From the Guidelines
Hyaluronic acid is not recommended for routine use in the treatment of symptomatic osteoarthritis of the knee due to limited evidence of its effectiveness. The most recent and highest quality study, published in 2022 by the American Academy of Orthopaedic Surgeons 1, found that hyaluronic acid intra-articular injection(s) is not recommended for routine use in the treatment of symptomatic osteoarthritis of the knee, with a moderate strength of recommendation. This is consistent with the findings of the 2020 American College of Rheumatology guideline, which conditionally recommended against the use of intraarticular hyaluronic acid injections in patients with knee and/or first CMC joint OA and strongly recommended against their use in patients with hip OA 1.
Key Points to Consider
- The effectiveness of hyaluronic acid for joint health is limited, and its use should be considered on a case-by-case basis, taking into account the individual patient's preferences and the potential risks and benefits.
- The 2021 US Department of Veterans Affairs/US Department of Defense clinical practice guideline found that hyaluronic acid injections may improve pain and function in patients with knee OA, but the evidence is not strong enough to support their routine use 1.
- When considering the use of hyaluronic acid, it is essential to weigh the potential benefits against the potential risks and to discuss the limitations of the evidence with the patient.
Clinical Implications
- Hyaluronic acid should not be used as a first-line treatment for osteoarthritis, but rather considered as an option for patients who have not responded to other treatments.
- Patients should be informed of the limited evidence supporting the use of hyaluronic acid and the potential risks associated with its use.
- Healthcare providers should carefully evaluate the individual patient's needs and preferences when considering the use of hyaluronic acid.
From the Research
Effectiveness of Hyaluronic Acid
- Hyaluronic acid (HA) has been found to be effective in various medical applications, including osteoarthritic chronic diseases, ophthalmology, and aesthetic dermatology 2.
- HA provides long-lasting, pain relieving, moisturizing, lubricating, and dermal filling effects, and improves tissue hydration, elasticity, and durability 2.
- In the treatment of inflammatory skin and joint diseases, HA-based formulations have shown remarkable efficacy, with improvements in joint pain, synovial inflammation, and articular swelling 3.
- HA has also been found to be effective in the treatment of dry eye syndrome, with improvements in corneal staining score, tear break-up time, and ocular surface disease index score 4, 5.
Medical Applications of Hyaluronic Acid
- HA has been used in ophthalmology for its lubricating properties, in rheumatology for its anti-inflammatory properties, and in dermatology for its moisturizing and revitalizing effects 6.
- HA has been found to be effective in the treatment of osteoarthritis, with improvements in joint pain and function 2, 3.
- HA has also been used in the treatment of dry eye disease, with improvements in tear production and ocular surface health 4, 5.
Comparison with Other Treatments
- HA has been found to be equivalently effective to cyclosporine A in the treatment of dry eye syndrome, with better tolerability and lower prevalence of adverse drug reactions 4.
- HA eye drops have been found to be superior to non-HA eye drops, including saline and artificial tears, in the treatment of dry eye syndrome 5.