Intra-Articular Botulinum Toxin in Osteoarthritis Treatment: A Systematic Review
DOI:
https://doi.org/10.25759/spmfr.510Keywords:
Botulinum Toxins/therapeutic use, Botulinum Toxins, Type A/therapeutic use, Injections, Intra-Articular, Osteoarthritis/drug therapyAbstract
Introduction: The study aimed to analyze current evidence regarding the effects of intra-articular (IA) Botulinum Toxin (BoNT) application in Osteoarthritis (OA) treatment on pain management and functional improvement.Methods: A comprehensive search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases from inception until October 2023 was performed according to PRISMA guidelines. The keywords were: “Injections, Intra-articular” AND “Botulinum toxins” AND “Osteoarthritis”. The inclusion criteria were: i) studies made with human study groups; ii) studies made in people with a diagnosis of osteoarthritis of any joint; iii) studies that used botulinum toxin type A; iv) studies that applied intra-articular BoNT in a joint. The exclusion criteria were: i) review articles; ii) follow-up periods with less than a month. Two independent reviewers were responsible for the selection and data extraction from each study.
Results: Three hundred and twenty-eight studies were reviewed and nineteen articles met the inclusion criteria. The studies compared IA BoNT to placebo and other OA treatments in temporomandibular, shoulder, knee and ankle joints.
Conclusion: Results reveal that IA BoNT can have short and long-term clinical benefits in pain control and mobility in patients with OA. However, more Randomized Clinical Trials (RCTs) should be performed to determine the effective dosages to administer IA BoNT for each joint.
Downloads
References
Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013;21(9):1145-1153. doi:10.1016/j.joca.2013.03.018
Nelson AE. Osteoarthritis year in review 2017: clinical. Osteoarthritis Cartilage. 2018;26(3):319-325. doi:10.1016/j.joca.2017.11.014
Dantas LO, Salvini T de F, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Braz J Phys Ther. 2021;25(2):135-146. doi:10.1016/j.bjpt.2020.08.004
Abramoff B, Caldera FE. Osteoarthritis: Pathology, Diagnosis, and Treatment Options. Medical Clinics of North America. 2020;104(2):293-311. doi:10.1016/j.mcna.2019.10.007
Palazzo C, Nguyen C, Lefevre-Colau MM, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Ann Phys Rehabil Med. 2016;59(3):134-138. doi:10.1016/j.rehab.2016.01.006
Sconza C, Leonardi G, Carfì C, et al. Intra-Articular Injection of Botulinum Toxin for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials. Int J Mol Sci. 2023;24(2). doi:10.3390/ijms24021486
Arendt-Nielsen L, Jiang GL, DeGryse R, Turkel CC. Intra-articular onabotulinumtoxinA in osteoarthritis knee pain: effect on human mechanistic pain biomarkers and clinical pain. Scand J Rheumatol. 2017;46(4):303-316. doi:10.1080/03009742.2016.1203988
Mendes JG, Natour J, Nunes-Tamashiro JC, Toffolo SR, Rosenfeld A, Furtado RNV. Comparison between intra-articular Botulinum toxin type A, corticosteroid, and saline in knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2019;33(6):1015-1026. doi:10.1177/0269215519827996
Boon AJ, Smith J, Dahm DL, et al. Efficacy of Intra-Articular Botulinum Toxin Type A in Painful Knee Osteoarthritis: A Pilot Study. PM and R. 2010;2(4):268-276. doi:10.1016/j.pmrj.2010.02.011
Chou CL, Lee SH, Lu SY, Tsai KL, Ho CY, Lai HC. Therapeutic effects of intra-articular botulinum neurotoxin in advanced knee osteoarthritis. Journal of the Chinese Medical Association. 2010;73(11):573-580. doi:10.1016/S1726-4901(10)70126-X
Hsieh LF, Wu CW, Chou CC, et al. Effects of Botulinum Toxin Landmark-Guided Intra-articular Injection in Subjects With Knee Osteoarthritis. PM and R. 2016;8(12):1127-1135. doi:10.1016/j.pmrj.2016.05.009
Bao X, Tan JW, Flyzik M, Ma XC, Liu H, Liu HY. Effect of therapeutic exercise on knee osteoarthritis after intraarticular injection of botulinum toxin type a, hyaluronate or saline: A randomized controlled trial. J Rehabil Med. 2018;50(6):534-541. doi:10.2340/16501977-2340
McAlindon TE, Schmidt U, Bugarin D, et al. Efficacy and safety of single-dose onabotulinumtoxinA in the treatment of symptoms of osteoarthritis of the knee: results of a placebo-controlled, double-blind study. Osteoarthritis Cartilage. 2018;26(10):1291-1299. doi:10.1016/j.joca.2018.05.001
Singh JA, Mahowald ML, Noorbaloochi S. Intraarticular botulinum toxin A for refractory painful total knee arthroplasty: A randomized controlled trial. Journal of Rheumatology. 2010;37(11):2377-2386. doi:10.3899/jrheum.100336
Rezasoltani Z, Dadarkhah A, Tabatabaee SM, Mofrad MK, Mofrad RK, Abdorrazaghi F. Therapeutic effects of intra-articular botulinum neurotoxin versus physical therapy in knee osteoarthritis. Anesth Pain Med. 2021;11(3). doi:10.5812/aapm.112789
Singh JA, Mahowald ML, Noorbaloochi S. Intra-articular botulinum toxin A for refractory shoulder pain: a randomized, double-blinded, placebo-controlled trial. Translational Research. 2009;153(5):205-216. doi:10.1016/j.trsl.2009.02.004
Hashemi SM, Mehdi S, Khamene H, Naderi-Nabi B, Ghasemi M. Effects of Ultrasound-Guided Intraarticular Botox vs. Corticosteroids for Shoulder Osteoarthritis. Vol 22. www.apicareonline.com
Sun SF, Hsu CW, Lin HS, Chou YJ, Chen JY, Wang JL. Efficacy of Intraarticular Botulinum Toxin A and Intraarticular Hyaluronate plus Rehabilitation Exercise in Patients with Unilateral Ankle Osteoarthritis: A Randomized Controlled Trial.; 2014. http://www.jfootankleres.com/content/7/1/9
Najafi S, Sanati E, Khademi M, Abdorrazaghi F, Mofrad RK, Rezasoltani Z. Intra-articular botulinum toxin type A for treatment of knee osteoarthritis: Clinical trial. Toxicon. 2019;165:69-77. doi:10.1016/j.toxicon.2019.04.003
Mahowald, M. L., Singh, J. A., & Dykstra, D. D. (2006). Long term effects of intra-articular botulinum toxin a for refractory joint pain. Neurotoxicity Research, 9(2-3), 179-188. https://doi.org/10.1007/BF03033937
Sari BC, Develi T. The effect of intraarticular botulinum toxin-A injection on symptoms of temporomandibular joint disorder. Journal of Stomatology, Oral and Maxillofacial Surgery. 2022 Oct;123(5):e316-e320. DOI: 10.1016/j.jormas.2022.04.019.
Batifol D, Huart A, Finiels PJ, Nagot N, Jammet P. Effect of intra-articular Botulinum toxin injections on temporo-mandibular joint pain. J Stomatol Oral Maxillofac Surg. 2018;119(4):319-324. doi:10.1016/j.jormas.2018.06.002
Ko GD, Lam KI, Looi J, Koprowicz KT, Tsai M, Hein TR. Beyond the muscular effects – OnabotulinumtoxinA injections for pain control in chronic knee osteoarthritis: A case report. J Pain Res. 2018;11:1967-1970. doi:10.2147/JPR.S159841
Singh JA, Mahowald ML, Kushnaryov A, Goelz E, Dykstra D. Repeat injections of intra-articular botulinum toxin a for the treatment of chronic arthritis joint pain. Journal of Clinical Rheumatology. 2009;15(1):35-38. doi:10.1097/RHU.0b013e3181953b14
Fenollosa Vázquez P, Aguirre RMI, Canós Verdecho MA, Delgado JP. Efectos de La Toxina Botulínica A (Botox ® ) Intraarticular En La Artrosis de Rodilla Avanzada.; 2011.
Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. 2011;23(5):471-478. doi:10.1097/BOR.0b013e328349c2b1
Syx D, Tran PB, Miller RE, Malfait AM. Peripheral Mechanisms Contributing to Osteoarthritis Pain. Curr Rheumatol Rep. 2018;20(2). doi:10.1007/s11926-018-0716-6
Hassan H, Walsh DA. Central pain processing in osteoarthritis: implications for treatment. Pain Manag. 2014;4(1):45-56. doi:10.2217/pmt.13.64
Schaible HG, Schmelz M, Tegeder I. Pathophysiology and treatment of pain in joint disease. Adv Drug Deliv Rev. 2006;58(2):323-342. doi:10.1016/j.addr.2006.01.011
Arezzo, Joseph C. PH.D.. Possible Mechanisms for the Effects of Botulinum Toxin on Pain. The Clinical Journal of Pain 18(6):p S125-S132, November 2002
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright statement
Authors must also submit a copyright statement (as seen below) on article submission.
To the Editor-in-chief of the SPMFR Journal:
The below signed author(s) hereby state that the article
________________________________________ (ref. MFR_________) is
an original unpublished work and all facts stated are a product of the author(s) investigation. This article does not violate any copyright laws or privacy statements. The author(s) also hereby confirm that there is no conflict of interest's issues in this article.
By submitting this article the author(s) agree that after publication all copyrights belong to the SPMFR Journal.
Signed by all authors
Date:
Names (capital letters):
Signatures:
The SPMFR Journal’s contents are follow a Creative Commons licence. After publication the authors can hand out the articles as long as the SPMFR Journal is credited.
