Published: 2022-02-25

Effectiveness of intra-articular hyaluronic acid versus corticosteroids in knee osteoarthritis: a comparative study

Mithilesh A. Nikam, Paresh V. Patil, Priyambada Kumar


Background: Osteoarthritis (OA) is the largest cause of disability worldwide and the most common cause of knee discomfort. OA is a chronic, progressive joint disease marked by articular cartilage deterioration and secondary hyperosteogeny. OA affects 35 percent of those over the age of 65 and produces considerable pain in the knee joint. The patient with OA not only suffers from chronic pain, stiffness, and reduced movement, physical and/or mental co-morbidity, but also has a direct impact on their quality of life.

Methods: 72 patients with symptomatic osteoarthritis of unilateral knee joint (pain >3 months) were included in the present study. They were randomly divided into two groups; group A (n=36) included patients who were given intra-articular injection hyaluronic acid and group B (n=36) included those who were given intra-articular corticosteroid injection. All the data was compared both within the group as well as with one another at different follow up time.

Results: There was no significant difference in the basic demographic distribution in both groups. Female sex predilection was seen in the present study. In patients receiving hyaluronic acid (HA), mean baseline visual analog scale (VAS) score was noted to be 7.45±1.4. Then at 2 weeks, 6 weeks, 3 months and 6 months follow up the mean VAS score was 3.4±1.3, 2.78±1.1, 3.71±1.4 and 3.90±1.2; p<0.05).

Conclusions: Steroids provide an acute symptomatic relief but their benefits are short lasting. On the other hand, HA provides long lasting therapeutic pain relief.


Intra-articular corticosteroids, Hyaluronic acid, Kellegren and Lawrence classification, Osteoarthritis, WOMAC, VAS score

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Poole AR, Rizkalla G, Ionescu M. Osteoarthritis in the human knee: a dynamic process of cartilage matrixdegradation, synthesis and reorganization. Agents Actions. 1993;39:3-13.

Ringdahl E, Pandit S. Treatment of knee osteoarthritis. Am Fam Physician. 2011;83:1287-92.

Moskowitz RW. The burden of osteoarthritis: clinical and quality-of-life issues. Am J Manag Care. 2009;15(8):223-9.

Herrero-Beaumont G, Roman-Blas JA, Bruyère O, Cooper C, Kanis J, Maggi S, Rizzoli R, Reginster JY. Clinical settings in knee osteoarthritis: Pathophysiology guides treatment. Maturitas. 2017;96:54-57.

Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137-62.

Buckwalter JA, Mankin HJ. Articular cartilage- Degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect. 1998;47:487-504.

Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs. Clin Rehabil. 2017;31(5):612-24.

Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop. 2014;5(3):351-61.

Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015;16:321.

Stern R, Jedrzejas MJ. Hyaluronidases: their genomics, structures, and mechanisms of action. Chem Rev. 2006;106(3):818-39.

Day R, Brooks P, Conaghan PG, Petersen M; Multicenter Trial Group. A double blind, randomized, multicenter, parallel group study of the effectiveness and tolerance of intraarticular hyaluronan in osteoarthritis of the knee. J Rheumatol. 2004;31(4):775-82.

Shimazu A, Jikko A, Iwamoto M, Koike T, Yan W, Okada Y, et al. Effects of hyaluronic acid on the release of proteoglycan from the cell matrix in rabbit chondrocyte cultures in the presence and absence of cytokines. Arthritis Rheum. 1993;36(2):247-53.

Gotoh S, Onaya J, Abe M, Miyazaki K, Hamai A, Horie K, Tokuyasu K. Effects of the molecular weight of hyaluronic acid and its action mechanisms on experimental joint pain in rats. Ann Rheum Dis. 1993;52(11):817-22.

Asari A, Miyauchi S, Matsuzaka S, Ito T, Kominami E, Uchiyama Y. Molecular weight-dependent effects of hyaluronate on the arthritic synovium. Arch Histol Cytol. 1998;61(2):125-35.

Creamer P. Intra-articular corticosteroid treatment in osteoarthritis. Curr Opin Rheumatol. 1999;11:417-21.

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(12):1704-11.

Kohn MD, Sassoon AA, Fernando ND. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res. 2016;474(8):1886-93.

Jordan KM, Arden NK, Doherty M, Bannwarth B. An Evidence Based Approach to the Management of Knee Osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145-55.

Hochberg MC, McAlindon T, Felson DT. Systemic and topical treatments. In Osteoarthritis: New insights. Part 2: Treatment approaches. Ann Intern Med. 2000;133:726-37.

Ostergaard M., Halberg P. Intra-articular corticosteroids in arthritic disease: a guide to treatment. BioDrugs. 1998;9(2):95-103.

Rozental TD, Sculco TP. Intra-articular corticosteroids: an updated overview. Am J Orthop (Belle Mead NJ). 2000;29(1):18-23.

Zhang FJ, Luo W, Gao SG. Expression of CD44 in articular cartilage is associated with disease severity in knee OA. Mod Rheumatol. 2013;23(6):1186-91.

Musumeci G, Loreto C, Carnazza ML. Acute injury affects lubricin expression in knee menisci: an immunohistochemical study. Ann Anat. 2013;195(2):151-8.

Bagga H, Burkhardt D, Sambrook P, March L. Long-term effects of IA hyaluronan on synovial fluid in osteoarthritis of the knee. J Rheumatol. 2006;33(5):946-50.

Bellamy N. WOMAC osteoarthritis index users guide. Queensland, Australia: University of Queensland. 2000;1-43.

Leardini G, Mattara L, Franceschini M, Perbellini A. Intra-articular treatment of knee OA. A comparative study between hyaluronic acid and 6-methyl prednisolone acetate. Clin Exp Rheumatol. 1991;9(4):375-81.

Jones AC, Pattrick M, Doherty S, Doherty M. Intra-articular HA compared to intra-articular THA in inflammatory knee OA. Osteoarthritis Cartilage. 1995;3(4):269-73.

Caborn D, Rush J, Lanzer W, Parenti D, Murray C; Synvisc 901 Study Group. A randomized, single-blind comparison of the efficacy and tolerability of hylan G-F 20 and triamcinolone hexacetonide in patients with osteoarthritis of the knee. J Rheumatol. 2004;31(2):333-43.

Merolla G, Sperling JW, Paladini P, Porcellini G. Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskelet Surg. 2011;95(3):215-24.