Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: Results of an extensive critical literature review

Maheu, E.; Bannuru, Raveendhara R.; Herrero‐Beaumont, Gabriel; Allali, F.; Bard, Hervé; Migliore, Alberto

doi:10.1016/j.semarthrit.2018.06.002

Cited by 117 publications

(113 citation statements)

References 91 publications

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“…HA is a high molecular weight polysaccharide that is an important part of synovial fluid and articular cartilage. Injecting HA into the knee joint cavity can physically lubricate the articular surface, reduce wear, and biologically nourish articular cartilage and promote the synthesis of endogenous HA, thereby delaying further joint disease [33][34][35]. A large number of RCTs and systematic reviews of the intra-articular injection of PRP or HA for KOA have been published [8,[36][37][38], and most studies have concluded that intra-articular injection of PRP, compared with HA, can relieve knee pain and improve the function of patients with KOA.…”

Section: Discussionmentioning

confidence: 99%

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Zhao

Huang

Liang

et al. 2020

BMC Musculoskelet Disord

109

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Background: Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of the intra-articular injection of PRP combined with HA compared with the intra-articular injection of PRP or HA alone in the treatment of KOA. Methods: The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Randomized controlled trials and cohort studies of PRP combined with HA for KOA were included. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Review Manager 5.3 was used to calculate the relative risk (RR) or standardized mean difference (SMD) of the pooled data. STATA 14.0 was used for quantitative publication bias evaluation. (Continued on next page)Results: Seven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (SMD: − 0.31; 95% confidence interval (CI): − 0.55 to − 0.06; P = 0.01 < 0.05). PRP combined with HA for KOA achieved better improvements in the WOMAC Function Score (SMD: -0.32; 95% CI: − 0.54 to − 0.10; P < 0.05) and WOMAC Total Score (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05) at the 12-month follow-up than did the application of PRP alone. In a comparison of Lequesne Index scores at the 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: − 0.67 to − 0.17; P < 0.05). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P > 0.05). Conclusions: Compared with intra-articular injection of PRP alone, that of PRP combined with HA can improve the WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA is not significantly different from PRP or HA alone.

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Section: Discussionmentioning

confidence: 99%

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Zhao

Huang

Liang

et al. 2020

BMC Musculoskelet Disord

109

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“…Notwithstanding the in vitro ndings cannot be extrapolated to the human clinical situation, high molecular weight HA is an alternative treatment for knee OA that articular injection of HA acts to restore intraarticular lubrication, consequently improving joint biomechanics [25,26]. Recent meta-analysis also suggests that HA injections are a safe and effective alternative in treating patients with symptomatic knee OA [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Identification and Functional Enrichment Analysis of Differentially Expressed Genes in Osteoarthritis

Meng

Xiao

et al. 2020

Preprint

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Background Osteoarthritis (OA) is a chronic, progressive, inflammatory, degenerative disease, which has become an osteoarthropathy that seriously affects physical health and quality of life of elderly people. However, the etiology and pathogenesis of OA remains unclear. Therefore, the study purposed to utilize bioinformatics technology to perform identification and functional enrichment analysis of differentially expressed genes in osteoarthritis. Method The main methods of this study consist of access to microarray data (GSE82107 and GSE55235), identification of differently expressed genes (DEGs) by GEO2R between OA and normal synovium samples, enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) by Gene Set Enrichment Analysis (GSEA), construction and analysis of protein-protein interaction (PPI) network, significant module and hub genes. Result A total of 300 DEGs were identified, consisting of 64 up-regulated genes and 11 down-regulated genes in OA samples compared to normal synovium tissues. Gene set enrichment analysis of DEGs provided a comprehensive overview of some major pathophysiological mechanisms in OA: cellular response to hydrogen peroxide, P53 signaling pathway and so on. The study also built the PPI network, and a total of 10 key genes were identified: CYR61, PENK, GOLM1, DUSP1, ATF3, STC2, FOSB, PRSS23, TF, and TNC. Conclusion DEGs exists between OA patients and normal cartilage tissue, which may be involved in the related mechanism of OA development, especially cellular response to hydrogen peroxide and CYR61.

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“…Furthermore, locally injected HA seems to be an effective treatment for OA comorbidity. Indeed, results from several in vitro and in vivo studies have indicated that exogenous HA can decrease the production of pro-inflammatory cytokines and stimulate the endogenous synthesis of HA and extracellular matrix components by synovial fibroblasts [5][6][7][8][9]. In all inflammatory conditions of the joint, the molecular weight of HA is reduced.…”

Section: Introductionmentioning

confidence: 99%

“…In all inflammatory conditions of the joint, the molecular weight of HA is reduced. Also, several clinical studies have shown that intra-articular HA relieves pain and improves function in symptomatic OA joints [9][10][11][12] and that the treatment has a positive global effect and is well tolerated. Some studies, mainly focused on the knee joint, have shown that repeated courses of HA treatment are safe and associated with total joint replacement delay for up to 3 years [13,14].…”

Section: Introductionmentioning

confidence: 99%

Hyaluronic Acid Injections in the Treatment of Osteoarthritis Secondary to Primary Inflammatory Rheumatic Diseases: A Systematic Review and Qualitative Synthesis

et al. 2020

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The purpose of this study is to review the current literature on the use of hyaluronic acid (HA) specifically applied to the treatment of osteoarthritis (OA) secondary to primary inflammatory rheumatic diseases. Osteoarthritis should be carefully considered because it has potentially devastating effects on health-related quality of life. Locally injected HA seems to be an effective treatment for OA but it is not clear how to place this treatment in the context of inflammatory rheumatic disorders. To retrieve relevant articles, we conducted the search through MEDLINE, EMBASE and Cochrane Databases performing the PICO strategy. We finally selected four randomized clinical trials and six observational studies and grouped them in accordance with its main objective within three focuses: the clinical effect of HA therapy in joints without any signs of inflammation, the clinical effects of HA therapy in joints with active synovitis, and the involvement and changes of synovial fluid in the treatment of secondary OA. Our qualitative analysis clearly showed that the current literature is marked by high levels of heterogeneity and therefore difficult to interpret. Therefore, our hypothesis that viscosupplementation should be considered as a treatment for chronic moderate symptomatic OA secondary to inflammatory rheumatic diseases, and not for flares with joint swelling, cannot be definitely supported. Welldesigned studies are necessary to definitively clarify the range of application of intra-articular HA injections in the treatment of inflammatory rheumatic disorders.

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Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: Results of an extensive critical literature review

Cited by 117 publications

References 91 publications

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

Identification and Functional Enrichment Analysis of Differentially Expressed Genes in Osteoarthritis

Hyaluronic Acid Injections in the Treatment of Osteoarthritis Secondary to Primary Inflammatory Rheumatic Diseases: A Systematic Review and Qualitative Synthesis

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