PMID- 32047830
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231113
IS  - 2325-9671 (Print)
IS  - 2325-9671 (Electronic)
IS  - 2325-9671 (Linking)
VI  - 8
IP  - 1
DP  - 2020 Jan
TI  - Hyaluronic Acid Injections or Oral Nonsteroidal Anti-inflammatory Drugs for Knee 
      Osteoarthritis: Systematic Review and Meta-analysis of Randomized Trials.
PG  - 2325967119897909
LID - 10.1177/2325967119897909 [doi]
LID - 2325967119897909
AB  - BACKGROUND: Intra-articular hyaluronic acid (HA) injections and oral nonsteroidal 
      anti-inflammatory drugs (NSAIDs) are common treatments for symptomatic knee 
      osteoarthritis (OA). However, the comparative effects of these treatments are 
      unclear. PURPOSE: To compare the efficacy and safety of intra-articular HA 
      injections compared with oral NSAIDs for the treatment of knee OA. STUDY DESIGN: 
      Systematic review; Level of evidence, 1. METHODS: We systematically searched 
      Medline, Embase, and the Cochrane Central Register of Controlled Trials for 
      randomized trials of knee OA treatment with HA injections compared with oral 
      NSAIDs. The main outcomes were knee pain, knee function, adverse events (AEs), 
      serious AEs, study withdrawals, and study withdrawals because of AEs. Pooled 
      effect sizes were reported at the final follow-up with standardized mean 
      difference (SMD) for efficacy outcomes and risk ratio (RR) for safety outcomes. 
      RESULTS: In 6 randomized trials of 831 patients (414 HA, 417 NSAIDs), with 
      follow-up ranging from 5 to 26 weeks, HA injections were associated with small, 
      statistically significant improvements in knee pain (SMD, 0.15; P = .04) and knee 
      function (SMD, 0.23; P = .01) compared with oral NSAIDs. The risk of AEs was 
      lower with HA compared with NSAIDs (19.8% vs 29.0%; RR, 0.74; P = .01). The risk 
      of a serious AE (RR, 1.37; P = .71), study withdrawal (RR, 1.05; P = .68), or 
      study withdrawal because of an AE (RR, 0.65; P = .22) was comparable between 
      groups. Gastrointestinal concerns were the most frequent AE reported, occurring 
      more often with NSAIDs (23.4% vs 14.1%; P = .001). AEs reported more frequently 
      with HA injections were injection site pain (11.7% vs 4.7%; P < .001), headache 
      (8.4% vs 4.4%; P = .03), and arthralgia (8.1% vs 2.9%; P = .001). Significant 
      heterogeneity or publication bias was not observed for any outcome. CONCLUSION: 
      Comparing short-term outcomes of HA injections with oral NSAIDs for treatment of 
      knee OA, HA injections provided statistically significant but not clinically 
      important improvements in knee pain and function, along with a lower overall risk 
      of AEs.
CI  - (c) The Author(s) 2020.
FAU - Miller, Larry E
AU  - Miller LE
AD  - Miller Scientific Consulting, Inc, Asheville, North Carolina, USA.
FAU - Fredericson, Michael
AU  - Fredericson M
AD  - Department of Orthopaedic Surgery, Division of Physical Medicine and 
      Rehabilitation, Stanford University Medical School, Stanford, California, USA.
FAU - Altman, Roy D
AU  - Altman RD
AD  - Division of Rheumatology and Immunology, David Geffen School of Medicine, 
      University of California, Los Angeles, Los Angeles, California, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200127
PL  - United States
TA  - Orthop J Sports Med
JT  - Orthopaedic journal of sports medicine
JID - 101620522
PMC - PMC6985976
OTO - NOTNLM
OT  - knee function
OT  - knee pain
OT  - nonsteroidal anti-inflammatory drug
OT  - safety
OT  - viscosupplementation
COIS- One or more of the authors has declared the following potential conflict of 
      interest or source of funding: L.E.M. has consulting affiliations with DePuy 
      Synthes and OsteoArthritis Centers of America. M.F. has received honoraria from 
      Fidia Pharma and hospitality payments from DePuy and Ipsen Innovation. R.D.A. has 
      received speaking fees from Genzyme and Iroko Pharmaceuticals; hospitality 
      payments from Bioventus; honoraria from Teva Pharmaceuticals; and consulting fees 
      from Meda Pharmaceuticals, Insys Therapeutics, Ferring Pharmaceuticals, Pfizer, 
      Genzyme, Iroko Pharmaceuticals, Novartis, Merck Sharp & Dohme, and 
      Sanofi-Aventis. He also reports affiliations with GlaxoSmithKline, Sorrento, and 
      Theralogix. AOSSM checks author disclosures against the Open Payments Database 
      (OPD). AOSSM has not conducted an independent investigation on the OPD and 
      disclaims any liability or responsibility relating thereto.
EDAT- 2020/02/13 06:00
MHDA- 2020/02/13 06:01
PMCR- 2020/01/27
CRDT- 2020/02/13 06:00
PHST- 2019/09/25 00:00 [received]
PHST- 2019/10/10 00:00 [accepted]
PHST- 2020/02/13 06:00 [entrez]
PHST- 2020/02/13 06:00 [pubmed]
PHST- 2020/02/13 06:01 [medline]
PHST- 2020/01/27 00:00 [pmc-release]
AID - 10.1177_2325967119897909 [pii]
AID - 10.1177/2325967119897909 [doi]
PST - epublish
SO  - Orthop J Sports Med. 2020 Jan 27;8(1):2325967119897909. doi: 
      10.1177/2325967119897909. eCollection 2020 Jan.