Induction of an acute attack of calcium pyrophosphate dihydrate arthritis by intra-articular injection of hylan G-F 20 (Synvisc)

Little is known about the induction of acute calcium pyrophosphate dihydrat e arthritis after the intraarticular injection of hylan G-F 20 (Synvisc). T wo reports have documented this adverse effect after the intra-articular in jection of hyaluronan. Our patient, a 60-year-old man with osteoarthritis i n both knees, presented with a history of an arthroscopy with meniscus shav ing 7 years previously. He was given an injection of hylan G-F 20 in the ri ght knee joint. Two days after the second injection, pain and swelling of t he knee occurred. There was a severe loss of physical function. Systemic in flammatory reactions such as fever were not observed. A microscopic investi gation of the synovial fluid showed evidence of calcium pyrophosphate dihyd rate crystals. Bacterial contamination was not detected. There was no indic ation for calcium pyrophosphate dihydrate in the history of the patient. So me days after receiving nonsteroidal anti-inflammatory drugs and an intra-a rticular injection of steroids, the symptoms disappeared.