Randomised controlled trial comparing the intra-articular hyaluronic acid versus intra-articular steroid in osteoarthritis of knee

Authors

  • Anurag Tiwari Department of Orthopaedics, Bansal Hospital, Bhopal, Indore, Madhya Pradesh, India
  • Ankit Thora Department of Orthopaedics, Shalby Hospital, Indore, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20182020

Keywords:

Osteoarthritis, Hyaluronic acid, Steroid, Intraarticular

Abstract

Background: Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling and stiffness. Intra-articular hyaluronic acid or steroids are being used for its treatment. The purpose of the present study was to assess the effect of intra articular hyaluronic acid in comparison to steroids for knee osteoarthritis.

Methods: A prospective randomized study including 70 patients (121 knees) diagnosed with osteoarthritis of knee, were randomly divided into two groups: 35 patients (58 knees) were given intra-articular hyaluronic acid and 35 patients (63 knees) were given intra-articular methylprednisolone. The outcome was evaluated with knee society score (KSS) and visual analog scale (VAS) before the injection and 1, 3 and 6 months after the injection.

Results: The mean KSS pain and function scores increased while VAS decreased in both the groups. All the scores showed improvement at 6 months follow up. In both the groups, the scores at 6 months were significantly better than the pre injection values, and the scores of hyaluronic acid group were significantly better compared to steroid group.

Conclusions: Intraarticular hyaluronic acid seems to be better for long term pain relief and preservation of function in comparison to intraarticular steroids in osteoarthritis of knee.

Metrics

Metrics Loading ...

References

Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum. 2008;58(1):26–35.

Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010;107:152-62.

Uthman I, Raynauld JP, Haraoui B. Intra-articular therapy in osteoarthritis. Postgrad Med J. 2003;79(934):449–53.

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.

Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: 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(12):1145–55.

Altman RD, Schemitsch E, Bedi A. Assessment of clinical practice guideline methodology for the treatment of knee osteoarthritis with intra-articular hyaluronic acid. Semin Arthritis Rheum. 2015;45(2):132–9.

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):28–33.

Iannitti T, Lodi D, Palmieri B. Intra-articular injections for the treatment of osteoarthritis:focus on the clinical use of hyaluronic acid. Drugs RD. 2011;11(1):13–27.

Reitinger S., Lepperdinger G. Hyaluronan, a ready choice to fuel regeneration:a mini review. Gerontology. 2013;59:71–6.

Dahl LB, Dahl IM, Engstrom-Laurent A, Granath K. Concentration and molecular weight of sodium hyaluronate in synovial fluid from patients with rheumatoid arthritis and other arthropathies. Ann Rheum Dis. 1985;44(12):817–22.

Pelletier JP, Martel-Pelletier J. The pathophysiology of osteoarthritis and the implication of the use of hyaluronan and hylan as therapeutic agents in viscosupplementation. J Rheumatol Suppl. 1993;39:19–24.

Pelletier JP, Martel-Pelletier J, Raynauld JP. Most recent developments in strategies to reduce the progression of structural changes in osteoarthritis: today and tomorrow. Arthritis Res Ther. 2006;8(2):206.

Vincent K. Hyaluronic acid (HA) visco-supplementation on synovial fluid inflammation in knee osteoarthritis: a pilot study. Open Orthop J. 2013;7:378–84.

Goldberg VM, Buckwalter JA. Hyaluronans in the treatment of osteoarthritis of the knee: evidence for disease-modifying activity. Osteoarthritis Cartilage. 2005;13(3):216–24.

Migliore A, Procopio S. Effectiveness and utility of hyaluronic acid in osteoarthritis. Clin Cases Miner Bone Metab. 2015;12(1):31–3.

Caldwell JR. Intra-articular corticosteroids:guide to selection and indications for use. Drugs. 1996;52(4):507–514.

Creamer P. Intra-articular corticosteroid treatment in osteoarthritis. Curr Opin Rheumatol. 1999;11(5):417–21.

Ostergaard M, Halberg P. Intra-articular corticosteroids in arthritic disease:a guide to treatment. Bio Drugs. 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.

Askari A, Gholami T, NaghiZadeh MM, Farjam M, Kouhpayeh SA, Shahabfard Z. Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail. Springerplus. 2016;5:442.

Ray TR. Using viscosupplementation to treat knee osteoarthritis. Physician Sports Med. 2013;41(4):16–24.

Heyworth BE, Lee JH, Kim PD, Lipton CB, Strauch RJ, Rosenwasser MP. Hylan versus corticosteroid versus placebo for treatment of basal joint arthritis:a prospective, randomized, double-blinded clinical trial. J Hand Surg Am. 2008;33(1):40–8.

Campbell KA, Erickson BJ, Saltzman BM. Is local viscosupplementation injection clinically superior to other therapies in the treatment of OA of the knee:a systematic review of overlapping meta-analyses. Arthroscopy. 2015;31(10):2036–45.

Downloads

Published

2018-06-23

How to Cite

Tiwari, A., & Thora, A. (2018). Randomised controlled trial comparing the intra-articular hyaluronic acid versus intra-articular steroid in osteoarthritis of knee. International Journal of Research in Orthopaedics, 4(4), 587–590. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20182020

Issue

Section

Original Research Articles