Background/Purpose:   Viscosupplementation (VS) is still controversial. One of the key points is the lack of well-identified factors of response. We aimed to identify clinical and radiologic factors associated with lack of a relevant response according to OMERACT-OARSI criteria after intra-articular (IA) hyaluronic acid (HA) injections in symptomatic knee OA patients.

Methods: We included the 166 patients with available data from the intent-to-treat population (n=205) of the HAV-2012 trial, a controlled, multicentre, double-blind, randomised, non-inferiority trial comparing 2 HA products for symptomatic tibiofemoral OA. At inclusion, demographic, anthropometric, clinical data (patient global assessment, WOMAC, knee effusion) and radiologic data (OARSI grade, patellofemoral OA) were recorded. Patients received 3 weekly IA injections of HA. At 6-month follow-up, VS response was defined according to OMERACT-OARSI criteria.

Results: Clinical characteristics at baseline and VS effectiveness were similar between the 2 HA groups, so their data were pooled. The mean age was 65.2 [63.7-66.8] years; 101 (60.8%) were women; 73 (44.0%) had severe tibiofemoral space narrowing. At baseline, mean WOMAC pain and function scores were 9.8 [9.3–10.3] and 27.5 [25.7–29.4], respectively. At 6 months, 113 patients (68.1%) were considered responders. Multivariate analysis showed that obesity and radiologic severity (OARSI grade 3 vs 1-2) were significantly associated with VS failure (p=0.0001 and p=0.011, respectively). Initial pain intensity and functional severity were not associated with VS response.

Conclusion: IA injection of HA for knee OA should mainly be considered in subjects with low BMI and mild tibiofemoral space narrowing.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/obesity-and-severity-of-joint-space-narrowing-are-associated-with-viscosupplementation-failure-in-patients-with-knee-osteoarthritis-post-hoc-analysis-of-a-double-blind-controlled-multicentre-rando/