Granulomatous synovitis after intraarticular Hylan GF-20. A report of two cases.
Intraarticular hyaluronan injections are used to treat osteoarthritis of the knee. Acute painful swelling with a joint effusion develops locally after the injection in about 10% of cases but resolves spontaneously. Crystals are identifiable in some patients, but the mechanism in crystal-negative cases remains unknown. We report knee arthritis with inflammatory joint fluid free of organisms and crystals in two patients after Hylan GF-20 treatment for femorotibial osteoarthritis. Synovial membrane histology disclosed granulomatous synovitis with epithelioid histiocytic and multinucleate giant cells but no visible foreign bodies. These two cases suggest that crystal-negative arthritis after Hylan GF-20 injection may be ascribable to granulomatous synovitis of the foreign-body giant-cell type.
Rheumatology Department A, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris V University, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
Laëtitia
L
Michou
Chantal
C
Job-Deslandre
Gonzague
G
de Pinieux
André
A
Kahan
D000368:Aged; D005260:Female; D015745:Granuloma, Foreign-Body / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects* / Q000031:analogs & derivatives*; D007270:Injections, Intra-Articular / Q000009:adverse effects; D013585:Synovitis / Q000209:etiology* / Q000473:pathology
C049816:hylan; D006820:Hyaluronic Acid