Intra-articular Therapies for Hand Osteoarthritis: A Systematic Review and Network Meta-analysis.

Abstract

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. 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. 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. Intra-articular injected platelet-rich plasma and dextrose can be recommended for treating hand osteoarthritis.