Corticosteroid injections for the treatment of osteoarthritis present a wide spectrum of effects ranging from detrimental to disease‐modifying

Bensa, Alessandro; Salerno, Manuela; Boffa, Angelo; de Girolamo, Laura; Laver, Lior; Magalon, Jérémy; Sánchez, Mikel; Tischer, Thomas; Filardo, Giuseppe

doi:10.1002/ksa.12242

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Journal article

Corticosteroid injections for the treatment of osteoarthritis present a wide spectrum of effects ranging from detrimental to disease‐modifying : a systematic review of preclinical evidence by the ESSKA Orthobiologic Initiative

Bensa, Alessandro ORCID Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
Salerno, Manuela Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Boffa, Angelo Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
de Girolamo, Laura Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Laver, Lior Department of Orthopaedics, Hillel Yaffe Medical Center (HYMC), Hadera, Israel - Arthrosport Clinic, Tel‐Aviv, Israel - Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
Magalon, Jérémy Cell Therapy Laboratory, Hôpital De La Conception, AP‐HM, Marseille, France - INSERM, NRA, C2VN, Aix Marseille Univ, Marseille, France - Regenerative Medicine Department of Excellence, Marseille, France
Sánchez, Mikel Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria‐Gasteiz, Spain - Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria‐Gasteiz, Spain
Tischer, Thomas Department of Orthopaedic Surgery, University of Rostock, Germany - Department of Orthopaedic and Trauma Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
Filardo, Giuseppe ORCID Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

2024

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Knee Surgery, Sports Traumatology, Arthroscopy. - 2024, vol. 32, no. 11, p. 2725-2745

English Purpose - Aim of this systematic review of preclinical evidence was to determine the effects of intra-articular corticosteroid (CS) injections in joints affected by osteoarthritis (OA). Methods - A systematic review was performed on animal studies evaluating intra-articular CS injections for OA joints. The search was performed on PubMed, Cochrane, and Web of Science databases. A synthesis of the results was performed investigating CS effects by evaluating studies comparing CS with control groups. Morphological, histological, immunohistochemistry evaluations, clinical outcomes, biomarkers and imaging results were evaluated. The risk of bias was assessed according to the Systematic Review Centre for Laboratory Animal Experimentation's tool. Results - Thirty-two articles analysing CS effects in OA animal models were included (1079 joints), 18 studies on small and 14 on large animals. CS injections showed overall positive effects in at least one of the outcomes in 68% of the studies, while 16% reported a deleterious effect. CS improved cartilage and synovial outcomes in 68% and 60% of the studies, but detrimental effects were documented in 11% and 20% of the studies, respectively. Clinical parameters evaluated in terms of pain, lameness or joint swelling improved in 63% of the studies but deteriorated in 13%. Evidence is limited on imaging and biomarkers results, as well as on the best CS type, dose, formulation and injection protocol. The risk of bias assessment revealed a 28% low and an 18% high risk of bias. Conclusion - Intra-articular CS injections induced a wide range of results on OA joints in experimental animal models, from disease-modifying and positive effects on pain and joint function at short-term evaluation to the lack of benefit or even negative effects. This underlines the need to identify more specific indications and treatment modalities to avoid possible detrimental effects while maximising the anti-inflammatory properties and the benefits of intra-articular CS in OA joints. Level of Evidence - Level II.

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