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Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys.

Abstract

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). This recommendation is based upon accumulating evidence that IA HA provides a significant benefit in knee OA. There is good evidence that IA HA injections reduce pain and increase function in knee OA, and the benefits are long-lasting as compared with IA corticosteroids. Evidence from real-life studies of repeat courses of IA HA demonstrates an improvement in pain or function lasting up to 40 months (12 months after the last injection cycle), a reduction in use of concomitant analgesia by up to 50%, and suggests that there may be a delay in the need for total knee replacement (TKR) of around 2 years. The clinical benefit of IA HA on knee OA may be 2-fold: (i) mechanical viscosupplementation of the joint (allowing lubrication and shock absorption) and (ii) the re-establishment of joint homeostasis through induction of endogenous HA production, which continues long after the exogenous injection has left the joint. The magnitude of the clinical effect may be different for different HA products, but this has not been proven so far and requires further investigation. IA HA injections are generally considered to be safe, although a slightly higher number of cases of local reactions and post-injection non-septic arthritis has been reported with high molecular weight cross-linked HAs. The use of IA HA in knee OA patients with mild-moderate disease, and for more severe patients wishing to delay TKR surgery, is recommended by the ESCEO task force. Further investigation into the OA patient types most likely to benefit from IA HA is warranted. Viscosupplementation with IA HA is a safe and effective component of the multi-modal management of knee OA.

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  • Authors+Show Affiliations

    ,

    Rheumatology Department, AP-HP, Saint-Antoine Hôpital, 184 Rue du faubourg Saint-Antoine, 75012 Paris, France. Electronic address: emaheu@wanadoo.fr.

    ,

    Rehabilitation Unit, Rheumatology Department, Hôpital Cochin, Université Paris Descartes, AP-HP, INSERM UMR-S 1124, Paris, France.

    Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman, 4000 Liège, Belgium.

    Source

    Seminars in arthritis and rheumatism 45:4 Suppl 2016 Feb pg S28-33

    MeSH

    Anti-Inflammatory Agents, Non-Steroidal
    Drug Therapy, Combination
    Evidence-Based Medicine
    Humans
    Hyaluronic Acid
    Injections, Intra-Articular
    Knee Joint
    Osteoarthritis, Knee
    Viscosupplements

    Pub Type(s)

    Journal Article
    Practice Guideline

    Language

    eng

    PubMed ID

    26806183

    Citation

    Maheu, Emmanuel, et al. "Efficacy and Safety of Hyaluronic Acid in the Management of Osteoarthritis: Evidence From Real-life Setting Trials and Surveys." Seminars in Arthritis and Rheumatism, vol. 45, no. 4 Suppl, 2016, pp. S28-33.
    Maheu E, Rannou F, Reginster JY. Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45(4 Suppl):S28-33.
    Maheu, E., Rannou, F., & Reginster, J. Y. (2016). Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Seminars in Arthritis and Rheumatism, 45(4 Suppl), pp. S28-33. doi:10.1016/j.semarthrit.2015.11.008.
    Maheu E, Rannou F, Reginster JY. Efficacy and Safety of Hyaluronic Acid in the Management of Osteoarthritis: Evidence From Real-life Setting Trials and Surveys. Semin Arthritis Rheum. 2016;45(4 Suppl):S28-33. PubMed PMID: 26806183.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. AU - Maheu,Emmanuel, AU - Rannou,François, AU - Reginster,Jean-Yves, Y1 - 2015/12/02/ PY - 2015/10/12/received PY - 2015/11/16/revised PY - 2015/11/25/accepted PY - 2016/1/26/entrez PY - 2016/1/26/pubmed PY - 2016/12/15/medline KW - Hyaluronic acid KW - Intra-articular injection KW - Knee osteoarthritis SP - S28 EP - 33 JF - Seminars in arthritis and rheumatism JO - Semin. Arthritis Rheum. VL - 45 IS - 4 Suppl N2 - 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). This recommendation is based upon accumulating evidence that IA HA provides a significant benefit in knee OA. There is good evidence that IA HA injections reduce pain and increase function in knee OA, and the benefits are long-lasting as compared with IA corticosteroids. Evidence from real-life studies of repeat courses of IA HA demonstrates an improvement in pain or function lasting up to 40 months (12 months after the last injection cycle), a reduction in use of concomitant analgesia by up to 50%, and suggests that there may be a delay in the need for total knee replacement (TKR) of around 2 years. The clinical benefit of IA HA on knee OA may be 2-fold: (i) mechanical viscosupplementation of the joint (allowing lubrication and shock absorption) and (ii) the re-establishment of joint homeostasis through induction of endogenous HA production, which continues long after the exogenous injection has left the joint. The magnitude of the clinical effect may be different for different HA products, but this has not been proven so far and requires further investigation. IA HA injections are generally considered to be safe, although a slightly higher number of cases of local reactions and post-injection non-septic arthritis has been reported with high molecular weight cross-linked HAs. The use of IA HA in knee OA patients with mild-moderate disease, and for more severe patients wishing to delay TKR surgery, is recommended by the ESCEO task force. Further investigation into the OA patient types most likely to benefit from IA HA is warranted. Viscosupplementation with IA HA is a safe and effective component of the multi-modal management of knee OA. SN - 1532-866X UR - https://www.unboundmedicine.com/medline/citation/26806183/Efficacy_and_safety_of_hyaluronic_acid_in_the_management_of_osteoarthritis:_Evidence_from_real_life_setting_trials_and_surveys_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-0172(15)00286-3 DB - PRIME DP - Unbound Medicine ER -