Systematic Literature Review and Expert Opinion for the Use of Viscosupplementation with Hyaluronic Acid in Different Localizations of Osteoarthritis

Abstract

Alberto Migliore,1 Gianfranco Gigliucci,1 Lyudmila Alekseeva,2 Raveendhara R Bannuru,3 Tomasz Blicharski,4 Demirhan Diracoglu,5 Athanasios Georgiadis,6 Hesham Hamoud,7 Natalia Martusevich,8 Marco Matucci Cerinic,9 Jan Perduk,10 Imre Szerb,11 Tomáš Trč,12 Xavier Chevalier13 1Rheumatology Unit - San Pietro Fatebenefratelli Hospital, Rome, Italy; 2Department of Metabolic Diseases of Bone and Joints, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation; 3Center for Treatment Comparison and Integrative Analysis (CTCIA) at Tufts Medical Center, Boston, MA, USA; 4Lubelskie Centrum Diagnostyczne, Świdnik, Poland; 5Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey; 6Department of Rheumatology, University of Ioannina, Ioannina, Greece; 7Department of Rheumatology Al Azhar University, Cairo, Egypt; 8Department of Rheumatology, Belarusian State Medical University, Minsk, Belarus; 9Division of Rheumatology, University of Florence, Florence, Italy; 10Department of Musculoskeletal Medicine and Sports, Hospital Košice -Šaca, Kosice Saca, Slovakia; 11Semmelweis University, Department of Traumatology Uzsoki Hospital, Department of Orthopaedics&Traumatology FIFA Medical Centre of Excellence Uzsoki u.29– 41, Budapest, Hungary; 12Department of Orthopaedic Surgery, Charles University and Motol University Hospital, Prague, Czech Republic; 13Rheumatology Division, Henri-Mondor Hospital, Créteil, FranceCorrespondence: Alberto MiglioreRheumatology Unit - San Pietro Fatebenefratelli Hospital, Rome, ItalyEmail [email protected]: Osteoarthritis (OA) is a significant cause of disability. Considering the increasing diffusion of the viscosupplementation (VS) with hyaluronic acid (HA), the International Symposium Intra Articular Treatment (ISIAT) appointed a Technical Expert Panel (TEP) to identify the criteria for successful VS with a specific HA in OA; this through a systematic literature review (SLR), performed following the PRISMA guidelines interrogating Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Grey Matters and American College of Rheumatology (ACR/EULAR) databases and the opinion of international experts. The research included only studies on adults and humans without limitations of language or time of publication. Researchers extracted both quantitative and qualitative data from each study. Mixed Methods Appraisal Tool (MMAT) was used to perform quality analysis for the level of evidence. The SLR retrieved 385 papers, 25 of which were suitable for the analysis. The TEP focused on the different formulations of the product Sinovial® [HA 0.8%, HA 1.6%, HA 2%, 800– 1200 kDa, HA 3.2% (1400– 2100 kDa/65– 110 kDa)]. The choice was due to the vast amount of evidence available. The TEP weighed the evidence in two rounds of a Delphi survey; the results, and any disagreement, were discussed in a final session. Three domains were considered: 1) the patients’ characteristics associated with the best results; 2) the contraindications and the conditions linked to increased risk of failure; 3) the clinical conditions in which VS is considered appropriate. The TEP concluded that VS with HA is safe and effective in the treatment of knee and hip OA of grades I to III and that it is possible to undertake VS in other situations (eg grade IV Kellgren-Lawrence – KL); a comprehensive examination of the patient should be performed before the procedure.Keywords: appropriateness, osteoarthritis, personalized medicine, viscosupplementation

Keywords

• appropriateness
• osteoarthritis
• personalized medicine
• viscosupplementation