Skip to main content

Advertisement

Log in

The intra-articular efficacy of hyaluronate injections in the treatment of rheumatoid arthritis

  • Original Article
  • Published:
Modern Rheumatology

Abstract

To determine whether the intra-articular injection of hyaluronate (HA) is a potential clinical option for the treatment of rheumatoid arthritis (RA), we have evaluated the clinical efficacy of intra-articular corticosteroid and HA by analyzing the patient-based database from a cross-sectional observational cohort. A total of 668 (14.1%) of 4725 patients in the database received injections. The logistic regression analysis showed that the Japanese version of the Stanford Health Assessment Questionnaire functional index [J-HAQ; odds ratio (OR) 1.53, 95% confidence interval (CI) 1.35–1.73] and disease activity score 28 (DAS28; OR 1.28, 95% CI 1.19–1.39) were predictive in the case of receiving a joint injection compared to non-injection. The patient-perceived satisfactory rate of injection was 64.0 (95% CI 51.9–76.2) for corticosteroid injections and 59.3 (95% CI 50.6–67.9) for HA injections; however, there were no significant differences between the corticosteroid and HA injection groups (P < 0.074). Our results demonstrate that HA and corticosteroid injections generally have similar efficacy rates when the patient-perceived satisfactory rate was employed as an index. These results are encouraging, as the use of HA stimulates interest in clinical studies aimed at assessing the potential role of viscosupplementation in treating RA, and HA may represent another treatment option for RA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hochberg MC, Perlmutter DL, Hudson JI, Altman AD. Preferences in the management of osteoarthritis of the hip and knee results of a survey of community-based rheumatologists in the United States. Arthritis Care Res. 1996;9:170–6.

    Article  CAS  PubMed  Google Scholar 

  2. Hill JJ Jr, Trapp R, Colliver J. Survey on the use of corticosteroid injections by orthopaedists. Contemp Orthop. 1989;18:39–45.

    Google Scholar 

  3. Modawal A, Ferrer M, Choi HK, Castle JA. Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005;54:758–67.

    PubMed  Google Scholar 

  4. Waddell DD, Bricker DC. Total knee replacement delayed with Hylan G-F 20 use in patients with grade IV osteoarthritis. J Manage Care Pharm. 2007;13:113–21.

    Google Scholar 

  5. Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003;290:3115–21.

    Article  CAS  PubMed  Google Scholar 

  6. Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004;86-A:538–45.

    PubMed  Google Scholar 

  7. Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Müllner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. Can Med Assoc J. 2005;172:1039–43.

    Article  Google Scholar 

  8. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2005;18(2):CD005321.

    Google Scholar 

  9. Pagnano M, Westrich G. Successful nonoperative management of chronic osteoarthritis pain of the knee: safety and efficacy of retreatment with intra-articular hyaluronans. Osteoarthritis Cartilage. 2005;13:751–61.

    Article  PubMed  Google Scholar 

  10. Modawal A, Ferrer M, Choi HK, Castle JA. Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005;54:758–67.

    PubMed  Google Scholar 

  11. Strand V, Conaghan PG, Lohmander LS, Koutsoukos AD, Hurley FL, Bird H, et al. An integrated analysis of five double-blind, randomized controlled trials evaluating the safety and efficacy of a hyaluronan product for intra-articular injection in osteoarthritis of the knee. Osteoarthritis Cartilage 2006;14:859–66.

    Google Scholar 

  12. Dagenais S. Intra-articular hyaluronic acid (viscosupplementation) for knee osteoarthritis. Issues Emerg Health Technol. 2006;94:1–4.

    PubMed  Google Scholar 

  13. Reichenbach S, Blank S, Rutjes AW, Shang A, King EA, Dieppe PA, et al. Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis. Arthritis Rheum. 2007;57:1410–8.

    Article  PubMed  Google Scholar 

  14. Divine JG, Zazulak BT, Hewett TE. Viscosupplementation for knee osteoarthritis: a systematic review. Clin Orthop Relat Res. 2007;455:113–22.

    Article  PubMed  Google Scholar 

  15. Conrozier T, Chevalier X. Long-term experience with hylan GF-20 in the treatment of knee osteoarthritis. Expert Opin Pharmacother. 2008;10:1797–804.

    Article  Google Scholar 

  16. Pendleton A, Arden N, Dougados M, Doherty M, Bannwarth B, Bijlsma JW, et al. EULAR recommendations for 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. 2000;59:936–44.

    Article  CAS  PubMed  Google Scholar 

  17. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum. 2000;43:1905–15.

    Article  Google Scholar 

  18. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee meta-analysis. Br Med J. 2004;328(7444):869.

    Google Scholar 

  19. Palacios LC, Jones WY, Mayo HG, Malaty W. Clinical inquiries. Do steroid injections help with osteoarthritis of the knee? J Fam Pract. 2004;53:921–2.

    PubMed  Google Scholar 

  20. Godwin M, Dawes M. Intra-articular steroid injections for painful knees. Systematic review with meta-analysis. Can Fam Physician. 2004;50:241–8.

    PubMed  Google Scholar 

  21. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intra-articular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;19:CD005328.

    Google Scholar 

  22. Wallen M, Gillies D. Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. Cochrane Database Syst Rev. 2006;1:CD002824.

    PubMed  Google Scholar 

  23. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis 2002 update. Arthritis Rheum. 2002;46:328–46.

    Article  Google Scholar 

  24. Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther. 2003;5:54–67.

    Article  CAS  PubMed  Google Scholar 

  25. Goldberg VM, Buckwalter JA. Hyaluronans in the treatment of osteoarthritis of the knee: evidence for disease-modifying activity. Osteoarthritis Cartilage. 2005;13:216–24.

    Article  CAS  PubMed  Google Scholar 

  26. Chou CL, Li HW, Lee SH, Tsai KL, Ling HY. Effect of intra-articular injection of hyaluronic acid in rheumatoid arthritis patients with knee osteoarthritis. J Chin Med Assoc. 2008;71:411–5.

    Article  PubMed  Google Scholar 

  27. McCarty DJ, Harman JG, Grassanovich JL, Qian C. Treatment of rheumatoid joint inflammation with intrasynovial triamcinolone hexacetonide. J Rheumatol. 1995;22:1631–5.

    CAS  PubMed  Google Scholar 

  28. Goto M, Hanyu T, Yoshio T et al. Intra-articular injection of hyaluronate (SI-6601D) improves joint pain and synovial fluid prostaglandin E2 levels in rheumatoid arthritis: a multicenter clinical trial. Clin Exp Rheumatol. 2001;19:377–83.

    CAS  PubMed  Google Scholar 

  29. Goto M, Hosako Y, Katayama M, et al. Biochemical analysis of rheumatoid synovial fluid after serial intra-articular injection of high molecular weight sodium hyaluronate. Int J Clin Pharmacol Res. 1993;13:161–6.

    CAS  PubMed  Google Scholar 

  30. Matsuno H, Yudoh K, Kondo M, et al. Biochemical effect of intra-articular injections of high molecular weight hyaluronate in rheumatoid arthritis patients. Inflamm Res. 1999;48:154–9.

    Article  CAS  PubMed  Google Scholar 

  31. Tanaka T, Souen S, Yamamoto M, et al. Additional analysis for a multi-center phase III comparative clinical study of high molecular hyaluronic acid (NRD101) on rheumatoid arthritis. Clin Rheumatol Relat Res. 2000;12:179–204.

    Google Scholar 

  32. Rasooly I, Papageorgiou AC, Badley EM. Comparison of clinical and self reported diagnosis for rheumatology outpatients. Ann Rheum Dis. 1995;54:850–2.

    Article  CAS  PubMed  Google Scholar 

  33. Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A, Taniguchi A, et al. Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol. 2007;17:283–9.

    Article  PubMed  Google Scholar 

  34. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.

    Article  CAS  PubMed  Google Scholar 

  35. Skedros JG, Hunt KJ, Pitts TC. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. 2007;8:63.

    Article  PubMed  Google Scholar 

  36. Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23:137–45.

    Article  CAS  PubMed  Google Scholar 

  37. Hawley DJ, Wolfe F. Sensitivity to change of the Health Assessment Questionnaire (HAQ) and other clinical and health status measures in rheumatoid arthritis: results of short-term clinical trials and observational studies versus long-term observational studies. Arthritis Care Res. 1992;5:130–6.

    Article  CAS  PubMed  Google Scholar 

  38. Wolfe F, Hawley DJ. The long-term outcomes of rheumatoid arthritis: Work disability: a prospective 18-year study of 823 patients. J Rheumatol. 1998;25:2108–17.

    CAS  PubMed  Google Scholar 

  39. Drossaers-Bakker KW, de Buck M, van Zeben D, Zwinderman AH, Breedveld FC, Hazes JM. Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheum. 1999;42:1854–60.

    Article  CAS  PubMed  Google Scholar 

  40. Welsing PM, van Gestel AM, Swinkels HL, Kiemeney LA, van Riel PL. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001;44:2009–17.

    Article  CAS  PubMed  Google Scholar 

  41. McCarty DJ, McCarthy G, Carrera G. Intraarticular corticosteroids possibly leading to local osteonecrosis and marrow fat induced synovitis. J Rheumatol. 1991;18:1091–4.

    CAS  PubMed  Google Scholar 

  42. Raynauld JP, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48:370–7.

    Article  CAS  PubMed  Google Scholar 

  43. Leopold SS, Redd BB, Warme WJ, Wehrle PA, Pettis PD, Shott S. Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee. A prospective, randomized trial. J Bone Joint Surg Am. 2003;85-A:1197–203.

    PubMed  Google Scholar 

  44. Tasciotaoglu F, Oner C. Efficacy of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis. Clin Rheumatol. 2003;22:112–7.

    Article  CAS  PubMed  Google Scholar 

  45. Leardini G, Mattara L, Franceschini M, Perbellini A. Intra-articular treatment of knee osteoarthritis. A comparative study between hyaluronic acid and 6-methyl prednisolone acetate. Clin Exp Rheumatol. 1991;9:375–81.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the statistical analyst, Dr. Eisuke Inoue for statistical support. The authors would also like to thank all participating rheumatologists and orthopedic surgeons and the staff of the IORRA cohort study group.

Conflicts of interest statement

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Seiji Saito.

About this article

Cite this article

Saito, S., Momohara, S., Taniguchi, A. et al. The intra-articular efficacy of hyaluronate injections in the treatment of rheumatoid arthritis. Mod Rheumatol 19, 643–651 (2009). https://doi.org/10.1007/s10165-009-0207-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10165-009-0207-8

Keywords

Navigation