Advertisement

Towards reaching consensus on hyaluronic acid efficacy in knee osteoarthritis

  • Larry E. MillerEmail author
Brief Report

Abstract

Intra-articular injection of hyaluronic acid (HA) is a controversial treatment for knee osteoarthritis (OA). While clinical efficacy of HA relative to saline injections has been demonstrated in many studies, these results are of limited value in real-world clinical practice since saline injection is not a knee OA treatment. Instead, rigorous postmarket comparative studies of HA versus approved knee OA treatments are encouraged. The conduct of such studies is particularly important given the paucity and heterogeneous nature of current evidence regarding nonsurgical knee OA treatment.

Key Points

Societal guidelines recommend nonsteroidal anti-inflammatory drugs and corticosteroid injections, but not hyaluronic acid injections, for knee osteoarthritis (OA) despite inconsistent supportive data.

This article encourages rigorous comparative post-approval studies to clarify the role of nonsurgical treatments used in clinical practice for knee OA.

Keywords

Corticosteroid Injection Nonsteroidal anti-inflammatory drugs Viscosupplementation 

Notes

Acknowledgments

No funds were received for this work.

Compliance with ethical standards

Conflict of interest

The author has previously received personal fees from DePuy Synthes, OrthogenRx, and OsteoArthritis Centers of America and has previously published manuscripts related to hyaluronic acid efficacy in knee osteoarthritis.

Ethical standards

The manuscript does not contain clinical studies or patient data.

References

  1. 1.
    Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE (2009) Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum 61(12):1704–1711.  https://doi.org/10.1002/art.24925 CrossRefGoogle Scholar
  2. 2.
    Maheu E, Rannou F, Reginster JY (2016) Efficacy and safety of hyaluronic acid in the management of osteoarthritis: evidence from real-life setting trials and surveys. Semin Arthritis Rheum 45(4 Suppl):S28–S33.  https://doi.org/10.1016/j.semarthrit.2015.11.008 CrossRefGoogle Scholar
  3. 3.
    Rutjes AW, Juni P, da Costa BR, Trelle S, Nuesch E, Reichenbach S (2012) Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med 157(3):180–191.  https://doi.org/10.7326/0003-4819-157-3-201208070-00473 CrossRefGoogle Scholar
  4. 4.
    Jevsevar D, Donnelly P, Brown GA, Cummins DS (2015) Viscosupplementation for osteoarthritis of the knee: a systematic review of the evidence. J Bone Joint Surg Am 97(24):2047–2060.  https://doi.org/10.2106/JBJS.N.00743 CrossRefGoogle Scholar
  5. 5.
    Hufford MR, Shiffman S (2002) Methodological issues affecting the value of patient-reported outcomes data. Expert Rev Pharmacoecon Outcomes Res 2(2):119–128.  https://doi.org/10.1586/14737167.2.2.119 CrossRefGoogle Scholar
  6. 6.
    Hrobjartsson A, Emanuelsson F, Skou Thomsen AS, Hilden J, Brorson S (2014) Bias due to lack of patient blinding in clinical trials. A systematic review of trials randomizing patients to blind and nonblind sub-studies. Int J Epidemiol 43(4):1272–1283.  https://doi.org/10.1093/ije/dyu115 CrossRefGoogle Scholar
  7. 7.
    Blue cross blue shield hyaluronic acid derivatives. https://www.caremark.com/portal/asset/FEP_Rationale_HyaluronicAcid.pdf. Accessed 1 Feb 2019
  8. 8.
    McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil 22(3):363–388.  https://doi.org/10.1016/j.joca.2014.01.003 CrossRefGoogle Scholar
  9. 9.
    He WW, Kuang MJ, Zhao J, Sun L, Lu B, Wang Y, Ma JX, Ma XL (2017) Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: a meta-analysis. Int J Surg 39:95–103.  https://doi.org/10.1016/j.ijsu.2017.01.087 CrossRefGoogle Scholar
  10. 10.
    Jevsevar DS, Shores PB, Mullen K, Schulte DM, Brown GA, Cummins DS (2018) Mixed treatment comparisons for nonsurgical treatment of knee osteoarthritis: a network meta-analysis. J Am Acad Orthop Surg 26(9):325–336.  https://doi.org/10.5435/JAAOS-D-17-00318 CrossRefGoogle Scholar
  11. 11.
    Erturk C, Altay MA, Altay N, Kalender AM, Ozturk IA (2016) Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis? Knee Surg Sports Traumatol Arthrosc 24(11):3653–3660.  https://doi.org/10.1007/s00167-014-3398-2 CrossRefGoogle Scholar
  12. 12.
    Petrella RJ, Emans PJ, Alleyne J, Dellaert F, Gill DP, Maroney M (2015) Safety and performance of Hydros and Hydros-TA for knee osteoarthritis: a prospective, multicenter, randomized, double-blind feasibility trial. BMC Musculoskelet Disord 16:57.  https://doi.org/10.1186/s12891-015-0513-6 CrossRefGoogle Scholar
  13. 13.
    Adams ME, Atkinson MH, Lussier AJ, Schulz JI, Siminovitch KA, Wade JP, Zummer M (1995) The role of viscosupplementation with hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone. Osteoarthr Cartil 3(4):213–225CrossRefGoogle Scholar
  14. 14.
    Altman RD, Moskowitz R (1998) Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan study group. J Rheumatol 25(11):2203–2212Google Scholar
  15. 15.
    Dickson DJ, Hosie G, English JR (2001) A double-blind, placebo-controlled comparison of hylan G-F 20 against diclofenac in knee osteoarthritis. J Clin Res 4:41–52Google Scholar
  16. 16.
    Petrella RJ, DiSilvestro MD, Hildebrand C (2002) Effects of hyaluronate sodium on pain and physical functioning in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med 162(3):292–298CrossRefGoogle Scholar
  17. 17.
    Ishijima M, Nakamura T, Shimizu K, Hayashi K, Kikuchi H, Soen S, Omori G, Yamashita T, Uchio Y, Chiba J, Ideno Y, Kubota M, Kurosawa H, Kaneko K, Research Group of Cartilage M (2014) Intra-articular hyaluronic acid injection versus oral non-steroidal anti-inflammatory drug for the treatment of knee osteoarthritis: a multi-center, randomized, open-label, non-inferiority trial. Arthritis Res Ther 16(1):R18.  https://doi.org/10.1186/ar4446 CrossRefGoogle Scholar
  18. 18.
    Buendia-Lopez D, Medina-Quiros M, Fernandez-Villacanas Marin MA (2018) Clinical and radiographic comparison of a single LP-PRP injection, a single hyaluronic acid injection and daily NSAID administration with a 52-week follow-up: a randomized controlled trial. J Orthop Traumatol 19(1):3.  https://doi.org/10.1186/s10195-018-0501-3 CrossRefGoogle Scholar
  19. 19.
    London NJ, Miller LE, Block JE (2011) Clinical and economic consequences of the treatment gap in knee osteoarthritis management. Med Hypotheses 76(6):887–892.  https://doi.org/10.1016/j.mehy.2011.02.044 CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Miller Scientific ConsultingAshevilleUSA

Personalised recommendations