According to recent research, injections of hyaluronic acid (known as viscosupplementation) for the treatment of ache ofosteoarthritis of the knee they make almost no difference to pain and could increase the risk of adverse situations.
The results of the study have been published
in the scientific journal British Medical Journal (BMJ).
Osteoarthritis of the knee: this is what the research says
Viscosupplementation has been used to treat arthrosis in fennel since the 1970s, but its efficacy and safety has long been questioned. Osteoarthritis of the knee is a chronic disease that involves inflammation and structural changes in the joints, resulting in joint pain and limitations in physical movement. It is a leading cause of disability among older people: with approximately 560 million people living with the condition globally.
National and international guidelines vary in their recommendations, but most advise against the use of viscosupplementation. In England, the guidelines of the National Institute for Health and Care Excellence (NICE) advise against its use, but health systems in other countries, including the United States, still offer it to patients. An international team of researchers therefore decided to review existing studies on the subject conducted over the past 50 years to assess how effective and safe viscosupplementation is for pain and function in patients with knee osteoarthritis.
Researchers identified 169 studies involving 21,163 patients with knee osteoarthritis that compared viscosupplementation with placebo treatment or no treatment.. The main analysis of this review, which included a subset of 24 large, methodologically superior studies involving 8,997 randomized patients, found that viscosupplementation was associated with a small reduction in pain compared to placebo, but the difference is was marginal and was described as “clinically irrelevant. “
Studies by the team of scientists found that since 2009 there is conclusive evidence that viscosupplementation and placebo treatment have led to the same clinical outcome in terms of pain reduction, which means that there is no point in giving the injections. The researchers also found from 15 large studies involving 6,462 randomized participants that viscosupplementation was linked to a 49% higher risk of serious adverse events than placebo.
The study authors explained that, based on their analysis of the studies between 2009 and 2021, more than 12,000 patients were likely unnecessarily subjected to these injections in viscosupplementation studies, which raises ethical concerns.
The study has some limitations as it represents summary estimates and does not necessarily rule out the possibility that selected patient populations may benefit from viscosupplementation. In addition, the researchers looked at adverse events that emerged rather than adverse events that were directly and clearly related to treatment. However, strengths include the fact that this is the largest collection of randomized viscosupplementation studies reported to date, which significantly reduces the risk of bias affecting the results.
Therefore, the scholars concluded: “There is strong and conclusive evidence that among patients with knee osteoarthritis, viscosupplementation, compared to placebo, is associated with a clinically insignificant reduction in pain intensity and an increased risk of serious adverse events. The results do not support a wide use of viscosupplementation for the treatment of osteoarthritis of the knee “.
It is important to specify, as the researchers themselves say, that each person is a case in itself and that you must completely rely on the care of your reference specialist, who will know how to best treat osteoarthritis of the knee.
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