Clinical Evidence

The use of IA-HA is now recommended in the guidelines for treating knee OA published by the American College of Rheumatology (24) and the European Union of Leagues Against Rheumatic Disease (25). The most comprehensive systematic review of randomized clinical trials (RCTs) evaluating IA-HA for the treatment of knee OA was recently published in the Cochrane Library of evidence-based medicine (26). The Cochrane review identified 63 RCTs of IA-HA, of which 37 compared IA-HA to intra-articular saline or another control (placebo) intra-articular procedure. The review concluded that the benefit of IA-HA was statistically significant and clinically important. Several other systematic reviews of IA-HA published in medical journals drew similar conclusions (27,28); though in one, the clinical importance of the benefit was considered no better than the clinical benefit of nonsteroidal anti-inflammatory drugs (NSAIDs) over acetaminophen (28). Several randomized pragmatic trials have evaluated the incremental clinical benefit of adding IA-HA into the treatment paradigm for knee OA and its cost-effectiveness (29-31), reporting that the availability of IA-HA provides clinically important benefits and good health economic value. IA-HA treatment is reimbursed as part of standard health insurance in many countries, including the United States (32-34).

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