Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. A review article
This study was published in 2016 in journal of Seminars in Arthritis and Rheumatism (IF 2016:4.498) by French orthopedics. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends intra-articular (IA) hyaluronic acid (HA) for management of knee osteoarthritis (OA) as second-line treatment in patients who remain symptomatic despite use of non- steroidal anti-inflammatory drugs (NSAIDs).
There is good evidence for the efficacy of IA HA in reducing pain and increasing function in knee OA as demonstrated in RCTs. While IA corticosteroids show early relief of symptoms, IA HA demonstrates a greater effect beyond 12 weeks after injection, and with longer lasting benefits up to 6 months. Evidence from a real- life study of repeat courses of IA HA demonstrates an improvement in pain or function lasting up to 40 months (12months after the last treatment cycle). Other observational studies suggest a reduction in use of concomitant analgesia by up to 50%, and a delay in the need for TKR surgery of around 2years. Further investigation into the OA patient phenotypes most likely to benefit from IA HA is warranted. However, the ESCEO recommends the use of IAHA in knee OA patients with mild to moderate disease, and for more severe patients who are either contraindicated to TKR surgery or wishing to delay the surgical procedure. Viscosupplementation with IAHA appears to be a safe and effective treatment and should be kept as a component of the multi-modal management of knee OA.