DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20172875

Intra articular hyaluronic acid injection, is it a wastage of money or justified?

Bhavesh H. Jesalpura, Sharvil H. Gajjar

Abstract


Background: Osteoarthritis of knee (OA Knee) is one of the most common form of joint disease and affects everyone in different proportion with aging. To reduce the burden on society and improve the productive life various modalities of treatment are suggested. Our goal was to find out how much Intra Articular Hyaluronic acid injection (I/A HA inj.) is effective and safe.

Methods: We have done a retrospective single blind study on 60 patients of OA Knee according to ACR Criteria, Grade I and II, who were treated with I/A HA inj. of a single brand. They were followed up up to 3 year after last injection and clinical assessment done based on VAS Scale and WOMAC Score.

Results: Out of 60 patients who have been given I/A HA injection, patients below age of 50 and ACR Grade I OA Knee, responded well with injection. However patients above age of 50 and ACR Grade II OA Knee responded poorly and require some other form of treatment as early as 1 month after stopping injection.

Conclusions: Though OA Knee is a degenerative disease which requires long term follow up to justify use of I/A HA injection, We believe that in early cases of OA Knee and Patients below age of 50 years, this treatment modality can work well and may prolong active life and delay surgical intervention and hence cost benefit ratio justifies use of this treatment modality. 


Keywords


Intra articular, Hyaluronic acid, Knee osteoarthritis

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References


Emery CA, Roos EM, Verhagen E, Finch CF, Bennell KL, Story B, et al. Oarsi clinical trials recommendations: Design and conduct of clinical trials for primary prevention of osteoarthritis by joint injury prevention in sport and recreation. Osteoarthritis Cartilage. 2015;23:815–25.

Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778-99.

Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81:646-56.

Lawrence JS, Brenner JM, Bier F. Osteoarthrosis: Prevalence in thepopulation and relationship between symptoms and x-ray changes. Ann Rheum Dis. 1966;25:1-24.

Silman AJ, Hochberg MC. Epidemiology of the Rheumatic Diseases. 2nd ed. Oxford: Oxford University Press; 2001.

Symmons D, Mathers C, Pfleger B. Global Burden of Osteoarthritis in year 2000: Global burden of disease 2000 study, World health report. 2002(5);1-57.

Akinpelu AO, Alonge TO, Adekanla BA, Odole AC. Prevalence and pattern of symptomatic knee osteoarthritis in Nigeria: A community-based study. Internet J Allied Health Sci Pract. 2009;7:3.

Davis MA, Ettinger WH, Neuhaus JM, Hauck WW. Sex differences in osteoarthritis of the knee. The role of obesity. Am J Epidemiol. 1988;127:1019-30.

Solomon L, Beighton P, Lawrence JS. Rheumatic disorders in the South African Negro. Patrt II. Osteo-arthrosis. S Afr Med J. 1975;49:1737-40

Takahashi K, Goomer RS, Harwood F, Kubo T, Hirasawa Y, Amiel D. The effects of hyaluronanon matrix metalloproteinase-3 (MMP-3), interleukin-1(IL-1), and tissue inhibitor of metalloproteinase-1(TIMP-1) gene expression during the development of osteoarthritis. Osteoarthritis Cartilage. 1999;7:182–90.

Brzusek D, Petron D. Treating knee osteoarthritis with intra-articular hyaluronans. Curr. Med. Res. Opin.2008, 24, 3307–3322.

Arnold W, Fullerton DS, Holder S, May CS. Viscosupplementation: Managed care issues for osteoarthritis of the knee. J Manag Care Pharm. 2007;13:S3–19.

Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rhematol Suppl. 2003;39:380-403.

Simon LS. Viscosupplementation therapy with intra-articular hyaluronic acid. Fact or fantasy? Rhem Dis Clin North Am. 1999;25(2):345-58.

Marshall KW. Intra-articular hyaluronan therapy. Curr Opin Rheumatol. 2000;12(5):468-74.

McCormack HM, Horne DJ, Sheather S. Clinical applications of visualanalogue scales: a critical review. Psychol Med. 1988;18:1007–19.

Woolacott NF, Corbett MS, Rice SJ. The use and reporting of WOMAC in the assessment of the benefit of physical therapies for the pain of osteoarthritis of the knee: findings from a systematic review of clinical trials. Rheumatology (Oxford). 2012;51(8):1440-6.

Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the knee. Arthritis Rheum. 1986;29:1039-49.

Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intra-articular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005328.

Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005321.

Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 2009;61:1704–11.

Wang CT, Lin YT, Chiang BL, Lin YH, Hou SM. High molecular weight hyaluronic aciddown-regulates the gene expression of osteoarthritis-associated cytokines and enzymes in fibroblast-likesynoviocytes from patients with early osteoarthritis. Osteoarthritis Cartilage. 2006;14:1237–47.

Gomis A, Miralles A, Schmidt RF, Belmonte C. Nociceptive nerve activity in an experimental model ofknee joint osteoarthritis of the guinea pig: Effect of intra-articular hyaluronan application. Pain. 2007;130:126–36.

Pozo MA, Balazs EA, Belmonte C. Reduction of sensory responses to passive movements of inflamedvknee joints by hylan, a hyaluronan derivative. Exp Brain Res. 1997;116:3–9.