Hyaluronic acid in osteoarthritis of the knee

• there is evidence that the beneficial effect is as least as good as achieved with NSAIDs but without the gastrointestinal side effects (1)
  • Huskisson and Donnelly, in a randomised, placebo, controlled trial of treatment of osteoarthritis of the knee, have shown that a course of 5 weekly hyaluronic acid injections can improve knee function for 4 months and reduce pain on walking for 6 months (1)
• a more recent meta-analysis (2):
  • confirmed the therapeutic efficacy and safety of intra-articular injection of hyaluronic acid for the treatment of osteoarthritis of the knee
• NICE however state that intra-articular hyaluronan injections are not recommended for the treatment of osteoarthritis (3)

Notes:

• a study compared intra-articular hylan versus hyaluronic acid for osteoarthritis (4)
  • there was no evidence for a difference in efficacy between the two treatments
• there is evidence that repeated cycles of intra-articular injections of hyaluronic acid not only improve knee osteoarthritis symptoms during the in-between cycle period but also exert a marked carry-over effect for at least 1 year after the last cycle (5)

Reference:

• (1) Hiskisson EC, Donnelly S (1999). Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology; 38: 602-7.
• (2) Wang CT et al. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am 2004;86:5338-45
• (3) NICE (February 2008).Osteoarthritis The care and management of osteoarthritis in adults
• (4) Juni P et al. Efficacy and safety of intraarticular hylan or hyaluronic acids for osteoarthritis of the knee: a randomized controlled trial.Arthritis Rheum. 2007 Nov;56(11):3610-9
• (5) Navarro-Sarabia F et al. A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project. Ann Rheum Dis. 2011 Nov;70(11):1957-62.