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WOMAC scores of intra-articular injection of sodium hyaluronate and placebo in the treatment of early and mid-stage knee osteoarthritis： a meta-analysis
- WU Zi-long, XIONG Han-ying, YUAN Quan-hua
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2022, 22(03):
250-259.
DOI: 10.3969/j.issn.1009-976X.2022.03.007
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Objective To investigate the clinical efficacy of intra-articular injection of sodium hyaluronate （HA） versus placebo （Placebo） in the treatment of early and mid-stage knee osteoarthritis （KOA） was determined by the meta-analysis. Methods According to the PICOS principles, from the beginning of database construction until September 15, 2020 to search and collect the double-blind randomized controlled trial （RCT） clinical research literatures of intra-articular injection of HA or Placebo for early and mid-term KOA published in Web of Science, Pubmed, Scopus, CNKI, Wanfang, Duxiu Academic, Superstar Journals and VIP Chinese Database. The data were extracted in strict accordance with the inclusion and exclusion criteria, and the quality of the literatures were evaluated by RoS2. The data were meta-analyzed by the Review Manager 5.3 software. Results A total of 10 double-blind RCT clinical studies were included after initial examination, extensive reading, intensive reading, and data extraction, including 2388 KOA patients were enrolled, which including 1243 in the HA group and 1145 in the Placebo group. At 6 months after treatments, the WOMAC pain, stiffness, or functional scores in the HA group and the differences of these from the baselines were significantly lower than that in the Placebo group, MD=0.89,95%CI：0.44~1.34, P=0.0001; MD=2.83, 95%CI：1.42~4.25,P<0.001; MD=0.33,95%CI：0.07~0.59, P=0.01） respectively, and the heterogeneities are extremely low; at 6 months after treatments, the WOMAC pain or function scores in the HA group were significantly lower than that in the Placebo group, they were （MD=-0.7,95%CI：-1.23~-0.17,P=0.01; MD=-1.92,95%CI：-3.63~-0.21, P=0.03）, but there was no significant difference in stiffness score between the two groups （MD=-0.3,95%CI：-0.68~0.08, P=0.12）. The VAS score at 6 months in HA group were significantly lower than that of the Placebo group （MD=-3.82, 95%CI：-6.36~-1.28, P=0.003）; there was no significant difference in the uses of emergency analgesics. Conclusion Intra-articular injection of HA is effective in treating early and mid-term KOA patients. Compared with Placebo group, it can significantly reduce knee pain and improve knee joint function after half a year of treatments. The long-term effect requires further high-quality double-blind RCT clinical trials to verify.
