Background Osteoarthritis (OA) is the commonest condition to affect human joints. It is a major cause of pain, disability and handicap, and a difficult condition to treat. Pharmacological treatment has been limited to the use of analgesics, non-steroidal anti-inflammatory drugs and the controversial use of intra-articular steroid injections. None of these options provide a truly effective treatment. Viscosupplementation has only recently become available in the UK. Hyaluronon in synovial fluid has multiple functions in joint homeostasis. It is reduced in concentration and molecular weight in OA. Therefore viscosupplementation would not only remove pathological synovial fluid (by prior joint aspiration) but also restore the molecular weight and concentration of hyaluronan.1
Objectives We wished to evaluate viscosupplementation for OA of the knee, and to ascertain which patient groups would derive the most benefit from Hyalgan.
Methods We have an ongoing dedicated visco-supplementation clinic. Patients are assessed to ensure suitability and are also advised about weight reduction (if appropriate) and quadriceps exercises. They attend weekly for the course of 5 injections. The patients are asked to complete a WOMAC Questionnaire pre-course and at 6 weeks, 3 and 6 months after treatment. This is a health status instrument for measuring clinically important patient relevant outcomes to anti-rheumatic drug therapy in patients with osteoarthritis of the hip or knee.2 No ethical approval was required.
Results Comparing pre-course WOMAC scores with all time intervals a statistically significant difference at 6 weeks (paired T test p = 0.0081) was found. Patients were sub-divided into 2 groups according to WOMAC scores, 1600. (Maximum score 2400, indicating maximum severity). These groups were also compared. Results to reach statistical significance were WOMAC changes at 6 weeks and 6 months in the >1600 group, compared to pre-course where p = 0.0053 and p = 0.023 respectively (unpaired T test).
Conclusion From our study patients reported an improved WOMAC at 6 weeks. Those with score >1600, pre-course do better than those with scores inconclusive but do appear to offer some benefit to patients.3 As with intra-articular steroid injections in this condition, it is difficult to predict who will benefit.4 Our work would suggest that patients with higher initial scores on WOMAC questionnaire may respond better.
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Bellamy N, et al. Validation study of WOMAC. J Rheumatol. 1988;15:1833–40
Wen DY. Intra-articular hyaluronic acid for knee osteoarthritis. Am Fam Physician 2000;62(3):565–70
Jones A, Doherty M. Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response. Ann Rheum Dis. 1996;55(11):829–32
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