The use of intra-articular viscosupplementation in osteoarthritis has been compared to using homeopathy treatments in a provocative session at this year’s EULAR congress.
In a talk addressing the efficacy of hyaluronic acid in osteoarthritis Professor Peter Jüni from Canada told the audience the latest data still showed a lack of efficacy.
Professor Jüni, a general internist, is the lead author of a meta-analysis published in the Annals of Internal Medicine in 2012 that found the injections had little effect on pain and no effect on function in people with osteoarthritis.
At the time the authors saw some association with adverse events, a signal that he told delegates was still there.
“There is some assay sensitivity…If you look at adverse events you see a signal against hyaluronic acid… so there is something happening in the trials – just not with efficacy,” he said.
Dr Jüni said the funnel plot seen in the meta-analysis on viscosupplementation reminded him of one of the first studies he published on homeopathy.
“Basically what you see is small study effects with hyaluronic acid… as dominant as what we see for small study effects in homeopathy,” he said.
“Perhaps we are a bit too mechanistic and we’re falling short a bit of understanding the complexity of what goes on in the joint,” he said.
“Injecting a single agent without figuring out what is actually happening in the joint, and also ignoring the single agent is being cleared within hours or perhaps days, is perhaps too naïve an option,” he added.
“From my point of view, it is probably not surprising that we do not find an overall effect”.
“The bottom line, from an efficacy point of view, is there isn’t much there…from a safety point of view its may not be better than nothing.”
Meanwhile, a study presented in the same session by Dr Florent Eymard, a rheumatologist from AP-HP Henri Mondor Hospital in Creteil in France found that higher BMI and radiologic severity were associated with a lack of response to viscosupplementation in patients with knee OA.