Viscosupplementation for treating knee osteoarthrosis: review of the literature

Tiago Youssef Ammar, Tomas Araujo Prado Pereira, Saulo Luís Lopes Mistura, André Kuhn, José Idilio Saggin, Osmar Valadão Lopes Júnior, Tiago Youssef Ammar, Tomas Araujo Prado Pereira, Saulo Luís Lopes Mistura, André Kuhn, José Idilio Saggin, Osmar Valadão Lopes Júnior

Abstract

The aim here was to evaluate the evidence that might support or refute the use of intra-articular viscosupplementation in treating patients with symptomatic knee osteoarthrosis. A review of the literature was conducted using the Medline, PubMed and Cochrane Controlled Trial Register databases and Cochrane database systematic reviews (Cochrane Library). Only studies presenting a high level of evidence were taken into consideration. This study included analysis on randomized clinical trials that included at least 100 patients in each intervention group, meta-analyses and systematic reviews. Two meta-analyses, five systematic reviews and six randomized clinical trials fulfilled the inclusion criteria for this review. In the light of the best evidence available so far, there is no consensus for indicating or even for contraindicating the use of intra-articular viscosupplementation among patients with symptomatic knee osteoarthrosis (level of evidence I and degree of recommendation A). Further studies with appropriate methodology are needed to elucidate this matter.

Keywords: Hyaluronic acid; Knee; Osteoarthritis; Viscosupplementation.

References

    1. Dieppe P.A., Lohmander L.S. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005;365(9463):965–973.
    1. Ontario treatment guidelines for osteoarthritis, rheumatoid arthritis, and acute musculoskeletal injury. Queen's Printer of Ontario; Toronto: 2000. Holbrook A.M. (Chair) for the Ontario Musculoskeletal Therapy Review Panel.
    1. Badley E., DesMeules M. Health Canadá; Ottawa: 2003. Arthritis in Canada: an ongoing challenge.
    1. Felson D.T. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am. 2002;42(1):1–9.
    1. Peat G., McCarney R., Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91–97.
    1. Ministério da Saúde do Brasil. Rede Interagencial de Informações para a Saúde. Available at: .
    1. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum. 2000;43(9):1905–1915.
    1. Manek N.J., Lane N.E. Osteoarthritis: current concepts in diagnosis and management. Am Fam Physician. 2000;61(6):1795–1804.
    1. Ayral X. Injections in the treatment of osteoarthritis. Best Pract Res Clin Rheumatol. 2001;15(4):609–626.
    1. George E. Intra-articular hyaluronan treatment for osteoarthritis. Ann Rheum Dis. 1998;57(11):637–640.
    1. Simon L.S. Viscosupplementation therapy with intra-articular hyaluronic acid. Fact or fantasy? Rheum Dis Clin North Am. 1999;25(2):345–357.
    1. Fam H., Bryant J.T., Kontopoulou M. Rheological properties of synovial fluids. Biorheology. 2007;44(2):59–74.
    1. Dahl L.B., Dahl I.M., Engström-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):817–822.
    1. Wen D.Y. Intra-articular hyaluronic acid injections for knee osteoarthritis. Am Fam Physician. 2000;62(3):565–570.
    1. Oxford Centre for Evidence-Based Medicine. Available at: .
    1. Chevalier X., Jerosch J., Goupille P., Van Dijk N., Luyten F.P., Scott D.L. Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: a randomised, multicentre, double-blind, placebo controlled trial. Ann Rheum Dis. 2010;69(1):113–119.
    1. Navarro-Sarabia F., Coronel P., Collantes E., Navarro F.J., De la Serna A.R., Naranjo A. 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;70(11):1957–1962.
    1. Wobig M., Dickhut A., Maier R., Vetter G. Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther. 1998;20(3):410–423.
    1. Raynauld J.P., Torrance G.W., Band P.A., Goldsmith C.H., Tugwell P., Walker V. A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (part 1 of 2): clinical results. Osteoarthritis Cartilage. 2002;10(7):506–517.
    1. Raman R., Dutta A., Day N., Sharma H.K., Shaw C.J., Johnson G.V. Efficacy of hylan G-F 20 and sodium hyaluronate in the treatment of osteoarthritis of the knee – a prospective randomized clinical trial. Knee. 2008;15(4):318–324.
    1. Jüni P., Reichenbach S., Trelle S., Tschannen B., Wandel S., Jordi B. Viscosupplementation Trial Group. Efficacy and safety of intraarticular hylan or hyaluronic acids for osteoarthritis of the knee: a randomized controlled trial. Arthritis Rheum. 2007;56(11):3610–3619.
    1. Aggarwal A., Sempowski I.P. Hyaluronic acid injections for knee osteoarthritis. Systematic review of the literature. Can Fam Physician. 2004;50:249–256.
    1. 2nd ed. American Academy of Orthopaedic Surgeons; Rosemont: 2013. Treatment of osteoarthritis of the knee – evidence-based guideline.
    1. Modawal A., Ferrer M., Choi H.K., Castle J.A. Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005;54(9):758–767.
    1. Espallargues M., Pons J.M. Efficacy and safety of viscosupplementation with Hylan G-F 20 for the treatment of knee osteoarthritis: a systematic review. Int J Technol Assess Health Care. 2003;19(1):41–56.
    1. Bellamy N., Campbell J., Robinson V., Gee T., Bourne R., Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005321.
    1. Miller L.E., Block J.E. US-approved intra-articular hyaluronic acid injections are safe and effective in patients with knee osteoarthritis: systematic review and meta-analysis of randomized, saline-controlled trials. Clin Med Insights Arthritis Musculoskelet Disord. 2013;6:57–63.
    1. Rutjes A.W., Jüni P., Da Costa B.R., Trelle S., Nüesch E., Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Adv Intern Med. 2012;157(3):180–191.
    1. United States Commetee on Health, Education, Labor, and Pensions. Subcommittee on Aging . Department of Health and Human Services; Washington: 2004. Centre of Disease Control's role in combating the burden of arthritis.
    1. Balazs E.A., Denlinger J.L. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl. 1993;39:3–9.
    1. Smith M.M., Ghosh P. The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatol Int. 1987;7(3):113–122.
    1. Bagga H., Burkhardt D., Sambrook P., March L. Longterm effects of intraarticular hyaluronan on synovial fluid in osteoarthritis of the knee. J Rheumatol. 2006:946–950.
    1. Ghosh P. The role of hyaluronic acid (hyaluronan) in health and disease: interactions with cells, cartilage, and components of synovial fluid. Clin Exp Rheumatol. 1994;12(1):75–82.
    1. Yasui T., Akatsuka M., Tobetto K., Hayaishi M., Ando T. The effect of hyaluronan on interleukin-1 alpha-induced prostaglandin E2 production in human osteoarthritic synovial cells. Agents Actions. 1992;37(1–2):155–156.
    1. Monfort J., Nacher M., Montell E., Vila J., Verges J., Benito P. Chondroitin sulfate and hyaluronic acid (500–730 kDa) inhibit stromelysin-1 synthesis in human osteoarthritic chondrocytes. Drugs Exp Clin Res. 2005;31(2):71–76.

Source: PubMed

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