Role of intra-articular hyaluronic acid preparations in medical managementof osteoarthritis of the knee

Objective: This article reviews the various pharmacological modalities for the treatment of osteoarthritis (OA) of the knee, with a particular emphasi s on the use of intra-articular (IA) hyaluronic acid (HA). Methods: A literature review of the pharmacotherapy of OA of the knee was p erformed. Reviewed studies included those involving acetaminophen, nonstero idal anti-inflammatory drugs (NSAIDs), topical analgesics, IA corticosteroi ds, and IA HA. Results: According to American College of Rheumatology (ACR) guidelines, ac etaminophen should be used as first-line oral therapy. NSAIDs can be tried if nonpharmacological therapy and acetaminophen fail to provide adequate sy mptom relief. Topical capsaicin cream, either as monotherapy or as adjuncti ve therapy, is recommended for patients who do not respond to analgesics or who do not wish to take systemic therapy. IA corticosteroids are recommend ed for patients who have an effusion and local signs of inflammation. IA HA preparations are indicated for the treatment of pain in patients with OA o f the knee who have failed to respond adequately to conservative nonpharmac ologic therapy and to simple analgesics. Clinical trials show that IA HA th erapy results in improvement in knee pain and function that is superior to placebo and comparable to NSAIDs. Conclusions: Treatment with IA HA products appears to offer a significant a dvantage over aspiration and placebo injections for up to 6 months. It also may have an advantage over IA glucocorticoids. Semin Arthritis Rheum 30:2-10. Copyright (C) 2000 by W.B. Saunders Company.