Clinical Rheumatology

, 30:1285 | Cite as

National, multicentre, prospective study of quality of life in patients with osteoarthritis of the knee treated with hylane G-F 20

  • Anne-Christine Rat
  • Cédric Baumann
  • Francis Guillemin
Original Article


The efficacy of viscosupplementation for the relief of pain and disability caused by knee osteoarthritis has been demonstrated, but its effects on Quality of Life (QoL) are less well known. The aim of this study was to describe the changes in QoL in patients receiving hylane G-F 20 in routine practice for the treatment of knee osteoarthritis and to determine the factors associated with changes in QoL. An observational, prospective, multicentre study was carried out in private ambulatory care patients. The study population consisted of patients receiving hylane G-F 20 injections for symptomatic, radiological Kellgren stage II or III knee osteoarthritis. The clinical and demographic data were recorded at inclusion and the QoL, SF36 and OsteoArthritis Knee and Hip Quality Of Life (OAKHQOL) questionnaires administered before the first injection and then during the 3- and 6-month visits. Three hundred patients were enrolled in the study (61% female, mean age 67 ± 11 years, 45% Kellgren stage II). After 3 and 6 months, all the SF36 scores and three OAKHQOL scores had significantly improved. In the multivariate analysis, low QoL scores at inclusion were correlated with a more marked improvement (p < 0.0001). Prior treatment with a viscosupplement was associated with a less substantial improvement in the SF36 physical functioning (β = 11.2, p = 0.03) and OAKHQOL mental health scores (β = 9.1, p = 0.01). The presence of effusion was only associated with changes on the SF36 physical functioning score (β = 15.4, p = 0.005). Administered in routine practice for symptomatic knee osteoarthritis, hylane G-F 20 improves QoL. Both joint effusion and prior viscosupplementation could be associated with a more modest improvement in QoL.


Hyaluronic acid Knee osteoarthritis Quality of life 



The authors would like to thank Genzyme SAS for their financial and practical support during this study, particularly Olivier Lescale and Françoise Grazian.


AC Rat and F Guillemin received grant support for consulting services to Genzyme. C Baumann has nothing to disclose.


  1. 1.
    Sprangers MA, de Regt EB, Andries F, van Agt HM, Bijl RV, de Boer JB, Foets M, Hoeymans N, Jacobs AE, Kempen GI, Miedema HS, Tijhuis MA, de Haes HC (2000) Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol 53:895–907PubMedCrossRefGoogle Scholar
  2. 2.
    Brooks PM (2002) Impact of osteoarthritis on individuals and society: how much disability? Social consequences and health economic implications. Curr Opin Rheumatol 14:573–577PubMedCrossRefGoogle Scholar
  3. 3.
    Hawley DJ, Wolfe F (1991) Pain, disability, and pain/disability relationships in seven rheumatic disorders: a study of 1,522 patients. J Rheumatol 18:1552–1557PubMedGoogle Scholar
  4. 4.
    van der Waal JM, Terwee CB, van der Windt DA, Bouter LM, Dekker J (2005) The impact of non-traumatic hip and knee disorders on health-related quality of life as measured with the SF-36 or SF-12. A systematic review. Qual Life Res 14:1141–1155PubMedCrossRefGoogle Scholar
  5. 5.
    van der Waal JM, Terwee CB, van der Windt DA, Bouter LM, Dekker J (2005) Health-related and overall quality of life of patients with chronic hip and knee complaints in general practice. Qual Life Res 14:795–803PubMedCrossRefGoogle Scholar
  6. 6.
    Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, Zimmerman-Gorska I, Dougados M (2003) EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 62:1145–1155PubMedCrossRefGoogle Scholar
  7. 7.
    American College of Rheumatology Subcommittee on Osteoarthritis Guidelines (2000) Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum 43:1905–1915CrossRefGoogle Scholar
  8. 8.
    Wang CT, Lin J, Chang CJ, Lin YT, Hou SM (2004) Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Jt Surg Am 86-A:538–545Google Scholar
  9. 9.
    Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G (2006) Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev (2):CD005321Google Scholar
  10. 10.
    Lo GH, LaValley M, McAlindon T, Felson DT (2003) Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. Jama 290:3115–3121PubMedCrossRefGoogle Scholar
  11. 11.
    Modawal A, Ferrer M, Choi HK, Castle JA (2005) Hyaluronic acid injections relieve knee pain. J Fam Pract 54:758–767PubMedGoogle Scholar
  12. 12.
    Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Mullner M (2005) Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ 172:1039–1043PubMedCrossRefGoogle Scholar
  13. 13.
    Acquadro C, Berzon R, Dubois D, Leidy NK, Marquis P, Revicki D, Rothman M (2003) Incorporating the patient’s perspective into drug development and communication: an ad hoc task force report of the Patient-Reported Outcomes (PRO) Harmonization Group meeting at the Food and Drug Administration, February 16, 2001. Value Health 6:522–531PubMedCrossRefGoogle Scholar
  14. 14.
    Willke RJ, Burke LB, Erickson P (2004) Measuring treatment impact: a review of patient-reported outcomes and other efficacy endpoints in approved product labels. Control Clin Trials 25:535–552PubMedCrossRefGoogle Scholar
  15. 15.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedCrossRefGoogle Scholar
  16. 16.
    Kosinski M, Keller SD, Hatoum HT, Kong SX, Ware JE Jr (1999) The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: tests of data quality, scaling assumptions and score reliability. Med Care 37:10–22Google Scholar
  17. 17.
    Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. a qualitative and systematic review of the literature. J Bone Jt Surg Am 86:963–974Google Scholar
  18. 18.
    Leplege A, Ecosse E, Verdier A, Perneger TV (1998) The French SF-36 health survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 51:1013–1023PubMedCrossRefGoogle Scholar
  19. 19.
    Rat AC, Coste J, Pouchot J, Baumann M, Spitz E, Retel-Rude N, Le Quintrec JS, Dumont-Fischer D, Guillemin F (2005) OAKHQOL: a new instrument to measure quality of life in knee and hip osteoarthritis. J Clin Epidemiol 58:47–55PubMedCrossRefGoogle Scholar
  20. 20.
    Rat AC, Pouchot J, Coste J, Baumann C, Spitz E, Retel-Rude N, Baumann M, Le Quintrec JS, Dumont-Fischer D, Guillemin F (2006) Development and testing of a specific quality-of-life questionnaire for knee and hip osteoarthritis: OAKHQOL (OsteoArthritis of Knee Hip Quality of Life). Jt Bone Spine 73:697–704CrossRefGoogle Scholar
  21. 21.
    Rat AC, Guillemin F, Pouchot J (2008) Mapping the osteoarthritis knee and hip quality of life (OAKHQOL) instrument to the international classification of functioning, disability and health and comparison to five health status instruments used in osteoarthritis. Rheumatol Oxf 47:1719–1725CrossRefGoogle Scholar
  22. 22.
    Goetz C, Ecosse E, Rat AC, Pouchot J, Coste J, Guillemin F (2010) Measurement properties of the osteoarthritis of knee and hip quality of life (OAKHQOL): an item response theory analysis. Rheumatology 50(3):500–505PubMedCrossRefGoogle Scholar
  23. 23.
    Lequesne MG, Mery C, Samson M, Gerard P (1987) Indexes of severity for osteoarthritis of the hip and knee. Validation–value in comparison with other assessment tests. Scand J Rheumatol Suppl 65:85–89PubMedCrossRefGoogle Scholar
  24. 24.
    Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombardier C, Felson D, Hochberg M, van der Heijde D, Dougados M (2005) Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis 64:34–37PubMedCrossRefGoogle Scholar
  25. 25.
    Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombardier C, Felson D, Hochberg M, van der Heijde D, Dougados M (2005) Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 64:29–33PubMedCrossRefGoogle Scholar
  26. 26.
    Ware JE, Kosinski M, Keller SK (1994) SF-36 physical and mental health summary scale: a user’s manual. Boston, MA: The Health InstituteGoogle Scholar
  27. 27.
  28. 28.
    Raynauld JP, Torrance GW, Band PA, Goldsmith CH, Tugwell P, Walker V, Schultz M, Bellamy N (2002) 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 10:506–517PubMedCrossRefGoogle Scholar
  29. 29.
    Mazieres B, Bard H, Ligier M, Bru I, d’Orsay GG, Le Pen C (2007) Medicoeconomic evaluation of hyaluronic acid for knee osteoarthritis in everyday practice: the MESSAGE study. Joint Bone Spine 74:453–460PubMedCrossRefGoogle Scholar
  30. 30.
    Kahan A, Lleu PL, Salin L (2003) Prospective randomized study comparing the medicoeconomic benefits of Hylan GF-20 vs. conventional treatment in knee osteoarthritis. Jt Bone Spine 70:276–281CrossRefGoogle Scholar
  31. 31.
    Rennesson-Rey B, Rat AC, Chary-Valckenaere I, Bettembourg-Brault I, Juge N, Dintinger H, Pourel J, Loeuille D (2008) Does joint effusion influence the clinical response to a single Hylan GF-20 injection for hip osteoarthritis? Joint Bone Spine 75:182–188PubMedCrossRefGoogle Scholar
  32. 32.
    Anandacoomarasamy A, Bagga H, Ding C, Burkhardt D, Sambrook PN, March LM (2008) Predictors of clinical response to intraarticular Hylan injections—a prospective study using synovial fluid measures, clinical outcomes, and magnetic resonance imaging. J Rheumatol 35:685–690PubMedGoogle Scholar
  33. 33.
    Conrozier T, Mathieu P, Schott AM, Laurent I, Hajri T, Crozes P, Grand P, Laurent H, Marchand F, Meignan F, Noel E, Rozand Y, Savoye JF, Vignon E (2003) Factors predicting long-term efficacy of Hylan GF-20 viscosupplementation in knee osteoarthritis. Jt Bone Spine 70:128–133CrossRefGoogle Scholar
  34. 34.
    Julovi SM, Yasuda T, Shimizu M, Hiramitsu T, Nakamura T (2004) Inhibition of interleukin-1beta-stimulated production of matrix metalloproteinases by hyaluronan via CD44 in human articular cartilage. Arthritis Rheum 50:516–525PubMedCrossRefGoogle Scholar
  35. 35.
    Rennesson-Rey B, Rat AC, Chary-Valckenaere I, Bettembourg-Brault I, Juge N, Dintinger H, Pourel J, Loeuille D (2008) Does joint effusion influence the clinical response to a single Hylan GF-20 injection for hip osteoarthritis? Jt Bone Spine 75:182–188CrossRefGoogle Scholar
  36. 36.
    Qvistgaard E, Christensen R, Torp-Pedersen S, Bliddal H (2006) Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthritis Cartilage 14:163–170PubMedCrossRefGoogle Scholar
  37. 37.
    Toh EM, Prasad PS, Teanby D (2002) Correlating the efficacy of knee viscosupplementation with osteoarthritic changes on roentgenological examination. Knee 9:321–330PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2011

Authors and Affiliations

  • Anne-Christine Rat
    • 1
    • 2
    • 3
    • 4
    • 5
  • Cédric Baumann
    • 1
    • 2
    • 3
  • Francis Guillemin
    • 1
    • 2
    • 3
  1. 1.INSERMCIC-EC CIE6NancyFrance
  2. 2.CHU NancyEpidémiologie et Evaluation CliniquesNancyFrance
  3. 3.Nancy-Université, Université Paul Verlaine Metz, Université Paris DescartesNancyFrance
  4. 4.CHU NancyService de rhumatologieNancyFrance
  5. 5.Centre d′Epidémiologie Clinique, INSERMCIC-EC CIE6, Service d′épidémiologie et évaluation cliniquesVandoeuvre-les-NancyFrance

Personalised recommendations