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

Objective 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 (RCTs) was conducted to examine the effectiveness of different injectants. Design The PubMed, Cochrane Library, Embase, ClinicalKey, and Scopus databases were searched for studies from inception to July 15, 2023. RCTs that applied intra-articular injection to hand osteoarthritis patients were included, and the outcomes of pain scores and functional scales were assessed. Results 14 RCTs with 674 patients met the inclusion criteria; 11 RCTs were included in the network meta-analysis. Intra-articular injected platelet-rich plasma (PRP) and dextrose significantly improved pain scores (mean difference [MD] = -4.03, 95% confidence interval [CI] = -6.51 to -1.56 for PRP; MD = -1.06, 95% CI = -2.1 to -0.02 for dextrose) and hand function (standard mean difference [SMD] = -0.93, 95% CI = -1.81 to -0.05 for PRP; SMD = -0.84, 95% CI = -1.58 to -0.09 for dextrose) in the long-term (≥6 months after treatment completion). The ranking probabilities revealed the highest effectiveness of PRP, followed by dextrose. No major adverse effects were reported. Conclusion Intra-articular injected PRP and dextrose can be recommended for treating hand osteoarthritis.