From the Guidelines
Rheumatoid arthritis patients can benefit from viscosupplementation (viscoreplacement) for the knee, though results may be less predictable than in osteoarthritis patients. Viscosupplementation involves injecting hyaluronic acid products like Synvisc, Euflexxa, or Orthovisc into the knee joint to improve lubrication and reduce pain. Typical regimens include 3-5 weekly injections, with effects potentially lasting 6 months. Before treatment, the physician should aspirate any joint effusion, and use proper sterile technique. Patients should avoid strenuous activity for 48 hours after injection. While viscosupplementation works by supplementing synovial fluid and potentially reducing inflammation, its effectiveness in rheumatoid arthritis is more variable because the underlying disease process differs from osteoarthritis. The inflammatory nature of rheumatoid arthritis may limit the durability of benefits. These injections should be considered as part of a comprehensive treatment plan that includes disease-modifying antirheumatic drugs (DMARDs) to address the underlying autoimmune condition, not as a standalone treatment for rheumatoid arthritis.
Key Considerations
- The use of viscosupplementation in rheumatoid arthritis is supported by some evidence, although it is not as strong as for osteoarthritis 1.
- The treatment should be individualized, taking into account the patient's disease activity, joint damage, and previous response to treatment.
- The European League Against Rheumatism (EULAR) recommends a comprehensive treatment approach, including DMARDs, for the management of rheumatoid arthritis 1.
- Viscosupplementation can be considered as an adjunctive treatment to help manage knee pain and improve function in patients with rheumatoid arthritis.
Treatment Approach
- Viscosupplementation should be used in conjunction with DMARDs and other treatments to address the underlying autoimmune condition.
- Patients should be closely monitored for response to treatment and potential side effects.
- The treatment plan should be adjusted as needed to optimize outcomes and minimize morbidity and mortality.
From the Research
Viscosupplementation for Rheumatoid Arthritis of the Knee
- Viscosupplementation, which involves the injection of hyaluronic acid (HA) into the affected joint, has been studied as a potential treatment for osteoarthritis (OA) of the knee 2, 3, 4.
- While the majority of research has focused on OA, some studies have explored the use of viscosupplementation in rheumatoid arthritis (RA) 5, 6.
- A study published in 2009 found that intra-articular injections of hyaluronate (HA) had similar efficacy rates to corticosteroid injections in patients with RA, with a patient-perceived satisfactory rate of 59.3% for HA injections 5.
- Another study published in 2023 discussed the potential therapeutic applications of HA in rheumatology, including its use in joint lubrication, cartilage maintenance, and modulation of inflammatory and/or immune responses 6.
- However, the use of HA therapy in rheumatology remains controversial, with conflicting evidence regarding its efficacy and safety 6.
Potential Benefits for Rheumatoid Arthritis Patients
- Viscosupplementation may offer several benefits for patients with RA, including:
- Reduced pain and inflammation
- Improved joint function and mobility
- Delayed progression of joint damage
- Potential reduction in the need for other medications, such as NSAIDs or corticosteroids
- However, more research is needed to fully understand the effects of viscosupplementation in RA patients and to determine its potential as a treatment option 5, 6.
Comparison to Other Treatments
- Viscosupplementation has been compared to other treatments for OA and RA, including: