Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Lo and colleagues1 concluded that intra-articular hyaluronan injections
have little benefit for osteoarthritis (OA) of the knee and that the effect
is similar in magnitude to the superiority of nonsteroidal anti-inflammatory
drugs (NSAIDs) over acetaminophen. It is important to recognize that the reported
effect size is small because it is measured over a control that cannot be
considered a simple placebo. Arthrocentesis has been reported to provide symptomatic
relief in patients with a significant effusion.2 Effectiveness
trials are more clinically relevant than efficacy trials, for the former are
more directly related to outcomes of actual practice. In contrast, however,
most trials of intra-articular hyaluronan have been efficacy trials, which
were required for regulatory approval. Thus, it is important to point out
that 2 recent effectiveness trials have found intra-articular hyaluronan injection
to be both clinically beneficial and cost effective.3-5
Band PA. Intra-articular Hyaluronic Acid for Treatment of Osteoarthritis of the Knee. JAMA. 2004;291(12):1440. doi:10.1001/jama.291.12.1440-a
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