased improvements. Disease-modifying changes
improved over shorter follow-ups; however, degenerative changes were
seen in the longer term. Determining the dose effect of corticosteroids
was challenging regarding different doses because there were few
in vivo studies. In vitro, lower doses appeared to be
safer for articular tissues. Main limitations: Lack of studies
regarding the topics. Conclusions: No benefits but drawbacks of
multiple IA injections in the long term were found in this review, and
results regarding the dose of corticosteroids in OA joints were not
consistent in in vivo, but in vitro, studies pointed out
that lower doses might be safer for joint tissues.