Article
Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis
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Published: | February 6, 2020 |
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Objectives/Interrogation: To evaluate the effectiveness of injection based therapy in base of thumb osteoarthritis.
Methods: Design: Systematic review and meta-analysis.
Data sources: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO were searched from database inception to 22nd May 2018.
Study selection: Randomised controlled clinical trials (RCTs) of adults with base of thumb osteoarthritis investigating an injection based intervention with a comparator.
Data extraction and analysis: Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points.
Results and Conclusions: In total, nine RCTs involving 504 patients were identified for inclusion after screening. All these studies compared different injection based therapies with each other, while no prospective study comparing an injection based therapy with a non injection based intervention was identified. Twenty injection based intervention groups were present within these nine trials, consisting of hyaluronic acid (9), corticosteroid (7), saline placebo (3) and dextrose (1). Only limited meta-analysis was possible due to the heterogeneity in the injections and outcomes used, as well as incomplete outcome data. Meta-analysis of two studies (92 patients) demonstrated no statistically significant difference in pain or function with corticosteroid versus hyaluronic acid in the short and medium term. Overall the available evidence does not suggest that any of the commonly used injection therapies are superior to placebo, one another or a non-injection based comparator.
Current evidence is equivocal regarding the use of injection therapy in base of thumb osteoarthritis, both in terms of which injection based therapy is the most effective and in terms of whether any injection based therapy is more effective than other non injection based interventions. Given limited understanding of both the short and longer term effects, there is a need for large, methodologically robust multicentre RCTs investigating the commonly used injection therapies.