The safety of intra-articular injections for the treatment of knee osteoarthritis: a critical narrative review

ABSTRACT

Introduction: International guidelines recommend that the management of knee osteoarthritis (OA) combine both nonpharmacological and pharmacological interventions. Intra-articular (IA) therapies are considered part of this multimodal approach and are well-established Food and Drug Administration (FDA) and European Medicines Agency (EMA)-approved treatments.

Areas covered: Safety data for knee OA, including IA corticosteroids, hyaluronic acid, platelet-rich plasma and botulinum toxin are critically reviewed, and evidence- and pratice-based measures to improve safety of IA therapies are discussed.

Expert opinion: The incidence of AEs attributable to IA therapies across clinical trials in knee OA is very low, and barely reaches significance when compared to the incidence of AEs in the comparator group. These events are exceptionally serious. Mild differences between products have been inconsistently reported mainly for IA HA. One can distinguish self-limited AEs such as post-injection pain and swelling that are the most frequently reported AEs, from AEs that are not self-limited but rare such as septic arthritis. The safety of IA therapies can be improved by applying simple measures designed to prevent AEs. However, even though no specific safety concerns have been raised to date about IA therapies, the quality of evidence is low, and there is a need to improve the monitoring and reporting of safety data from clinical trials and post-marketing surveillance.

KEYWORDS:

• Knee
• osteoarthritis
• intra-articular injections
• corticosteroids
• hyaluronic acid
• platelet-rich plasma
• botulinum toxin A
• safety profile

Article highlights

• Intra-articular injections of hyaluronic acid and corticosteroids are parts of the pharmacological treatment of knee osteoarthritis

• There are no recommendations for intra-articular injections of platelet-rich plasma and botulinum toxin A in knee osteoarthritis

• No specific safety concerns have been raised regarding intra-articular therapies from clinical trials and post-marketing surveillance

• Simple clinical measures can improve the safety of intra-articular therapy

This box summarizes key points contained in the article.

Declaration of interest

F Rannou received consultancies, honoraria, grants from Pierre Fabre, Expanscience, Servier, Genevrier, Thuasne, Sanofi. He is also treasurer of OARSI. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper has not been funded.