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Intra-articular hyaluronic acid injection for knee osteoarthritis: efficacy and adverse effects underestimated?

Queries and Comments Prescrire concluded in 2016 that the harm-benefit balance of hyaluronic acid by intra-articular injection seemed unfavourable. Several readers have since expressed their profound disagreement, citing the effects noted in their daily practice. How can such a difference be explained? Could the clinical data available in 2020 potentially call Prescrire's conclusions into question?

In practice

  • Overall, a large number of trials and meta-analyses do not support any major effectiveness of this treatment. Nevertheless, evaluation data have shown that intra-articular injection of hyaluronic acid has modest efficacy compared to placebo injection in relieving symptoms associated with knee osteoarthritis. In this setting, there are options for orally administered treatment, thus avoiding intra‑articular injection: paracetamol, and when this does not bring sufficient relief, an NSAID such as ibuprofen at moderate doses, or naproxen, which seem to have similar efficacy to that of hyaluronic acid.
  • On an individual basis, patients and healthcare professionals sometimes observe significant relief after intra-articular injection of hyaluronic acid. However, this observation is limited to patients who derive benefit from this treatment and does not take into account the patients who suffer a serious adverse effect, leading to loss of independence. The use of intra-articular hyaluronic acid injection should remain the exception.

©Prescrire 1 July 2020

Source: "Queries and Comments. Intra-articular hyaluronic acid injection for knee osteoarthritis: efficacy and adverse effects underestimated?" Prescrire International 2020; 29 (217): 188-189. Subscribers only.

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See also:

“Osteoarthritis of the
knee. Hyaluronic acid,
a drug to avoid”
Prescrire Int 2017;
26 (180): 78
Pdf, subscribers only

“Osteoarthritis of the
knee: avoid intra-articular
hyaluronic acid injections"
(October 2013)

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