The Effectiveness of Injected Corticosteroid Type, Dose, and Volume for the Treatment of Pain in Small- and Intermediate-size Joints: A Systematic Review

Abstract Objective To systematically evaluate the scientific literature examining the efficacy of corticosteroid injections in small- and intermediate-size joints, specifically looking at the effect of corticosteroid type, dose, and volume on clinical outcomes (pain and/or function). Type Systematic review Literature Survey Medline (PubMed)®, Cochrane Central Register of Controlled Trial, and SportDiscus® databases were searched. Methodology Inclusion criteria included adult patients enrolled in prospective studies evaluating pain- and/or function-related improvements following a corticosteroid injection of a small- or intermediate-sized joint. Synthesis A total of 28 articles were included in the study, all including patients with osteoarthritis and/or rheumatoid arthritis. Only six studies contained level I evidence, and most studies were prospective case series without a control. Most studies used 10-20mg of corticosteroid for small joints and 20-40mg in intermediate joints; wrist joints were the only joint studied that directly compared doses – 20mg was noninferior to 40mg. Triamcinolone hexacetonide was found to be superior to methylprednisolone in the interphalangeal finger joints; no other joints compared steroid types. No studies evaluated the effect of volume on clinical outcomes. Most studies showed pain and/or functional improvements for weeks to months. Conclusions Very few studies directly examine the effect of corticosteroid type, corticosteroid dose, or injectate volume on clinical outcomes for small- or intermediate-size joint arthralgia. Future studies are needed to better elucidate the most effective treatment protocols. Level of evidence Level II, systematic review of cohort studies