Health & Fitness

Knee osteoarthritis treatments: meta analysis, mega study

Kristen Sparrow • January 07, 2015

I don’t have access to the study and can’t really make out what they are trying to say, except that they accept and admit the strong placebo effect of intraarticular injections.  Acetaminophen doesn’t work, which makes sense since it has no antiinflammatory properties.  They follow for 3 months.  This does NOT seem like strong evidence for intraarticular injections or even anti-inflammatories given the possible risks.  But, yes, I am biased.
From the iconic knee acupuncture study by Berman (2006!!)  “Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncturegroup at 8 weeks (mean difference, -2.9 [95% CI, -5.0 to -0.8]; P=0.01) but not in WOMAC pain score (mean difference, -0.5 [CI, -1.2 to 0.2]; P=0.18) or the patient global assessment (mean difference, 0.16 [CI, -0.02 to 0.34]; P> 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, -2.5 [CI, -4.7 to -0.4]; P=0.01), WOMAC pain score (mean difference, -0.87 [CI, -1.58 to -0.16]; P=0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P=0.02).”
So they followed them for twice as long as in the meta study here and saw definite improvement compared to control and sham.

Comparative Effectiveness of Pharmacologic Interventions for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis

Raveendhara R. Bannuru, MD; Christopher H. Schmid, PhD; David M. Kent, MD; Elizaveta E. Vaysbrot, MD; John B. Wong, MD; and Timothy E. McAlindon, MD

Data Synthesis: Network meta-analysis was performed using a Bayesian random-effects model; 137 studies comprising 33 243 participants were identified. For pain, all interventions significantly outperformed oral placebo, with effect sizes from 0.63 (95% credible interval [CrI], 0.39 to 0.88) for the most efficacious treatment (hyaluronic acid) to 0.18 (CrI, 0.04 to 0.33) for the least efficacious treatment (acetaminophen). For function, all interventions except IA corticosteroids were significantly superior to oral placebo. For stiffness, most of the treatments did not significantly differ from one another.
Limitation: Lack of long-term data, inadequate reporting of safety data, possible publication bias, and few head-to-head comparisons.
Conclusion: This method allowed comparison of common treatments of knee OA according to their relative efficacy. Intra-articular treatments were superior to nonsteroidal anti-inflammatory drugs, possibly because of the integrated IA placebo effect. Small but robust differences were observed between active treatments. All treatments except acetaminophen showed clinically significant improvement from baseline pain. This information, along with the safety profiles and relative costs of included treatments, will be helpful for individualized patient care decisions.