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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-b

To the Editor: In their meta-analysis, Dr Lo and colleagues1 concluded that intra-articular hyaluronic acid has a small beneficial effect compared with saline and suggested that publication bias had overestimated the therapeutic effect. We have several concerns about their methods.

First, the authors examined only 22 published studies, including some with products not approved for use in the United States, and did not account for excluded data. Sodium hyaluronate, however, has been evaluated in more than 60 trials, 55 of which have been published. These trials have involved more than 5000 patients. Many of these were randomized, saline-controlled trials that demonstrated a significant benefit for sodium hyaluronate.2