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

Orazio De Lucia, Antonella Murgo, Francesca Pregnolato, Irene Pontikaki, Mirian De Souza, Alessandro Sinelli, Rolando Cimaz, Roberto Caporali

Research output: Contribution to journalReview articlepeer-review

Abstract

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. Well-designed studies are necessary to definitively clarify the range of application of intra-articular HA injections in the treatment of inflammatory rheumatic disorders.

Original languageEnglish
Pages (from-to)1347-1359
Number of pages13
JournalAdvances in Therapy
Volume37
Issue number4
DOIs
Publication statusPublished - Apr 1 2020

Keywords

  • Hyaluronic acid
  • Osteoarthritis
  • Qualitative synthesis
  • Rheumatic diseases
  • Rheumatology
  • Systematic review
  • Viscosupplementation

ASJC Scopus subject areas

  • Pharmacology (medical)

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