Can hybrid hyaluronic acid represent a valid approach to treat rizoarthrosis? A retrospective comparative study

Abstract

Background: Osteoarthritis (OA) of the trapeziometacarpal joint (TMJ) is a disabling condition with a significant impact on quality of life. The optimal management of hand OA requires a combination of non-pharmacological and pharmacological treatments that include intra-articular (i.a.) therapy. EULAR experts recommend corticosteroid injections in TMJ OA and underline the usefulness of hyaluronic acid (HA). The aim of this study was the assessment of the efficacy and tolerability of i.a. injections of a hybrid formulation of HA (Sinovial H-L®) in comparison to triamcinolone in patients with TMJ OA.

Methods: This 6-months observational comparative study, retrospective analyzed the medical records of 100 patients with monolateral or bilateral TMJ OA, treated with two injections of Sinovial H-L® (Sinovial H-L Group) or of triamcinolone acetonide (Triamcinolone Group). Clinical assessments were recorded at the time of the first and second injection and after one, 3 and 6 months. The primary outcomes were the change in global pain on a Visual Analogue Scale (VAS) and in hand function evaluated by the Functional Index for Hand OA (FIHOA) from baseline to month 6. Secondary outcomes were the improvement of the duration of morning stiffness, Health Assessment Questionnaire (HAQ) and the Medical Outcomes Study 36-Item Short Form (SF-36). The comparison between the two groups of treatment were performed with the Wilcoxon rank-sum test for continuous variables and with chi-square or Fisher exact test for categorical variables. Statistical significance was set at p < 0.05.

Results: Both therapies provided effective pain relief and joint function improvement, but the benefits achieved were statistically significantly superior in the Sinovial H-L Group than the Triamcinolone Group after one month (p < 0.01) from the beginning of the therapy and during the 6-months follow-up (p < 0.001). Furthermore, Sinovial H-L® was associated with a significant decrease in the duration of morning stiffness and with a significant improvement in the HAQ score and physical component summary (PCS)-SF-36.

Conclusions: Our results suggested that the hybrid formulation of HA may be more effective than triamcinolone in pain relief and joint function improvement with a rapid and persistent effect, resulting a valid alternative to steroid in the management of TMJ OA.

Trial registration: ClinicalTrials.gov, date of registration: June 14, 2017, NCT03200886 . The present trial was retrospectively registered.

Keywords: Hybrid hyaluronic acid; Intra-articular therapy; Retrospective comparative study; Trapeziometacarpal joint.

Fig. 1

Flow diagram of the study population. OA: Osteoarthritis; TMJ: trapeziometacarpal joint; i.a.: intra-articular; HA: Hyaluronic acid

Fig. 2

a, b Changes from baseline at each evaluation time point for the patient’s assessment of global hand pain by Visual Analogue Score (VAS, 0–100 mm) (a) and Functional Index for Hand Osteoarthritis (FIHOA) score (b) in the study groups. The arrows indicate the i.a. injections **p < 0.01; ***p < 0.001 (Wilcoxon rank-sum test) Sinovial H-L Group vs Triamcinolone Group

Fig. 3

Change from baseline at each evaluation time point for the Health Assessment Questionnaire (HAQ) score in the study groups. The arrows indicate the i.a. injections. ***p < 0.001 (Wilcoxon rank-sum test) Sinovial H-L Group vs Triamcinolone Group