The Booster Effect of a Single Quarterly Dose of Hyaluronic Acid in Knee Osteoarthritis: Five-Year Results of a Registry-Based Study (original) (raw)
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Annals of the Rheumatic Diseases, 2011
Objective AMELIA (OsteoArthritis Modifying Effects of Long-term Intra-articular Adant) was designed to compare against placebo the effi cacy and safety of repeated injections of hyaluronic acid (HA) and its effect on disease progression over 40 months. Methods A multicentre, randomised, patient and evaluator-blinded, controlled study in 306 patients fulfi lling American College of Rheumatology criteria for knee osteoarthritis, radiological grades II-III (Kellgren-Lawrence) and joint space width ≥2 mm. Patients received four cycles of fi ve intra-articular HA or placebo injections with a follow-up of 6 months after the fi rst and second cycles, and 1 year after the third and fourth cycles. Osteoarthritis Research Society International (OARSI) 2004 responder criteria were used to assess effi cacy. The consumption of rescue medication was a secondary outcome. Adverse events were recorded for safety purposes. Results At the 40-month visit signifi cantly more patients responded to HA compared with placebo (OARSI 2004, p=0.004). The number of responders to HA increased through the study, whereas those to placebo did not change. Signifi cant differences were also found in favour of HA for each individual component of the OARSI 2004. No safety problems were recorded. Conclusions The results of AMELIA offer pioneer evidence that repeated cycles of intra-articular injections of HA 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. In this respect, it is not possible to establish if this carry-over effect refl ects true osteoarthritis remission or just a modifi cation of the disease's natural course. ClinicalTrials.gov number, NCT00669032 Osteoarthritis is a chronic disorder characterised by joint cartilage degeneration as the central feature associated with concomitant changes in synovium and subchondral bone metabolism. 1 Osteoarthritis of the knee, the principal large joint to be affected, results in disabling symptoms in 10% of people older than 55 years, a quarter of whom are severely affected. 2 Most current pharmacological options are limited to alleviating pain and improving functional activity but effective therapeutic alternatives to slow disease progression are also needed.
Cureus
Osteoarthritis (OA) is a degenerative joint disease that causes persistent joint pain and stiffness of mainly the large peripheral weight-bearing joints. It is a leading cause of functional disability and poor quality of life. Various modalities of therapy are recommended by different research organizations at different stages of OA including non-pharmacological, pharmacological, and surgical interventions. Intra-articular injections of hyaluronic acid (HA) is widely used for over three decades in the treatment of OA. However controversies exist regarding its safety and efficacy, the number of injections and courses, type of preparation, duration of its effects, and combining it with other drugs or molecules. This study aimed to review the most recent data available in the published literature to address these. Electronic databases like Medline, Embase, ProQuest, and Google Scholar were searched for articles using keywords, intraarticular injections, hyaluronic acid, and osteoarthritis knee. The review was carried out as per PRISMA guidelines. Thirty-eight randomized control trials (RCTs) investigating the efficacy and safety of intra-articular injection of HA were included in the systematic review. Out of the 38 studies, 22 (57.9%) were double-blind, eight (21%) single-blind, three (7.9%) non-blind, four (10%) with simple randomization, and one (2.7%) was open-labeled. Total 5,025 patients were included in these studies. The mean age of the patients was 60.28 years and the osteoarthritis grade of the knee joint was 1 to 3. HA was studied as a test preparation in 19 (50%) while in another 19 (50%) it was studied as a control. In 24 (63.2%) studies, HA was used as high molecular weight preparation in eight (21%) as low molecular weight preparation while in six studies the information was not available. HA was used as a standalone preparation in 31 studies, in two studies it was injected with platelet-rich plasma (PRP) and with either low-level laser therapy (LLLT), triamcinolone (TA), betamethasone (CS), poly deoxyribonucleotide (PDRN) or dexamethasone (DX) in one study each. In the majority of the studies, HA was given as a single injection (52.6% studies) or weekly three injections (28.9% studies). In 13.2 %, it was given as weekly 5 injections and in 5.3% as weekly two injections. IA-HA injections have a limited role in the treatment of knee osteoarthritis in those patients who do not have sufficient pain relief with topical or oral medication and physical therapy. It is safe and effective except for minor side effects such as local pain and swelling lasting for a few days. Severe allergic reactions are extremely rare. They provide adequate pain relief and functional improvement for up to six months irrespective of a number of injections and type of preparations used. The combination formulations with corticosteroids or PRP or MSCs show better results than HA alone. Combining HA with newer molecules such as peptides or diclofenac for sustained and disease-modifying effects requires more studies in the future.
Managing knee ostheoarthritis: efficacy of hyaluronic acid injections
Acta reumatologica portuguesa, 2013
Osteoarthritis (OA) is the most common form of chronic arthritis worldwide. The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. The use of intra-articular viscosupplementation in the nonoperative management of patients with osteoarthritis has become quite popular. Recent clinical data have demonstrated that the anti-inflammatory and chondroprotective actions of hyaluronic acid viscosupplementation reduce pain, from 4 to 14 weeks after injection, while improving patient function. Viscosupplements are comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events, and hyaluronic acid has more prolonged effects than IA corticosteroids. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra...
Romanian Journal of Physical Therapy, 2022
Introduction: Intra-articular Hyaluronic acid (IAHA) injection provides intra-articular (IA) anti-inflammatory effect and improves synovial fluid flow dynamics and viscoelasticity. The aim of this prospective observational, clinical study was to evaluate the safety and efficacy of Hyaluronic Acid (HA) (40mg/2ml) 3 times with one week interval for the treatment of osteoarthritis (OA). Methods and materials: A total of 105 adults with OA were enrolled in the study. Each patient received 3 injection cycles of HA with one week interval. WOMAC OA Index was used to assess the effectiveness of injection and SF-36 to observe the change in quality of life. Physical examination was performed before injection and at the 3rd and 6th months following injection. Results: WOMAC score showed significant reduction from baseline (61.6) to 3rd treatment procedure visit (32.1), 3 months (16.2) and 6 months follow up visit (4.8) respectively (p<0.001). Significant improvement was observed in quality of life from baseline values to 3 month and 6 month follow up visit (p<.0001) Discussion: Studies have shown that HA is safe and well tolerated to achieve clinically significant improvement in patients with mild to moderate knee OA. It is presented that repeated IAHA injections are an effective treatment for knee OA, and reduce pain and contribute to recovery. It was concluded that HA with higher molecular weight improved pain more and suggested that the use of HA products may be effective in knee OA. A significant increase was observed in SF-36 parameters reporting quality of life with IAHA, and HMW-IAHA added to usual care is effective for knee OA in working individuals. Conclusion: Three weekly IA injections of HA provided pain relief and functional improvements with high treatment satisfaction in patients with painful knee OA lasted for a minimum 6 months.
Seminars in arthritis and rheumatism, 2018
Hyaluronic acid (HA) is a commonly prescribed intra-articular (IA) therapy for knee osteoarthritis (OA). While a single series of IA-HA has been well studied, the efficacy and safety of repeated courses of IA-HA injection therapy in knee OA patients have not been evaluated as frequently. A literature search was conducted using MEDLINE, EMBASE and PubMed databases. The primary outcome measure was knee pain reduction after each treatment course and/or last reported follow-up visit. Secondary outcomes were treatment-related adverse events (AEs) and serious adverse events (SAEs). A total of 17 articles (7 RCTs and 10 cohort studies) met the pre-defined inclusion criteria. Of the RCTs, six were double-blind with two trials including open label extension studies, and one was single-blind. Studies ranged from investigating a single reinjection cycle to four repeat injection cycles. Eleven studies evaluated one reinjection, five studies evaluated ≥2 repeated courses of IA-HA, and one study ...
Muscle Ligaments and Tendons Journal, 2021
Background. Knee osteoarthritis (OA) is an age-related progressive condition that has resulted in a significant burden worldwide. In this survey, we aimed to compare intra-articular hypertonic saline (HS) and hyaluronic acid (HA) safety and efficacy in the pain and function improvement of patients suffering from knee OA. Eventually, we made a comparison with physical therapy (PH), in a six-month follow-up. Methods. This study is a three-arm single-blinded randomized clinical trial evaluating 130 radiographically confirmed knee osteoarthritis patients suffering from chronic knee pain. A group of participants received three weekly injections of HA (Hyalgan ®), while the other group experienced an injection of five milliliters of 5% HS and the third group engaged in ten-session physiotherapy. Patients assessed before intervention, one, three, and six months post-intervention using the visual analogue scale (VAS) for pain and Knee injury and osteoarthritis outcome score (KOOS) for function and quality of life (QOL). Results. In this study, We did not identify any remarkable adverse effects. All KOOS subscales scores decreased in the HA and HS group significantly. A similar trend was detected in pain improvement, considering VAS. PH group experienced only pain reduction but not function improvement. Comparing two injected agents, HS group obtained better scores not only in pain and symptom reduction, but also in function and QOL improvement. Conclusions. However, both HS and HA can be effectively used for improving function and reducing pain and unpleasant symptoms in knee OA patients, HS prolotherapy demonstrated more acceptable outcomes through six-month follow-up.
HA injections for knee osteoarthritis
2015
Conclusion: Intra-articular injection of US-approved viscosupplements is safe and efficacious through 26 weeks in patients with symptomatic knee OA. Read this review and sign up to receive Journal of Pain Research here: http://www.dovepress.com/articles.php?article\_id=21643
The Open Rheumatology Journal, 2013
Introduction: Osteoarthritis is the most common age-related degenerative joint disease. It affects all the joints containing hyaline cartilage. Knee osteoarthritis is the most cumbersome in terms of prevalence and disability. The aim of this study to evaluate the efficacy of intra-articular hyaluronic acid in patients with knee osteoarthritis with regard to joint pain and function, as well as patient satisfaction, assessed at one month and at one year, and by age group. Methods: In this prospective randomised study, 172 patients who were diagnosed knee OA and who received three consecutive intra-articular injections of HA weekly were included. Patients 65 years of age or older were accepted as the “elderly group”, and those under 65 were accepted as the “middle-aged group”. Clinical evaluations of efficacy and safety were conducted at the beginning of the study, one month after the third injection, and one year after the third injection. Results: In the two groups, the intragroup an...