Long Term Care: Journal Article

Quite a few patients with osteoarthritis (OA) on my Long Term Care rotation stated during their visit that they were receiving or about to receive “injections” for treatment. I had heard of gel injections while on my Family Medicine rotation, but it was not until I looked into them during this rotation that I learned there are different types, all with conflicting evidence about their efficacy: corticosteroids (CS), platelet-rich plasma (PRP), hyaluronic acid (HA), stromal vascular fraction (SVF). Without clear evidence on efficacy, it seems that selecting an optimal injection (or to choose injection at all) is challenging for clinicians (which is perhaps why my family medicine and long term care preceptors did not seem entirely enthused when patients mentioned getting them).

The study I found to learn more about gel injections is of very high level of evidence. It is a network meta-analysis that evaluated RCTs to identify the most effective intra-articular (IA) treatment for knee OA. In the study, 79 RCTs of over 8,700 patients were reviewed and the findings were as follows: 1)SVF consistently ranked highest in pain reduction across all time points and provided the best functional outcomes at 12 months, suggesting significant efficacy in knee OA management; 2) PRP showed benefits at 6 months for pain relief; 3) HA and corticosteroid combinations performed well at shorter intervals. These results indicate that different injectables may offer advantages at specific follow-up periods. Like much of medicine (and especially for the geriatric population), this suggests that clinicians should consider tailored combinations. And like in all of medicine, further research is needed to confirm long-term benefits and refine these treatment strategies.