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Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis
  1. Nicholas Riley1,
  2. Martinique Vella-Baldacchino1,
  3. Neal Thurley2,
  4. Sally Hopewell3,
  5. Andrew J Carr4,
  6. Benjamin John Floyd Dean4
  1. 1Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
  2. 2University of Oxford Health Care Libraries, Oxford, UK
  3. 3Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Oxford, UK
  4. 4NDORMS, University of Oxford, Oxford, UK
  1. Correspondence to Dr Benjamin John Floyd Dean; bendean1979{at}gmail.com

Abstract

Objective To evaluate the effectiveness of injection-based therapy in base of thumb osteoarthritis.

Design Systematic review and meta-analysis.

Data sources MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO were searched from inception to 22 May 2018.

Study selection Randomised controlled trials (RCTs) and non-RCTs of adults with base of thumb osteoarthritis investigating an injection-based intervention with any comparator/s.

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 model for short-term and medium-term follow-up.

Results In total, 9 RCTs involving 504 patients were identified for inclusion. All compared different injection-based therapies with each other, no studies compared an injection-based therapy with a non-injection-based intervention. Twenty injection-based intervention groups were present within these nine trials, consisting of hyaluronic acid (n=9), corticosteroid (n=7), saline placebo (n=3) and dextrose (n=1). 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 RCTs (92 patients) demonstrated reduced Visual Analogue Scale pain on activity with corticosteroid versus hyaluronic acid (mean difference (MD) −1.32, 95% CI −2.23 to −0.41) in the medium term, but no differences in other measures of pain or function in the short term 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.

Conclusion 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-term and long-term effects, there is a need for a large, methodologically robust RCT investigating the commonly used injection therapies and comparing them with other therapeutic options and placebo.

PROSPERO registration number CRD42018095384.

  • base of thumb
  • osteoarthritis
  • corticosteroid
  • hyaluronic acid
  • systematic review

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter bendean1979

  • Contributors BJFD is lead author for this review and has led the project from the start. BJFD designed the review, wrote and submitted the review protocol to PROSPERO, communicated with the research librarian who carried out the searches, carried out the screening/data extraction and data analysis and finally wrote the manuscript. MV-B and BJFD carried out the screening and data extraction. NR resolved any conflicts between BJFD and MV-B in terms of screening and data extraction. SH, AJC, MV-B and NR have been involved in the development of the study, writing the manuscript and have also reviewed the final manuscript. NT has been involved in the development of the study, carrying our the searches as well as writing and reviewing the final manuscript.

  • Funding This work was supported by BMA’s Doris Hillier Arthritis and Rheumatism grant.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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