Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND: To evaluate the efficacy and safety of intra-articular methylprednisolone for reducing pain in patients with knee osteoarthritis. METHODS: We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11), and the Cochrane Library (1900-2017.11) for randomized clinical trials comparing the use of methylprednisolone to treat knee osteoarthritis. The primary outcomes are Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and WOMAC function scores. Each outcome was combined and calculated using the statistical software STATA 12.0. Fixed/random effect model was adopted based on the heterogeneity tested by I(2) statistic. RESULTS: A total of 739 patients were analyzed across 4 randomized controlled trials (RCTs). The present meta-analysis revealed that there were significant differences between groups regarding the WOMAC pain scores at 4 weeks (WMD = −1.384, 95% CI: −1.975 to −0.793, P = .000), 12 weeks (WMD = −1.587, 95% CI: −2.489 to −0.685, P = .001), and 24 weeks (WMD = −1.563, 95% CI: −2.245 to −0.881, P = .000). Significant differences were identified in terms of physical function at 4 weeks (WMD = −7.925, 95% CI: −13.359 to −2.491, P = .004), 12 weeks (WMD = −7.314, 95% CI: −13.308 to −1.320, P = .117), and 24 weeks (WMD = −6.484, 95% CI: −11.256 to −1.711, P = .008). CONCLUSION: Intra-articular methylprednisolone injection was associated with an improved pain relief and physical function in patients with knee osteoarthritis. Additionally, no severe adverse effects were observed. Due to the limited quality of the evidence currently available, higher quality RCTs were required.