A summary of the current conflicting literature on the use of intraarticular hyaluronate in OA suggests at best a small treatment benefit which is quickly outweighed by the cost and adverse events, writes David Hunter in a case study education piece in the NEJM.

Despite insufficient evidence of its efficacy it was a treatment that was still used regularly by orthopedists, rheumatologists and other healthcare professionals.

“At present the management of osteoarthritis is best characterized as palliative, with numerous missed opportunities for more beneficial intervention and typical clinical practice that does not reflect guidelines recommendations,” he wrote.

“The treatment of osteoarthritis is not unique in this regard,” he said.

At this point in time there was also no sufficient evidence to indicate that younger patients with less severe disease, or other patient subgroups had a more favourable outcome with the treatment, he added.