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Ann Rheum Dis 2001;60:518-520 doi:10.1136/ard.60.5.518
  • Concise report

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

  1. C Bernardeaua,b,
  2. B Buckib,
  3. F Liotéa,b
  1. aFédération de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière (AP-HP), 2 rue A Paré, 75475 Paris Cedex 10, France, bLaboratoire de Radiologie expérimentale et de Physiopathologie articulaire, Université Paris VII (JE 2149)
  1. Professor Liotéfrederic.liote{at}lrb.ap-hop-paris.fr
  • Accepted 10 October 2000

Abstract

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 has been postulated to explain this complication. However, it is not known whether apatite crystals or low amounts of calcium pyrophosphate dihydrate (CPPD) crystals are also involved as to determine this requires a complete synovial fluid (SF) analysis. Two cases of such an acute arthritis are reported in patients after receiving a second Hylan GF-20 intra-articular injection. The SF did not contain CPPD, monosodium urate, or calcium apatite microcrystals as examined by microscopic analysis (using a compensated polarised light microscope) after alizarin red staining. Further studies are required to investigate possible direct proinflammatory effects of hyaluronic acid degradation products.

Footnotes

  • This work was funded in part by Paris VII University, the “Association Rhumatisme et Travail”, and by the “Association pour la Recherche en Pathologie Synoviale (ARPS)”.

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