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Osteoarthritis

Is viscosupplementation really so unsafe for knee OA?

The latest in a series of meta-analyses of trials assessing viscosupplementation for knee osteoarthritis is the first to raise concerns about its safety. Questions remain, however, regarding the methodological rigour with which the serious adverse events were analyzed, and the biological plausibility of the events reported.

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References

  1. Craig, D. G. et al. Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity. Br. J. Clin. Pharmacol. 73, 285–294 (2012).

    Article  CAS  Google Scholar 

  2. Zhang, W. et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 16, 137–162 (2008).

    Article  CAS  Google Scholar 

  3. Bannuru, R. R. et al. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 61, 1704–1712 (2009).

    Article  CAS  Google Scholar 

  4. Rutjes, A. W. et al. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann. Intern. Med. http://dx.doi.org/10.7326/0003-4819-157-3-201208070-00473.

  5. Bannuru, R. R., Natov, N. S., Dasi, U. R., Schmid, C. H. & McAlindon, T. E. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis—meta-analysis. Osteoarthritis Cartilage 19, 1704–1711 (2011).

    Article  Google Scholar 

  6. Bellamy, N. et al. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD005321. http://dx.doi.org/10.1002/14651858.CD005321.pub2.

  7. Schneeweiss, S. et al. NSAID switching and short-term gastrointestinal outcome rates after the withdrawal of rofecoxib. Pharmacoepidemiol. Drug Saf. 18, 1134–1142 (2009).

    Article  CAS  Google Scholar 

  8. Kelly, J. C. Viscosupplementation for knee OA: little gain, big risks. Medscape Medical News [online], (2012).

  9. Huskisson, E. C. & Donnelly S. Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology (Oxford) 38, 602–607 (1999).

    Article  CAS  Google Scholar 

  10. Strand, V., Baraf, H. S., Lavin, P. T., Lim, S. & Hosokawa, H. A multicenter, randomized controlled trial comparing a single intra-articular injection of gel-200, a new cross-linked formulation of hyaluronic acid, to phosphate buffered saline for treatment of osteoarthritis of the knee. Osteoarthritis Cartilage 20, 350–356 (2012).

    Article  CAS  Google Scholar 

Download references

Acknowledgements

T. E. McAlindon is supported by funds from the NIH. R. R. Bannuru is supported by the Agency for Healthcare Research and Quality (grant number F32HS021396). The content of this commentary is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Agency for Healthcare Research and Quality.

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Correspondence to Timothy E. McAlindon.

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T. E. McAlindon has received speaker's bureau (honoraria) from Bioiberica and has acted as a consultant for Flexion Therapeutics and Sanofi-Aventis, but not with regard to any specific product discussed in this commentary. R. R. Bannuru declares no competing interests.

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McAlindon, T., Bannuru, R. Is viscosupplementation really so unsafe for knee OA?. Nat Rev Rheumatol 8, 635–636 (2012). https://doi.org/10.1038/nrrheum.2012.152

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