title: Short-term effect of ultrasound-guided low-molecular-weight hyaluronic acid injection on clinical outcomes and imaging changes in patients with rheumatoid arthritis of the ankle and foot joints. A randomized controlled pilot trial.
abstract: To determine whether hyaluronic acid (HA) injection into rheumatoid arthritis ankles and feet can achieve improvement in foot function and reduce synovial hyper-vascularization. Forty-four patients with RA having unilateral or bilateral painful ankle and foot involvement (N = 75) were studied. All the patients were randomized to receive HA (N = 40) or lidocaine (LI) (N = 35) injection at 2-week intervals; Clinical assessments were performed using a visual analog scale (VAS) and foot function index (FFItotal) including subscales of pain (FFIpain)before injection at baseline, 4 weeks (first evaluation) and 12 weeks (secondary evaluation). Imaging evaluation based on color Doppler ultrasound (CDUS) and synovitis scores was performed simultaneously. HA injection improved the VAS score (p = .009), FFIpain(p = .041), and FFItotal(p = .032) considerably more than LI injections did at the first evaluation. The CDUS values at first evaluation (p = .005) and secondary evaluation (p < .001) decreased significantly compared with the base line values. HA injections reduced the CDUS values of more than half of the joints (54%, p = .042) while the control group exhibited no change (20%, p = .56). However, HA injection did not reduce the CDUS values more than LI injection did. Regarding the evaluation of synovial hypertrophy, no significant difference was observed between or within the groups in the synovitis scores. HA injection improved short-term foot function and pain reduction. HA injection may have a modest effect in reducing synovial hyper-vascularization. Further large-scale study is warranted to confirm this result.
authors.affiliation: a Department of Physical Medicine and Rehabilitation , Taipei Veterans General Hospital Yuli Branch , Hualien , Taiwan.|b Institute of Clinical Medicine , National Yang-Ming University , Taipei , Taiwan.
authors.forename: Chien-Chih
authors.initials: CC
authors.lastname: Wang
authors.affiliation: c Department of Physical Medicine and Rehabilitation , Taipei Veterans General Hospital , Taipei , Taiwan.|d School of Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Si-Huei
authors.initials: SH
authors.lastname: Lee
authors.affiliation: d School of Medicine, National Yang-Ming University , Taipei , Taiwan.|e Department of Allergy , Immunology and Rheumatology, Taipei Veterans General Hospital , Taipei , Taiwan.
authors.forename: Hsiao-Yi
authors.initials: HY
authors.lastname: Lin
authors.affiliation: f Department of Physical Medicine and Rehabilitation , Taichung Veteran General Hospital Puli Branch , Nantou , Taiwan.
authors.forename: Fu-Wei
authors.initials: FW
authors.lastname: Liu
authors.affiliation: d School of Medicine, National Yang-Ming University , Taipei , Taiwan.|g Department of Radiology , Taipei Veterans General Hospital , Taipei , Taiwan.
authors.forename: Hong-Jen
authors.initials: HJ
authors.lastname: Chiou
authors.affiliation: c Department of Physical Medicine and Rehabilitation , Taipei Veterans General Hospital , Taipei , Taiwan.|d School of Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Rai-Chi
authors.initials: RC
authors.lastname: Chan
authors.affiliation: c Department of Physical Medicine and Rehabilitation , Taipei Veterans General Hospital , Taipei , Taiwan.|d School of Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Chen-Liang
authors.initials: CL
authors.lastname: Chou
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000473:pathology; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007270:Injections, Intra-Articular / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014463:Ultrasonography
chemical_list: D018501:Antirheumatic Agents; D006820:Hyaluronic Acid
keywords: Hyaluronic acid; ankle; foot; rheumatoid arthritis; synovitis; ultrasound