Are Multiple Intra-articular Corticosteroid injections Effective for Osteoarthritis Pain?

Sarfaroj Khan 


January 22, 2021


  • This meta-analysis found that the effect of multiple intra-articular corticosteroid (IACS) injections on pain relief in patients with osteoarthritis (OA) did not appear statistically different from that of the comparator.

  • There was some evidence of potentially detrimental effects of multiple IACS injections.

Why this matters

  • Efficacy and safety of multiple IACS injections reflecting recommended best practice are yet to be assessed.

  • Data from studies with more pragmatic designs will better inform clinical practice.

Study design

  • 6 randomised controlled trials (RCTs) were included for efficacy assessment and 16 studies (14 RCTs; 2 observational studies) for safety assessment.

  • Funding: None.

Key results

  • Multiple IACS injections appeared more effective in reducing pain than the comparator (standard mean difference [SMD], −0.47; 95% CI, 0.62-0.31). However, there was considerable heterogeneity (I2=92.6%).

  • In the subgroup analysis according to varying time points at 6, 12, 26, 52 and 106 weeks, apart from pain reduction at 26 months (SMD, −0.55; 95% CI, −1.06 to −0.05), no difference was seen between IACS and comparator.

  • One RCT showed that regular IACS injections given every 3 months for 2 years caused greater cartilage volume loss vs saline injection (mean change in cartilage loss, −0.21 mm vs −0.10 mm).

  • One cohort study revealed that multiple IACS injections were associated with worsening of joint space narrowing (HR, 3.02; 95% CI, 2.25-4.05) and increased risk of joint replacement (HR, 2.54; 95% CI, 1.81-3.57).

  • Minor local adverse events were similar in both groups.


  • Heterogeneity among RCTs.


Ayub S, Kaur J, Hui M, Espahbodi S, Hall M, Doherty M, Zhang W. Efficacy and safety of multiple intra-articular corticosteroid injections for osteoarthritis-a systematic review and meta-analysis of randomized controlled trials and observational studies. Rheumatology (Oxford). 2021 Jan 12 [Epub ahead of print]. doi: 10.1093/rheumatology/keaa808. PMID: 33432345.  View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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