We are pleased to share with you a recent publication in Osteoarthritis and Cartilage. This publication is entitled "Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective".
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Bhandari M, Bannuru RR, Babins EM, Martel-Pelletier J, Khan M, Raynauld JP, Frankovich R, Mcleod D, Devji T, Phillips M, Schemitsch EH, Pelletier JP. Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective. Osteoarthritis and Cartilage. September 2017. 25(1):S362
Purpose: Osteoarthritis (OA) is a chronic condition characterized by a loss of joint cartilage and is a major cause of disability in Canada, with an estimated CN$195 billion annual cost. Knee OA leads to persistent pain and loss of function, and treatment goals primarily focus on symptom relief and retention of function. Injecting supplemental intra-articular hyaluronic acid (IAHA) into the joint capsule has therapeutic benefits, and numerous recently published meta-analyses (MAs) and commentaries have highlighted new evidence on the role of IAHA therapy for knee OA. Use of IAHA therapy remains controversial, however, with many international guideline recommendations providing either uncertain, partial, or no support for its use in this setting. Within the last year, numerous published MAs and associated commentaries have highlighted new evidence including the importance of intrinsic HA properties, realization of the IA placebo treatment effect, and renewed perspectives on the clinical benefit of HA therapy.
Methods: A diverse, multi-disciplinary group of specialists met to discuss new evidence in light of this controversy and to clarify the role of IAHA therapy as a class for the treatment of mild to moderate knee OA in Canada. Given that controversy surrounding HA therapy peaked with the publication of two recent MAs, PubMed was searched from Jan 2012 to Jan 29 2016 using the search terms viscosupplementation (OR aliases) AND knee osteoarthritis (OR aliases) and supplemented with a bibliographic review of recently published English only MAs of RCTs evaluating class effects of IAHA therapy compared to IA placebo and/or non-interventional controls. Outcomes of interest were pain, stiffness, function and safety. Two independent reviewers confirmed eligibility and extracted data of interest. These findings were analyzed to address controversies surrounding IAHA therapy for mild to moderate knee OA within the Canadian treatment context.
Results: Evidence indicates that IAHA therapy is safe, with significantly improved pain, function and stiffness outcomes compared to placebo or non-interventional controls in patients with mild to moderate knee OA up to 26 weeks. Intrinsic qualities of HA agents are important, with evidence suggesting that higher MW HA provides greater pain control than lower MW agents. When the IA placebo effect is added to HA outcomes, the full therapeutic value of IAHA therapy is clinically important and especially pronounced for higher MW agents. There is a role for IAHA therapy after first-line pharmacological failure in mild to moderate knee OA.
Conclusions: The full therapeutic effect of IAHA therapy is of considerable clinical importance, consisting of the combined IA placebo and HA therapeutic effects. The full therapeutic value of IAHA therapy is especially pronounced for higher MW agents. IAHA therapy is a safe and effective option for patients with mild to moderate knee OA failing first-line pharmacological therapy.