Pai S K, Allgar V, Giannoudis P V
Leeds General Infirmary, Leeds, UK.
Int J Clin Pract. 2014 Aug;68(8):1041-7. doi: 10.1111/ijcp.12430. Epub 2014 May 5.
To systematically review evidence and perform a meta-analysis of the efficacy of intra-articular (IA) injections of Hylan G-F 20 for the treatment of painful osteoarthritis (OA) of the knee.
Systematic review of the Embase and PubMed databases up to July 2013 of randomised placebo-controlled trials studying the effect of Hylan G-F 20 in patients with painful knee OA, with a meta-analysis of trials reporting visual analogue scores (VAS) for weight-bearing pain in the knees of patients followed up for a minimum of 6 months.
Six placebo-controlled randomised trials were identified on systematic review of which two studies met criteria for inclusion in the meta-analysis. Meta-analysis demonstrated that at 6-month follow up, there was no significant difference between Hylan G-F 20 and control in terms of reduction in VAS for weight bearing pain. (Mean Difference - 12.96 (95% CI: -35.48, 9.56). Z tests used to test for overall effect showed that the difference between the two groups was not significant (p = 0.26).
A significant placebo effect exists for patients receiving IA injections for the treatment of painful knee OA. The withdrawal of fluid from the affected knee prior to any injectable therapy may itself have additional benefits which in isolation have not been studied. This may form the basis of future research. The authors' acknowledge that although limited conclusions can be drawn from the results of this study, the meta-analysis presented has not been performed previously and will further contribute to the knowledge on this subject.
Although Hylan G-F 20 may produce improvement in VAS scores for weight-bearing pain at 6-month follow up in OA knees treated with it, patients should be informed that this may be equivalent to that seen with control treatments.
系统评价关节内注射透明质酸钠凝胶（Hylan G-F 20）治疗膝关节疼痛性骨关节炎（OA）疗效的证据，并进行荟萃分析。
系统检索截至2013年7月的Embase和PubMed数据库，纳入研究Hylan G-F 20对膝关节疼痛性OA患者疗效的随机安慰剂对照试验，并对报告随访至少6个月的患者膝关节负重疼痛视觉模拟评分（VAS）的试验进行荟萃分析。
系统评价共识别出6项安慰剂对照随机试验，其中2项研究符合纳入荟萃分析的标准。荟萃分析表明，在6个月随访时，Hylan G-F 20组与对照组在减轻负重疼痛VAS方面无显著差异。（平均差-12.96（95%可信区间：-35.48，9.56）。用于检验总体效应的Z检验显示两组间差异不显著（p = 0.26）。
接受关节内注射治疗膝关节疼痛性OA的患者存在显著的安慰剂效应。在任何注射治疗前从患膝抽出积液本身可能有额外益处，但尚未单独研究。这可能构成未来研究的基础。作者承认，尽管本研究结果只能得出有限结论，但所呈现的荟萃分析此前尚未进行，将进一步增进对该主题的认识。
尽管Hylan G-F 20可能使接受治疗的OA膝关节在6个月随访时负重疼痛的VAS评分有所改善，但应告知患者这可能与对照治疗效果相当。
