THU0468 EFFICACY AND SAFETY OF INTRA-ARTICULAR THERAPIES IN RHEUMATIC AND MUSCULOSKELETAL DISEASES: AN OVERVIEW OF SYSTEMATIC REVIEWS INFORMING THE 2020 EULAR RECOMMENDATIONS FOR INTRA-ARTICULAR THERAPIES INCLUDING SYNOVIORTHESIS

Abstract

Background: Intra-articular therapy (IAT) is subject to wide variability and there are gaps in the evidence on its efficacy and safety. Objectives: To assess the efficacy and safety of frequently used IATs to inform a EULAR Taskforce. Methods: We performed an overview of systematic reviews (SR) of randomised clinical trials (RCT) assessing efficacy and safety of IAT in adults with RMDs. MEDLINE was searched until January 2019. SRs were assessed with the AMSTAR-2 tool. Critically low-confidence SRs were excluded. Results: Of 159 articles identified, 42 were reviewed in detail and 15 met the inclusion criteria (146 RCTs). The populations included were mainly knee osteoarthritis (OA) in 10 SRs, rheumatoid arthritis (RA) in 3, hip and temporo-mandibular (TM) OA and shoulder adhesive capsulitis in 1 SR each. In knee OA, Hyaluronic Acid (HA) showed a modest benefit over placebo for pain and function but with unclear clinical significance in some studies. Platelet rich plasma (PRP) showed a small effect over HA only for function. Mesenchymal stem cells (MSC) performed better than PRP and HA for some outcomes, however, in studies with high risk of bias. Intra-articular Glucocorticoids (GC) were better than placebo (PBO) for pain and function. More adverse events (AE) were seen in the PRP group compared with HA and for HA compared with PBO including serious AE each in 1 SR on knee OA. Results for other included diseases are shown in table 1. Conclusion: Most of the SRs assessed had results of low confidence. HA and GC showed a small, short term benefit in knee arthritis in OA and RA compared to PBO. High risk of bias prevents conclusions on the efficacy of PRP and MSC in knee OA. More AE were reported in PRP and HA treated groups.