PMID- 27238876
OWN - NLM
STAT- MEDLINE
DCOM- 20170901
LR  - 20220409
IS  - 1532-866X (Electronic)
IS  - 0049-0172 (Linking)
VI  - 46
IP  - 2
DP  - 2016 Oct
TI  - Clinical benefit of intra-articular saline as a comparator in clinical trials of 
      knee osteoarthritis treatments: A systematic review and meta-analysis of 
      randomized trials.
PG  - 151-159
LID - S0049-0172(16)30009-9 [pii]
LID - 10.1016/j.semarthrit.2016.04.003 [doi]
AB  - OBJECTIVES: Hyaluronic acid and corticosteroids are common intra-articular (IA) 
      therapies widely used for the management of mild to moderate knee osteoarthritis 
      (OA). Many trials evaluating the efficacy of IA administered therapies commonly 
      use IA saline injections as a placebo comparator arm. Using a systematic review 
      and meta-analysis, our objective was to assess the clinical benefit associated 
      with use of IA saline in trials of IA therapies in the treatment of patients with 
      painful knee OA. METHODS: MEDLINE and Embase databases were searched for articles 
      published up to and including August 14th, 2014. Two reviewers assessed the 
      eligibility of potential reports and the risk of bias of included trials. We 
      analyzed short (</=3 months) and long-term (6-12 months) pain reduction of the 
      saline arm of included trials using standardized mean differences (SMDs; 
      estimated assuming a null effect in a comparator group) that were combined and 
      weighted using a random effects model. Treatment-related adverse events (AEs) 
      were tabulated and presented using descriptive statistics. RESULTS: From 40 
      randomized controlled trials (RCTs) eligible for inclusion only 38 provided 
      sufficient data to be included in the meta-analysis. Based on data with moderate 
      inconsistency IA saline was found to significantly improve short-term knee pain 
      in 32 studies involving 1705 patients (SMD = -0.68; 95% CI: -0.78 to -0.57; P < 
      0.001; I(2) = 50%). Long-term knee pain was significantly decreased following IA 
      injection with saline in 19 studies involving 1445 patients (SMD = -0.61; 95% CI: 
      -0.76 to -0.45; P < 0.001) with a substantial degree of inconsistency (I(2) = 
      74%). Overall, 29 of the included trials reported on adverse events, none of 
      which found any serious treatment-related AEs following IA injection with saline. 
      CONCLUSIONS: Pain relief observed with IA saline should prompt health care 
      providers to consider the additional effectiveness of current IA treatments that 
      use saline comparators in clinical studies, and challenges of identifying IA 
      saline injection as a "placebo."
CI  - Copyright (c) 2016 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Altman, Roy D
AU  - Altman RD
AD  - Department of Medicine, David Geffen School of Medicine, University of 
      California, Los Angeles, Los Angeles, CA. Electronic address: 
      journals@royaltman.com.
FAU - Devji, Tahira
AU  - Devji T
AD  - Department of Clinical Epidemiology and Biostatistics, McMaster University, 
      Hamilton, Ontario, Canada.
FAU - Bhandari, Mohit
AU  - Bhandari M
AD  - Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 
      Hamilton, Ontario, Canada.
FAU - Fierlinger, Anke
AU  - Fierlinger A
AD  - Ferring Pharmaceuticals Inc., Parsippany, NJ.
FAU - Niazi, Faizan
AU  - Niazi F
AD  - Ferring Pharmaceuticals Inc., Parsippany, NJ.
FAU - Christensen, Robin
AU  - Christensen R
AD  - Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and 
      Frederiksberg Hospital, Copenhagen, Denmark.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20160427
PL  - United States
TA  - Semin Arthritis Rheum
JT  - Seminars in arthritis and rheumatism
JID - 1306053
RN  - 451W47IQ8X (Sodium Chloride)
SB  - IM
CIN - Semin Arthritis Rheum. 2017 Feb;46(4):e20. PMID: 27622868
MH  - Humans
MH  - Injections, Intra-Articular
MH  - Knee Joint/drug effects
MH  - Osteoarthritis, Knee/*drug therapy
MH  - Pain/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Sodium Chloride/administration & dosage/*therapeutic use
MH  - Treatment Outcome
OTO - NOTNLM
OT  - hyaluronic acid
OT  - intra-articular therapy
OT  - osteoarthritis
OT  - placebo
OT  - steroids
EDAT- 2016/05/31 06:00
MHDA- 2017/09/02 06:00
CRDT- 2016/05/31 06:00
PHST- 2015/12/09 00:00 [received]
PHST- 2016/03/31 00:00 [revised]
PHST- 2016/04/15 00:00 [accepted]
PHST- 2016/05/31 06:00 [entrez]
PHST- 2016/05/31 06:00 [pubmed]
PHST- 2017/09/02 06:00 [medline]
AID - S0049-0172(16)30009-9 [pii]
AID - 10.1016/j.semarthrit.2016.04.003 [doi]
PST - ppublish
SO  - Semin Arthritis Rheum. 2016 Oct;46(2):151-159. doi: 
      10.1016/j.semarthrit.2016.04.003. Epub 2016 Apr 27.