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No significant benefit seen with sodium hyaluronate for thumb joint arthritis
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SAN DIEGO — Sodium hyaluronate injected into arthritic first carpal metacarpal joints resulted in no improvement in pain during a 12-month minimum follow-up and produced limited improvement in other clinical measures at 1 and 3 months compared with placebo, according to the results of a level 1 study.
 Germaine R. Fritz |
Germaine R. Fritz, DO, and colleagues found that, overall, 0.5 ml of the joint fluid therapy performed only slightly better than 0.5 ml of saline when the treatments were injected in 27 patients/37 thumbs once a week for 3 weeks.
“Use of hyaluronic acid in first carpal metacarpal joint arthritis is safe, well tolerated, but fails to produce any evidence of a clinically significant benefit in use over placebo,” Fritz said at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons, here.
The FDA-approved study on the off-label use of the same substance found in the knee injection product Supartz (Smith & Nephew) included 13 patients in the treatment group and 15 patients in the control group. The groups had similar demographics and consisted of 70% women, according to Fritz.
“Including our study, as well as evaluations in other research studies that have been cited, there is a profound placebo effect, with many patients developing improvement of symptoms with use of just saline alone at the 12 month evaluation,” she said.
Reference:
- Fritz GR, Toth J, Holland DC. The use of sodium hyaluronate in treatment of first carpal metacarpal joint arthritis. Paper #271. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
I just want to compliment you on a prospective, single-center randomized study with a placebo control and remark how effective the saline appeared to be at12 months, and it points to how effective the placebo is.
I guess my only concern with regard to your conclusions is the possibility of a type 2 experimental error based on your numbers because you found no significant difference.
– Richard H. Gelberman, MD
Chairman, Department of Orthopedic Surgery
Washington University, St. Louis
Session moderator
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