Background:

Several pharmacological interventions are used for the management of adhesive capsulitis of the shoulder, although the optimal treatment has yet to be defined.

Purpose:

To conduct a network meta-analysis to compare the effects of different pharmacological interventions for adhesive capsulitis, administered either alone or after distension of the shoulder capsule.

Study Design:

Network meta-analysis.

Methods:

The authors searched Scopus, PubMed, and the Cochrane Central Register of Controlled Trials up to April 22, 2018, for completed studies. They enrolled trials that assessed the results of different pharmacological treatments for the primary management of adhesive capsulitis. The primary outcome was pain relief as measured by self-administered questionnaires. The secondary outcome included the assessment of composite instruments that evaluated, at a minimum, pain and function. The authors clinically interpreted the results after back-transforming the standardized mean differences into mean differences in simple instruments and assessed the quality of the source studies using the Cochrane “risk of bias” tool.

Results:

The authors considered 30 trials with a total of 2010 participants in this systematic review. For pain relief, there was a significant difference in favor of intra-articular corticosteroids and distension of the shoulder capsule with steroids as compared with control in the short term (mean difference in visual analog scale (VAS): –1.4 [95% CI, −2.5 to −0.4] and −1.7 [95% CI, −3.2 to −0.1], respectively). Furthermore, rotator-interval injections were found to be superior to placebo (mean difference in VAS: –7.2; 95% CI, −10.1 to −4.4), although the intervention was considered in only 1 trial. Finally, there was a statistically significant difference in favor of multiple-site corticosteroid injections compared to placebo in both the short- (mean difference in Shoulder Pain and Disability Index [SPADI]: −86.7; 95% CI, −133.6 to −40) and intermediate-term assessment (mean difference in SPADI: −102.9; 95% CI, −163.9 to −41.8).

Conclusion:

Intra-articular corticosteroid intervention, administered either alone or after distension of the shoulder capsule, provided clinically meaningful improvements in the short term. Likewise, rotator-interval corticosteroid injections yielded promising results in terms of pain relief. However, these short-term benefits of steroids dissipated over time. Multiple-site corticosteroid injections showed clinical advantage over placebo for short- and intermediate-term composite outcome assessments.

中文翻译：

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药理学疗法对肩部粘膜囊炎的疗效：系统评价和网络荟萃分析。

背景：

尽管尚待确定最佳的治疗方法，但仍有几种药理干预措施可用于治疗肩部黏膜囊炎。

目的：

进行网络荟萃分析，比较单独或在肩囊扩张后施用的粘附性囊炎的不同药理干预措施的效果。

学习规划：

网络荟萃分析。

方法：

作者搜索了Scopus，PubMed和Cochrane对照试验中央登记册，直至2018年4月22日，以完成研究。他们招募了一些试验，这些试验评估了黏膜囊膜炎的主要治疗方法的不同药物治疗的结果。主要结果是通过自行填写的调查问卷测得的疼痛缓解。次要结果包括评估至少评估疼痛和功能的复合器械。作者在将标准均值差异转换为简单仪器中的均值差异后，对结果进行了临床解释，并使用Cochrane“偏倚风险”工具评估了来源研究的质量。

结果：

作者在这项系统评价中考虑了30项试验，共有2010名参与者参加。为了缓解疼痛，短期内与对照组相比，在关节内使用皮质类固醇和使用类固醇的肩capsule囊扩张有显着差异（视觉模拟量表（VAS）的均值：–1.4 [95％CI， -2.5至-0.4]和-1.7 [分别为95％CI，-3.2至-0.1]。此外，尽管仅在1个试验中考虑了干预措施，但发现转子间隔注射优于安慰剂（VAS的均值差异：–7.2； 95％CI，-10.1至-4.4）。最后，与安慰剂相比，多位皮质类固醇激素注射在统计学上有显着差异（肩痛和残疾指数[SPADI]的均值差异：-86.7； 95％CI，-133）。

结论：

单独或在肩囊扩张后进行关节内糖皮质激素干预，在短期内可提供临床上有意义的改善。同样，在缓解疼痛方面，间隔间隔注射皮质类固醇激素也产生了令人鼓舞的结果。但是，类固醇的这些短期益处会随着时间的流逝而消失。在短期和中期的综合结果评估中，多部位皮质类固醇激素的注射显示出优于安慰剂的临床优势。