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Intra-articular steroid or hyaluronan injections for OA knee

Issue 29 Synovium (Spring 2010)

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Given that NICE guidelines ( have recommended steroid but not hyaluronan injections for knee osteoarthritis, a review of studies comparing these two treatments1 is timely. Pooled data from 7 randomised trials involving over 600 patients revealed that steroids were more effective in relieving pain at 2 weeks, that the two treatments were equally effective at 4 weeks, and that at 8, 12 and 26 weeks hyaluronan was more effective. Hyaluronan injections are significantly more expensive than steroid injections and, as they are typically administered in a course of 3 injections given at weekly intervals, are heavy on appointment time. They appear safe and have fewer potential adverse effects or interactions with other medication. Does the longer duration of effectiveness justify the extra cost – given that it would appear that an equal or greater number of steroid injections might be needed to produce the same duration of symptom relief? Might a single – larger-dose – injection of hyaluronan be just as effective?

A very recent study from France2 suggests it might be. In a randomised controlled trial 253 patients were allocated to receive 6 ml of hyaluronan (hylan G-F 20) – equal to three times the usual single injection – or placebo. Pain relief and functional capacity were assessed at 4, 8, 12, 18 and 26 weeks and found to be significantly improved after hyaluronan – although a significant placebo response was also noted. Another question to which we don’t yet know the answer is whether there might be a case for injecting both steroids and hyaluronan at the same time.

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