Intra-articular sodium hyaluronate in osteoarthritis of the knee

Objectives: Hyaluronan (HA) has recently been approved in the United States for management of pain in osteoarthritis (OA) of the knee and is the first biological available for use in OA. To better understand the therapeutic r ole of HA, this review focuses on comparative clinical trial data. Methods: Literatuue reports of clinical trials comparing HA with placebo, n onsteroidal anti-inflammatory drugs, and intra-articular corticosteroids we re reviewed. The pivotal US trial evaluating HA efficacy and safety was sum marized. Results: Over the past decade, 5 of 8 controlled clinical trials demonstrat ed HA was superior to placebo in relieving the pain of OA, A sixth trial sh owed improvement in a subset of older patients with more severe disease. Co mparison of HA with corticosteroids showed equal pain relief in the first f ew weeks after therapy, with HA demonstrating more sustained benefit up to 60 days. In the recent US trial, HA was statistically superior to placebo a nd at least as effective as naproxen in providing analgesia. Un all trials reporting adverse effects, the primary adverse effect with HA was pain at t he injection site. Conclusions: HA appears effective in relieving the pain of OA of the knee a nd provides a relatively safe alternative for patients for whom conventiona l therapy has failed. Semin Arthritis Rheum 30:11-18. Copyright (C) 2000 by W.B. Saunders Company .