Acute arthritis after intra-articular hyaluronate injection: onset of effusions without crystal

doi:10.1136/ard.60.5.518

Annals of the Rheumatic Diseases 2001;60:518-520; doi:10.1136/ard.60.5.518

Ann Rheum Dis 2001;60:518-520 ( May )

Concise report

Acute arthritis after intra-articular hyaluronate injection: onset of effusions without crystal C Bernardeau^a ^b, B Bucki^b, F Lioté^a ^b

^a Fédération de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière (AP-HP), 2 rue A Paré, 75475 Paris Cedex 10, France, ^b Laboratoire de Radiologie expérimentale et de Physiopathologie articulaire, Université Paris VII (JE 2149)

Correspondence to: Professor Lioté frederic.liote{at}lrb.ap-hop-paris.fr

Accepted for publication 10 October 2000

Side effects of intra-articular hyaluronate injection include aseptic acute arthritis, which develops within hours after injection.Based on standard crystal analysis, calcium crystal shedding hasbeen postulated to explain this complication. However, it is notknown whether apatite crystals or low amounts of calcium pyrophosphatedihydrate (CPPD) crystals are also involved as to determine thisrequires a complete synovial fluid (SF) analysis. Two cases ofsuch an acute arthritis are reported in patients after receivinga second Hylan GF-20 intra-articular injection. The SF did notcontain CPPD, monosodium urate, or calcium apatite microcrystalsas examined by microscopic analysis (using a compensated polarisedlight microscope) after alizarin red staining. Further studiesare required to investigate possible direct proinflammatory effectsof hyaluronic acid degradationproducts.

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