Saturday, January 9, 2016

Hyaluronic acid injections - do they work? The importance of controlled trials

Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence.

These authors sought to determine the clinical significance of injectable hyaluronic acid (HA) in the treatment of knee osteoarthritis, and to assess which trial-level factors influence the overall treatment effect of HA. They conducted a comprehensive literature search to locate randomized controlled trials that compared HA with control treatment and had a minimum of thirty patients per subgroup.

Their most consistent finding was that double-blinded, sham-controlled trials had much smaller treatment effects than trials that were not sufficiently blinded (p < 0.05). For double-blinded trials, the overall treatment effect was less than half of the minimal important difference for pain, function, and stiffness. They concluded that meta-analysis of only the double-blinded, sham-controlled trials with at least sixty patients did not show clinically important differences of HA treatment over placebo. 

Comment: While this is not study of the effect of hyaluronic acid injection for shoulder arthritis, there is every reason to believe that the results would be similar at best.
We're including this article for another reason - it shows the importance of good controls. Note in the figure below, the double blind studies show a net minimal effect, whereas the open label studies (HA vs usual care) show a stronger effect.


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