Original articleInjection of intra-articular sodium hyaluronidate (Sinovial®) into the carpometacarpal joint of the thumb (CMC1) in osteoarthritis. A prospective evaluation of efficacy
Introduction
Peripheral osteoarthritis (OA) often affects the hand, leading to an underestimated degree of disability, and potentially considerable negative effects on quality of life [1]. Estimates of the prevalence of OA of the hand vary widely. A recent survey based on radiographic data showing at least one affected joint put the figure at 67% of women and 54.8% of men [2].
The most commonly affected sites are: the distal interphalangeal joints (DIP), 47.3%; thumb base, 35.8%; proximal interphalangeal joints (PIP), 18.2%; and metacarpophalangeal joints (MCP), 8.2% [2].
In the absence of guidelines for the treatment of OA of the hand, most patients are managed using analgesics, slow-acting osteoarthritis drugs aimed at the relief of symptoms (SySADOA), slow disease-modifying osteoarthritis drugs (SMOAD), splints, and intra-articular steroid injections.
Intra-articular steroids are reported to be efficacious in knee OA [3], but a recent double-blind randomised controlled trial [4] failed to detect a clinical benefit in moderate to severe OA of the CMC1 compared with placebo injections and long terms benefits are not observed [5]. CMC1 intraarticular hyaluronic acid injections literature is scarce, two recent studies seem to show efficacy on pain and function [6], [7].
Viscosupplementation with hyaluronic acid injections seems to relieve pain and improve function in the management of OA in various joints, principally the knee [8]. The goal of the present prospective study was to investigate a difference of efficacy in pain relief of one, two or three injections of hyaluronic acid in OA of the CMC1. We studied the effect of injections all the study long and looked for a difference in efficacy at three months on pain and functionality.
Section snippets
Patients
Outpatients attending the Rheumatology Department of the University Hospital of Nice with symptomatic OA of the CMC1 joint (visual analogue scale [VAS] <40) and refractory to other therapeutic interventions were enrolled. Exclusion criteria included symptomatic OA in any other digit, use of steroid injection in the previous 6 months and previous use of sodium hyaluronidate injection. Subjects with blood coagulation abnormalities, infection, and hand trauma were also excluded. All subjects had
Results
Forty-two subjects were enrolled in the study between October 2003 and June 2005. Five patients were lost to follow up between one and three month (two each in groups 1 and 3, one in group 2). All five exhibited X-ray grade 3. The reasons for drop out were lack of efficacy (n = 3) and non-attendance to scheduled visits (n = 2). These patients did not differ significantly from the study population at baseline.
The mean age was 64.8 years (8.0), and 90.5% were women. With regard to professional status,
Discussion
The injections were performed easily and were well tolerated. No significant differences were found between each group all the study long for pain relief and function. Intra groups analyses showed significant improvements in both pain (VAS) and function (Dreiser test) in groups 2 and 3 but did not reach significance in group 1. Efficacy was reported as early as the first month and persisted at 3 months.
The literature regarding the use of hyaluronic acid injections in OA of the hand is scanty
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