What is the current evidence on the use of Hyaluronic acid (HA) in medical treatments?

From the Guidelines

Hyaluronic acid injections are not recommended for routine use in the treatment of symptomatic osteoarthritis of the knee, according to the most recent and highest quality evidence. This recommendation is based on the latest guidelines from the American Academy of Orthopaedic Surgeons, which state 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 1.

Key Points to Consider

• The 2022 AAOS clinical practice guideline summary advises against the routine use of hyaluronic acid injections for knee osteoarthritis, citing a moderate strength of recommendation 1.
• The 2020 American College of Rheumatology guideline conditionally recommends against the use of intraarticular hyaluronic acid injections in patients with knee and/or first CMC joint OA, and strongly recommends against their use in patients with hip OA, due to limited evidence of benefit and potential harm 1.
• The decision to use hyaluronic acid injections should be made on a case-by-case basis, taking into account patient preferences and the potential benefits and risks of treatment.

Clinical Implications

• Practitioners should be cautious when considering hyaluronic acid injections for osteoarthritis treatment, given the lack of strong evidence supporting their effectiveness.
• Alternative treatments, such as nonpharmacologic therapies, topical and oral NSAIDs, and intraarticular steroids, should be considered before hyaluronic acid injections.
• Patient education and shared decision-making are crucial in determining the best course of treatment for individual patients.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Hyaluronic Acid Uses and Effects

• Intraarticular injections of hyaluronic acid have been used to treat symptomatic knee osteoarthritis, with approximately 2/3 of treated knees receiving 2/3 relief of pain 2.
• However, the treatment is not without complications, and it is recommended only for patients with symptoms and significant surgical risk factors, or for patients with mild radiographic disease in whom conservative treatment has failed 2.
• Oral formulations of hyaluronic acid may expose patients to a greater risk, particularly those with a history of cancer, as it can interact with specific receptors and promote cell proliferation 3.

Comparative Effectiveness of Hyaluronic Acid

• The effectiveness of intra-articular hyaluronic acid injections for knee osteoarthritis management has been evaluated, with results showing no significant difference in the risk of surgical interventions among hyaluronic acid users compared to corticosteroid users and nonusers 4.
• However, a sensitivity analysis showed a lower risk of surgery among hyaluronic acid users compared to nonusers 4.

Medical Applications of Hyaluronic Acid

• Hyaluronic acid has several medical applications, including viscosurgery for eye operations, intra-articular injections for osteoarthritis, and wrinkle filling on the face 5.
• Its concentration in tissues decreases with age, leading to a loss of function and structure of tissues 5.

Combined Treatment with Corticosteroid and Hyaluronic Acid

• Combined intra-articular injection of corticosteroid and hyaluronic acid has been shown to reduce pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis 6.
• The combination of corticosteroid and hyaluronic acid led to reductions in pain at 2-4,24-26, and 52 weeks compared to hyaluronic acid injections alone 6.