Hyaluronic acid versus corticosteroid in the treatment of knee osteoarthritis

Study Type: ACE Review
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
Synopsis
Six ACE Reports were identified from the OrthoEvidence database which compared intra-articular injection(s) of hyaluronic acid to corticosteroid in the treatment of osteoarthritis of the knee. All of the included studies were randomized controlled trials which reported pain and/or functional outcomes within 6 months of intervention. Pooled analysis of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Non-funded None disclosed
Funding: Sponsor: Conflicts:
Non-funded None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Wlliam Beaumont Army Medical Center, Department of Clinical Investigation None disclosed
Funding: Sponsor: Conflicts:
Industry funded Wyeth Pharmaceuticals None disclosed
Background
Osteoarthritis (OA) of the knee is a degenerative condition that is increasingly prevalent in the current population. The degradation and deterioration of the cartilage and synovial fluid seen with the condition ultimately leads to significant pain, inflammation and stiffness, reducing the functional ability of those who suffer from it. While surgical options exist to address these symptoms, conservative methods are typically preferred when dealing with early stages of the disease. Intra-articular injections of corticosteroids have been used extensively in the past to manage OA symptoms, although the effect of steroids has been inconsistent among trials. Additionally, there is concern that repeated injections of corticosteroids may actually accelerate joint degeneration. Recent interest has arisen to help identify an appropriate alternative material for injection therapy in cases of knee OA. Viscosupplementation through intra-articular injections of hyaluronic acid (hyaluronan being a naturally produced glycosaminoglycan that plays an important role in the synovial fluid for cartilage protection) has shown promise. However, as an alternative treatment to steroid injections, the efficacy of hyaluronic acid is largely unknown.
What was the principal research question?
What is the comparative efficacy of hyaluronic acid to corticosteroid intra-articular injections for the treatment of osteoarthritis of the knee?
Report Characteristics: Six reports from the OrthoEvidence database were identified of randomized clinical trials that compared intra-articular hyaluronic acid injections to corticosteroid injections in the treatment of knee osteoarthritis. The publication dates of the included trials ranged from May 2003 to January 2010. The trials included a combined total of 479 patients.
Report Selection: The following search terms were used to identify relevant articles from the OrthoEvidence database: "hyaluronic acid" OR "hyaluronate" OR "Hylan G-F 20" AND "corticosteroid" AND "knee osteoarthritis". Inclusion criteria were studies that (1) compared intra-articular injections of hyaluronic acid to corticosteroid to (2) treat osteoarthritis of the knee and (3) assessed pain and functional outcome.
Outcomes: The outcome measures included in the studies were: a visual analog scale (VAS) for pain, functional outcome through the Knee Society Score (KSS), Lequesne Index (LI), or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and improvement in knee range of motion (ROM) in flexion.
Heterogeneity: Heterogeneity was assessed using the I-squared statistic for poolable outcomes. Since heterogeneity was assumed to be high, pooling was conducted using a random effects model.
Report Details and Scores
CONTENT IS LOCKED
Pooling and Statistical Analysis
Main Findings
3 and 6 month VAS pain scores for Hyaluronic acid vs. Corticosteroid
3 month Lequesne Index for Hyaluronic acid vs. Corticosteroid
3 month Knee Society Scores for Hyaluronic acid vs. Corticosteroid
What should I remember most?
Implications for patient treatment and future research:
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.