Short-term effect of ultrasound-guided low-molecular-weight hyaluronic acid injection on clinical outcomes and imaging changes in patients with rheumatoid arthritis of the ankle and foot joints. A randomized controlled pilot trial

• Published in: Modern rheumatology 2017-11, Vol.27 (6), p.973-980
• Main Authors: Wang, Chien-Chih, Lee, Si-Huei, Lin, Hsiao-Yi, Liu, Fu-Wei, Chiou, Hong-Jen, Chan, Rai-Chi, Chou, Chen-Liang
• Format: Article
• Language: English
• Subjects: Aged; ankle; Ankle Joint - diagnostic imaging; Ankle Joint - pathology; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; Female; foot; Foot Joints - diagnostic imaging; Foot Joints - pathology; Humans; Hyaluronic acid; Hyaluronic Acid - administration & dosage; Hyaluronic Acid - adverse effects; Hyaluronic Acid - therapeutic use; Injections, Intra-Articular - adverse effects; Injections, Intra-Articular - methods; Male; Middle Aged; Pilot Projects; rheumatoid arthritis; synovitis; Ultrasonography; ultrasound
• ISSN: 1439-7595; 1439-7609
• DOI: 10.1080/14397595.2016.1270496

To determine whether hyaluronic acid (HA) injection into rheumatoid arthritis ankles and feet can achieve improvement in foot function and reduce synovial hyper-vascularization. Forty-four patients with RA having unilateral or bilateral painful ankle and foot involvement (N = 75) were studied. All the patients were randomized to receive HA (N = 40) or lidocaine (LI) (N = 35) injection at 2-week intervals; Clinical assessments were performed using a visual analog scale (VAS) and foot function index (FFI total ) including subscales of pain (FFI pain) before injection at baseline, 4 weeks (first evaluation) and 12 weeks (secondary evaluation). Imaging evaluation based on color Doppler ultrasound (CDUS) and synovitis scores was performed simultaneously. HA injection improved the VAS score (p = .009), FFI pain (p = .041), and FFI total (p = .032) considerably more than LI injections did at the first evaluation. The CDUS values at first evaluation (p = .005) and secondary evaluation (p < .001) decreased significantly compared with the base line values. HA injections reduced the CDUS values of more than half of the joints (54%, p = .042) while the control group exhibited no change (20%, p = .56). However, HA injection did not reduce the CDUS values more than LI injection did. Regarding the evaluation of synovial hypertrophy, no significant difference was observed between or within the groups in the synovitis scores. HA injection improved short-term foot function and pain reduction. HA injection may have a modest effect in reducing synovial hyper-vascularization. Further large-scale study is warranted to confirm this result.