Viscosupplementation of the hip (hyaluronic acid injection) reduces NSAID consumption in patients with symptomatic osteoarthritis

Migliore A, Granata M, Tormenta S, Laganà B, Piscitelli P, Bizzi E, Massafra U, Alimonti A, Maggi C, De Chiara R, Iannessi F, Sanfilippo A, Sotera R, Scapato P,Carducci S, Persod P, Denaro S, Camminiti M, Pagano MG, Bagnato G, Iolascon G.
Operative Unit of Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy.
The consumption of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with gastrointestinal morbidity and also with mortality. The recommendations of the Osteoarthritis Research Society International (OARSI) on hip osteoarthritis and knee osteoarthritis state that non-steroidal anti-inflammatory drugs should be used at the lowest effective dose, and that their long-term use should, where possible, be avoided. The guidelines for the treatment of osteoarthritis of the hip include the use of viscosupplementation (injection of hyaluronic acid), which aims to restore the normal and rheological properties of the synovial fluid.
The aim of this multicentre, open-label, retrospective study was to investigate whether the consumption of non-steroidal anti-inflammatory drugs can be reduced by the use of hyaluronic acid injection into the hip in patients with symptomatic hip osteoarthritis.
The patients had unilateral or bilateral osteoarthritis of the hips and were assessed according to the criteria of the American Rheumatology Association and the radiological criteria of Kellgren and Lawrence, and were given hyaluronic acid intra-articularly. Consumption of non-steroidal anti-inflammatory drugs over the 24 months after the injection was assessed, together with the Lequesne and Kellgren-Lawrence scores, a pain visual analogue scale and age.
A total of 2343 patients took part in the study. The consumption of non-steroidal anti-inflammatory drugs fell by 48.2% at the third month, compared with the control group. This difference increased at the 12th and 24th months, the reduction being 50% and 61% respectively. These differences were statistically significant.
The authors concluded that intra-articular injections of hyaluronic acid provide pain relief in hip osteoarthritis and reduce the consumption of non-steroidal anti-inflammatory drugs in a large cohort of patients over a long period of follow-up. Multiple sessions of viscosupplementation (hyaluronic acid injections) are needed in order to keep the level of non-steroidal anti-inflammatory drug consumption low. High consumption of non-steroidal anti-inflammatory drugs is associated with a high risk of gastrointestinal and cardiovascular complications, whereas by contrast the use of hyaluronic acid is well tolerated and is associated with a very low rate of adverse effects. For these reasons, further study is required to assess the usefulness and the cost of intra-articular hyaluronic acid injection in the management of osteoarthritis of the hip.