Conflicts of Interest Reporting in Trials and Guidelines Addressing Glucocorticoid Injections for Knee Osteoarthritis

Objective: This study aimed to characterize conflict of interest disclosure practices in trials and guidelines recommending glucocorticoid injections for knee osteoarthritis. Methods: Three databases (CINAHL, Ovid MEDLINE ALL, and Embase) were queried for randomized controlled trials from database inception to April 2025 that assessed glucocorticoid injection treatment effect for knee osteoarthritis. Clinical practice guidelines were retrieved from a recent systematic review. Study details, authors, affiliations, and conflict of interest disclosures were extracted. Transparency and appropriateness with addressing disclosures were assessed for every article, and disclosures were examined and compared with three national public conflict of interest disclosure databases. All conflicts were categorized and proportions calculated. Results: Seventy-five trials and 14 guidelines were included. Twenty-nine percent of trials (n = 22) and 14.3% of guidelines (n = 2) had no conflict of interest statement. Ten trials (13.3%) and six guidelines (42.9%) reported a conflict of interest for at least one author. Eleven trials (14.7%) and six guidelines (42.9%) had discrepancies between disclosures in articles and reports in public databases. Forty-three trial authors (34.1%) and 19 (9.4%) guideline authors had discrepancies between disclosures in the articles and public databases. Conclusion: Conflict of interest reporting practices in trials and guidelines assessing effectiveness of glucocorticoid injections for knee osteoarthritis are poor, with a lack of transparency. Quality and thoroughness with reporting conflicts of interest is necessary to best understand industry influence on treatment recommendations. (Figure presented.).