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Intra-articular Therapies for Hand Osteoarthritis: A Systematic Review and Network Meta-analysis
Hung-Lun Chen1, Pei-Wei Weng, Chieh-Yu Pan
1From the Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (H-LC, C-YP, H-CC); Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (P-WW); Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (P-WW); Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan (Y-MH); Department of Rehabilitation and Movement Science, University of Vermont, College of Nursing and Health Sciences, Burlington, Vermont (RE); Swiss Paraplegic Research, Nottwil, Switzerland (RE); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (H-CC); and Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (H-CC).
Objective:
Intra-articular injection therapy for hand osteoarthritis has inconclusive evidence regarding the effectiveness of different regimens. A systematic review and network meta-analysis of randomized controlled trials was conducted to examine the effectiveness of different injectants.
Design:
The PubMed, Cochrane Library, Embase, ClinicalKey, and Scopus databases were searched for studies from inception to July 15, 2023. Randomized controlled trials that applied intra-articular injection to hand osteoarthritis patients were included, and the outcomes of pain scores and functional scales were assessed.
Results:
Fourteen randomized controlled trials with 674 patients met the inclusion criteria; 11 randomized controlled trials were included in the network meta-analysis. Intra-articular injected platelet-rich plasma and dextrose significantly improved pain scores (mean difference = -4.03, 95% confidence interval = -6.51 to -1.56 for platelet-rich plasma; mean difference = -1.06, 95% confidence interval = -2.1 to -0.02 for dextrose) and hand function (standard mean difference = -0.93, 95% confidence interval = -1.81 to -0.05 for platelet-rich plasma; standard mean difference = -0.84, 95% confidence interval = -1.58 to -0.09 for dextrose) in the long-term (≥6 mos after treatment completion). The ranking probabilities revealed the highest effectiveness of platelet-rich plasma, followed by dextrose. No major adverse effects were reported.
Conclusions:
Intra-articular injected platelet-rich plasma and dextrose can be recommended for treating hand osteoarthritis.
