Authors: Orazio De Lucia, Angela Flavia Luppino, Francesca Pregnolato, Antonella Murgo, Irene Pontikaki, Maurizio Gattinara, Tania Ubiali, Rolando Cimaz & Roberto Caporali
Abstract
Objective
Hip involvement in juvenile idiopathic arthritis (JIA) is one of most important causes of pain and disability. Total hip arthroplasty (THA) is considered the standard when medical approaches fail to relieve pain. However, THA is problematic for many reasons. As current literature lacks studies valuating medical management of osteoarthritis (OA) secondary to JIA, we assessed the long-term pain relief effect of US-guided intra-articular viscosupplementation in hip osteoarthritis secondary to JIA versus primary OA under different etiological conditions.
Methods
Patients in both groups received intra-articular Hylan G-F 20 2 ml once a month for 3 consecutive months and every 6 months for 2 years as maintenance. Effectiveness (VAS and WOMAC), NSAID/analgesic consumption, tolerability, withdrawals and reason for discontinuation were collected at each time point. An inverse probability weighting was used to balance the two groups.
Results
We retrospectively retrieved data of 14 JIA patients and 26 primary OA. Weighting successfully accounted for differences between the disease groups supporting the results. Viscosupplementation led to an early and significant improvement of pain and function and concomitant decrease in NSAIDs consumption, while the response diverged over 1 year with loss of benefits in JIA. The worst outcome was observed in active JIA.
Conclusions
Duration of symptom relief after intra-articular injection of hyaluronic acid depends on the nature of arthritis. Multiple courses of viscosupplementation are required to maintain low-dose NSAIDs consumption in patients responsive to treatment while shortening the time between consecutive injections might provide persistent positive results in patients suffering from JIA.
Key Summary Points |
Why carry out this study?Hip THA in patients affected by JIA may be problematic for many reasons. Therefore, effective medical treatments are required Currently, no studies had evaluated efficacy of medical management of OA secondary to JIA |
What was learned from the study?Duration of symptom relief after intra-articular injection of hyaluronic acid depends on the nature of hip osteoarthritis (OA) Different clinical response depends on the characteristic features of synovial environment in patients suffering from inflammatory rheumatological conditions A different therapeutic schedule for HA intra-articular injections may be necessary in patients affected by JIA |