title: Viscosupplementation for osteoarthritis: a primer for primary care physicians.
abstract: BACKGROUND
  Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and conservative pharmacologic therapies are recommended for the initial treatment of OA, including acetaminophen, and topical and oral non-steroidal anti-inflammatory drugs. However, safety concerns continue to mount regarding the use of these treatments and none have been shown to impact disease progression. Viscosupplementation with injections of hyaluronans (HAs) are indicated when non-pharmacologic and simple analgesics have failed to relieve symptoms (e.g., pain, stiffness) associated with knee OA. This review evaluates literature focusing on the efficacy and/or safety of HA injections in treating OA of the knee and in other joints, including the hip, shoulder, and ankle.
  
  
  METHODS
  Relevant literature on intra-articular (IA) HA injections as a treatment for OA pain in the knee and other joints was identified through PubMed database searches from inception until January 2013. Search terms included "hyaluronic acid" or "hylan", and "osteoarthritis".
  
  
  CONCLUSIONS
  Current evidence indicates that HA injections are beneficial and safe for patients with OA of the knee. IA injections of HAs treat the symptoms of knee OA and may also have disease-modifying properties, potentially delaying progression of OA. Although traditionally reserved for second-line treatment, evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA.
  
  
  CONCLUSIONS
  For primary care physicians who treat and care for patients with OA of the knee, IA injection with HAs constitutes a safe and effective treatment that can be routinely administered in the office setting.
authors.affiliation: Weill Cornell Medical College, 1484-1486 1st Avenue, New York, NY, 10075, USA, mcr2004@med.cornell.edu.
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000188:drug therapy* / Q000503:physiopathology; D020370:Osteoarthritis, Knee / Q000188:drug therapy* / Q000503:physiopathology; D010147:Pain Measurement; D061214:Patient Safety; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000187:drug effects / Q000503:physiopathology; D013704:Temporomandibular Joint / Q000187:drug effects / Q000503:physiopathology; D016896:Treatment Outcome; D055676:Viscosupplementation / Q000379:methods*
chemical_list: D006820:Hyaluronic Acid