Hip viscosupplementation under ultra-sound guidance riduces NSAID consumption in symptomatic hip osteoarthritis patients in a long follow-up. Data from italian registry

A. Migliore 1,17, M. Granata 2, S. Tormenta 2, B. Laganà 3, P. Piscitelli 4, E. Bizzi 1, U. Massafra 1, A. Alimonti 1, C. Maggi 6, R. De Chiara 7, F. Iannessi 2, A. Sanfilippo 8, R. Sotera 9, P. Scapato 10, S. Carducci 11, P. Persod 12, S. Denaro 13, M. Camminiti 14, M.G. Pagano 14, G. Bagnato 15, G. Iolascon 16

1 Operative Unit of Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome (Italy)  2 Operative Unit of Rheumatology, ACO, S. Filippo Neri Hospital, Rome (Italy)  3 Department of Radiology, S. Pietro Fatebenefratelli Hospital, Rome (Italy)  4 Division of Medical Sciences, 2nd Medical School, S. Andrea Hospital, Sapienza University, Rome (Italy)  5 ISBEM Institute of Research, Pescara (Italy)  6 Division of Orthopaedics and Traumatology, Stradella Hospital, Pavia (Italy)  7 Orthopaedic Clinic, University of Reggio Calabria, Reggio Calabria (Italy)  8 Orthopaedic and Traumatology Clinic, Palermo University, Palermo (Italy)  9 Department of Radiology, Palermo University, Palermo (Italy) 10 Department of Internal Medicine, Second Division, General Hospital, Rieti (Italy) 11 Operative Unit of Radiology, General Hospital, Rieti (Italy) 12 Kinesis Center, Cagliari (Italy) 13 Operative Unit of Rehabilitation, Siracusa Hospital, Siracusa (Italy) 14 Operative Unit of Rheumatology and Osteoporosis, Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria (Italy) 15 Operative Unit of Rheumatology, Policlinico G. Martino, University of Messina (Italy) 16 Department of Orthopedics and Traumatology, 2nd University of Naples, Naples (Italy) 17 “Research Center”, S. Pietro Fatebenefratelli Hospital, Rome (Italy)

---

• Rheumatology

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) consumption is strictly related to a high gastrointestinal and cardiovascular mortality and morbidity rate. Osteoarthritis Research Society International (OARSI) recommendations in patients with symptomatic hip or knee OA stated that NSAIDs should be used at the lowest effective dose but their long-term use should be avoided if possible. OARSI guidelines for the treatment of the hip OA include the use of viscosupplementation, which aims to restore physiological and rheological features of the synovial fluid.

Objective: Aim of this multicentric, open and retrospective study is to investigate if NSAID consumption may be reduced by the use of ultrasound-guided intra-articular injection of several hyaluronic acid (HA) products in hip joint administered in patients affected by symptomatic hip OA.

Materials and Methods: Patients affected by mono or bilateral symptomatic hip OA according to American Rheumatology Association (ARA) criteria, radiological OA graded II-IV (Kellgren and Lawrence) entered the study and were administered with ultrasound-guided intra-articular injection of hyaluronic acid products. As a primary endpoint, consumption of NSAIDs was evaluated by recording the number of days a month (range 0-30) the patient had used NSAID during the previous month, reported at each visit during the 24 months follow-up period. Secondary endpoints included further analysis for subgroups of patients categorized for Lequesne index score, Kellgren-Lawrence score, pain visual analogue scale (VAS) score, ultrasound pattern, age, hyaluronic acid used.

Results: 2343 patients entered the study. Regarding primary endpoint, the consumption of NSAIDs was reduced of 48.2% at the third month when compared with baseline values. This sparing effect increased at 12th and 24th month with a reduction respectively of 50% and 61% in comparison to baseline values. These differences were statistically significant.

Conclusions: These data point out that intra-articular hyaluronan preparations provide OA pain relief and reduce NSAIDs consumption in a large cohort of patients for a long period of follow-up. Multiple courses of viscosupplementation (vs) are required to maintain low dose of NSAID consumption over time. NSAIDs consumption is strictly related to an high gastrointestinal and cardiovascular mortality and morbidity rate, instead HA intra-articular treatment is well tolerated and is associated with a low incidence of adverse effects. For these reasons further studies evaluating cost-effectiveness and cost-utility of VS in the management of hip OA are required.

Corresponding Author: Emanuele Bizzi, MD; e-mail: ebizzi@email.it

Free PDF Download