Shao-Hsien Liu1,2, Catherine E Dubé3,4, Charles B Eaton3,4, Jeffrey B Driban3,4, Timothy E McAlindon3,4, Kate L Lapane3,4. 1. From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA. shaohsien.liu@umassmed.edu. 2. S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School. shaohsien.liu@umassmed.edu. 3. From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA. 4. S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School.
Abstract
OBJECTIVE: We examined the longterm effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA). METHODS: Using Osteoarthritis Initiative data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injections (n = 412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect on symptoms of newly initiated injection use compared to nonusers over 2 years of followup. RESULTS: Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. About 18.9% had additional injection use after initiation, but switching between injection types was common. Compared to nonusers, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points, 95% CI 0.82-1.66), stiffness (yearly worsening: 0.30 points, 95% CI 0.10-0.49), and physical functioning (yearly worsening: 2.62 points, 95% CI 0.94-4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50, 95% CI -0.11 to 1.11; stiffness: -0.07, 95% CI -0.38 to 0.24; and functioning: 0.49, 95% CI -1.34 to 2.32). CONCLUSION: Although intraarticular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptom relief over 2 years of followup for persons with knee OA.
OBJECTIVE: We examined the longterm effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA). METHODS: Using Osteoarthritis Initiative data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injections (n = 412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect on symptoms of newly initiated injection use compared to nonusers over 2 years of followup. RESULTS: Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. About 18.9% had additional injection use after initiation, but switching between injection types was common. Compared to nonusers, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points, 95% CI 0.82-1.66), stiffness (yearly worsening: 0.30 points, 95% CI 0.10-0.49), and physical functioning (yearly worsening: 2.62 points, 95% CI 0.94-4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50, 95% CI -0.11 to 1.11; stiffness: -0.07, 95% CI -0.38 to 0.24; and functioning: 0.49, 95% CI -1.34 to 2.32). CONCLUSION: Although intraarticular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptom relief over 2 years of followup for persons with knee OA.
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