title: AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis: importance for individual patient outcomes.
abstract: Osteoarthritis (OA) is a disabling disease that produces severe morbidity reducing physical activity. Our position statement on treatment of knee OA with viscosupplementation injection (hyaluronic acid, HA) versus steroid (intra-articular corticosteroids, IAS) and placebo (intra-articular placebo, IAP) is based on the evaluation of treatment effect by examining the number of participants within a treatment arm who met the Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) criteria, which is different and more relevant than methods used in other reviews which examined if the average change across the treatment groups were clinically different. We performed a systematic literature search for all relevant articles from 1960 to August 2014 in the MEDLINE, EMBASE and Cochrane CENTRAL. We performed a network meta-analysis (NMA) of the relevant literature to determine if there is a benefit from HA as compared with IAS and IAP. 11 papers met the inclusion criteria from the search strategy. On NMA, those participants receiving HA were 15% and 11% more likely to respond to treatment by OMERACT-OARSI criteria than those receiving IAS or IAP, respectively (p<0.05 for both). In the light of the aforementioned results of our NMA, the American Medical Society for Sport Medicine recommends the use of HA for the appropriate patients with knee OA.
authors.affiliation: Community and Preventive Medicine, Lead Physician Drexel Athletics, Philadelphia, Pennsylvania, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Trojian
authors.affiliation: Department of Orthopedics and Sports Medicine, St Jude Medical Center, Fullerton, California, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Concoff
authors.affiliation: Department of Orthopaedic Surgery, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Joy
authors.affiliation: Maine Medical Center Sports Medicine, Portland, Maine, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Hatzenbuehler
authors.affiliation: UCONN School of Pharmacy, Hartford Hospital Evidence-Based Practice Center, Portland, Maine, USA.
authors.forename: Whitney J
authors.initials: WJ
authors.lastname: Saulsberry
authors.affiliation: Hartford Hospital Evidence-Based Practice Center, Portland, Maine, USA.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D055676:Viscosupplementation / Q000379:methods; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid