Six-months pain relief and functional recovery after intra-articular injections with hyaluronic acid (mw 500-730 KDa) in trapeziometacarpal osteoarthritis

Abstract

Background: this retrospective open label study evaluates the efficacy and tolerability of intra-articular injections of Hyaluronic Acid (HA) (MW 500-730 KDa - Hyalgan®) for the treatment of pain and disability of trapeziometacarpal joint osteoarthritis (TMCJ OA).

Methods: fifty eight patients, 50 females (86%) and 8 male (14%), aged between 40-75 years, suffering from TMCJ OA according to Kellgren-Laurence grades 2-3 on standard plain radiography, were included. Patients with known inflammatory arthritis, previous thumb trauma and intra-articular (i.a.) injections with corticosteroids were excluded. Primary endpoints were: pain (VAS), NSAID intake, radial and palmar ab-/adduction, pinch strength. All patients received an i.a. injection of 0.8 mL of HA (MW 500-730 KDa) once weekly for three weeks. Control examinations were carried out at 1, 3, and 6 months.

Results: intra-articular HA injections have significantly reduced spontaneous and provoked pain and improved hand mobility. At 1,3, and 6 months from baseline, the spontaneous and provoked pain revealed a statistically significant improvement (p<0,0001). NSAID's intake evidenced a statistically significant reduction against baseline (p<0.017). The adverse events (21%) were related to local symptoms such as pain during or following HA administration.

Conclusions: this study shows that i.a. HA injections for TMCJ OA can induce a significant improvement of function associated to stiffness decrease and pain relief.

Keywords: hyaluronic acid; osteoarthritis; trapeziometacarpal joint.

Figures

Figure 1.

Mean values of pain on a 0–10 Visual Analogue Scale (VAS) perceived during voluntary and passive activity.

Figure 2.

Mean values of pain on a 0–10 Visual Analogue Scale (VAS) perceived during day and night.

Figure 3.

The mean radial abduction and palmar adduction of the target thumb.

Figure 4.

Statistically significant reduction of Mean NSAID consumption rate at baseline and at each study point.

Figure 5.

Percentage of patients changing swelling conditions from baseline at each study point.