Background Carpometacarpal osteoarthritis (CMC OA) is highly prevalent in older adults, and is often unresponsive to medical treatment. Intra-articular hyaluronic acid (HA) has been widely shown to improve pain and function in patients with knee OA and it seems to be a promising therapy also for CMC OA. To date no studies compared the efficacy of different HA compounds in CMC OA.
Objectives To investigate the three-month efficacy of two different HA compounds on pain relief in CMC OA.
Methods Eighty female patients affected by symptomatic CMC OA (aged 65±8 years, mean ± SD) were treated with three once-weekly intra-articular injections of HA (Hyalgan 1ml, MW 500-700 kDalton, or Jointex 1ml, MW 800-1200 kDalton). All subjects met ACR criteria for hand OA and had CMC OA grade 1-4 according to Kellgren and Lawrence on standard X-ray performed within 6 months before the inclusion. Fourty patients (aged 64±8 years, mean ± SD) were treated with Hyalgan while 40 patients (aged 67±8 years, mean ± SD) were treated with Jointex. All the patients were followed for a 3-month period after the last injection. Treatment efficacy was assessed through visual analogue scale (VAS) pain quantification (baseline; 2nd and 3rd injection; one and three months after the last injection). Side effects were recorded.
Results In both groups VAS was significantly reduced after the first injection and reached the slowest score one month after the last injection (Hyalgan: 2nd injection vs baseline, p=0.0019; 3rd injection vs baseline, p<0.0001; 3rd injection vs 2nd injection, p=0.057; Jointex: 2nd injection vs baseline, p=0.0008; 3rd injection vs baseline, p<0.0001; 3rd injection vs 2nd injection, p=0.0096). The efficacy was maintained for all the whole follow-up period (Hyalgan and Jointex: one month vs baseline, p<0.0001; three months vs baseline, p<0.0001 - one month vs 3rd injection, p=n.s.;three months vs 3rd injection, p=n.s.). No significant differences in VAS score were found between the two groups at baseline and during the follow-up period (Hyalgan vs Jointex: baseline 7.05±2.33 vs 7.08±2.07; 3rd injection 4.35±2.85 vs 4.30±2.29; 1month 3.75±2.65 vs 3.25±2.22; 3months 4.23±2.90 vs 4.03±2.56; p=n.s.). Only minor side effects were observed in both treatment groups (mild pain and/or ecchymosis in injection site).
Conclusions Our study supports viscosupplementation with HA as a safe and efficacious approach for symptomatic CMC OA. In our preliminary study no significant differences were found between intra-articular Hyalgan and Jointex for pain relief. Further studies are needed to determine the long-term efficacy and the optimal treatment schedule.
Disclosure of Interest None Declared