Hip osteoarthritis treatment with intra-articular injections: hyaluronic acid versus glucocorticoid - a systematic review. 2020

Filipa Vilabril, and Jorge Rocha-Melo, and José Vítor Gonçalves, and José Vilaça-Costa, and Iva Brito
Centro Hospitalar de Trás-os-Montes e Alto Douro.

OBJECTIVE To compare the effects of intra-articular injection of glucocorticoid (GC) and hyaluronic acid (HA) on pain and disability caused by hip osteoarthritis (HO). METHODS A systematic review of the literature was carried out within MEDLINE (via PubMed), Web of Science, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases, using the keywords (MeSH words): "hip osteoarthritis", "glucocorticoid", "corticosteroid", "corticoid", "hyaluronic acid" and "viscosupplementation". Two independent authors applied inclusion and exclusion criteria, selecting randomized clinical trials with direct comparison between intra-articular injection of GC and HA in patients with HO. RESULTS 157 articles were found in the initial search. After applying the exclusion criteria, 36 articles were read, with final selection of 3 randomized clinical trials (n = 484). Two studies compared the administration of these products with placebo (saline) - and one also compared it with a fourth group of patients undergoing only physical therapy. Qvistgaard et al. demonstrated clinical superiority of GC (moderate clinical benefit) and HA (marginal clinical benefit) in pain, at 4 weeks, both compared to placebo; however, there was no statistically significant difference between GC and HA during the 12-week follow-up. Atchia et al. reported a statistically significant improvement in pain and function in patients treated with GC during 8 weeks. Spitzer et al. demonstrated an overall clinical response in patients in both groups throughout the study, with a faster response for those treated with GC. However, the authors highlight the superiority in all outcome measures of HA compared to GC in cases of moderate HO, at 26 weeks. CONCLUSIONS Few studies directly compare the clinical effect between intra-articular injections of GC and HA in HO, showing heterogeneity in the type of population, number of administrations, formulation of HA and follow-up period. The analyzed studies had a short follow-up time. The results obtained seem to demonstrate a superiority of GC compared to HA in managing pain, namely in the speed of clinical response. However, Spitzer et al. demonstrated an overall superiority of HA in patients with moderate HO, which suggests that optimal selection of patients remains to be defined.

UI MeSH Term Description Entries
D007270 Injections, Intra-Articular Methods of delivering drugs into a joint space. Intra Articular Injection,Intraarticular Injection,Injections, Intraarticular,Intra-Articular Injections,Intraarticular Injections,Articular Injection, Intra,Articular Injections, Intra,Injection, Intra Articular,Injection, Intra-Articular,Injection, Intraarticular,Injections, Intra Articular,Intra Articular Injections,Intra-Articular Injection
D005938 Glucocorticoids A group of CORTICOSTEROIDS that affect carbohydrate metabolism (GLUCONEOGENESIS, liver glycogen deposition, elevation of BLOOD SUGAR), inhibit ADRENOCORTICOTROPIC HORMONE secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. Glucocorticoid,Glucocorticoid Effect,Glucorticoid Effects,Effect, Glucocorticoid,Effects, Glucorticoid
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006820 Hyaluronic Acid A natural high-viscosity mucopolysaccharide with alternating beta (1-3) glucuronide and beta (1-4) glucosaminidic bonds. It is found in the UMBILICAL CORD, in VITREOUS BODY and in SYNOVIAL FLUID. A high urinary level is found in PROGERIA. Amo Vitrax,Amvisc,Biolon,Etamucine,Healon,Hyaluronan,Hyaluronate Sodium,Hyvisc,Luronit,Sodium Hyaluronate,Acid, Hyaluronic,Hyaluronate, Sodium,Vitrax, Amo
D015207 Osteoarthritis, Hip Noninflammatory degenerative disease of the hip joint which usually appears in late middle or old age. It is characterized by growth or maturational disturbances in the femoral neck and head, as well as acetabular dysplasia. A dominant symptom is pain on weight-bearing or motion. Coxarthrosis,Osteoarthritis of the Hip,Osteoarthritis Of Hip,Coxarthroses,Hip Osteoarthritis,Osteoarthritis Of Hips
D055675 Viscosupplements Viscoelastic solutions that are injected into JOINTS in order to alleviate symptoms of joint-related disorders such as OSTEOARTHRITIS. Visco Supplements,Viscosupplement,Supplements, Visco

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