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March 24/31, 2004

Intra-articular Hyaluronic Acid for Treatment of Osteoarthritis of the Knee

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(12):1440. doi:10.1001/jama.291.12.1440-a

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