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Tarapore R, Lindsey S, Strickland P, McKinstry R. Demonstrating antibiotic stewardship while diagnosing and treating bilateral pseudoseptic arthritis: a case report. J Med Case Rep 2024; 18:242. [PMID: 38724965 PMCID: PMC11084000 DOI: 10.1186/s13256-024-04568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Although viscosupplementation is a commonly used treatment for osteoarthritis and is widely regarded as a safe treatment option, it is associated with the rare complication of pseudoseptic arthritis. Most existing case reports that cite this rare complication employed the use of early broad-spectrum antibiotics. CASE PRESENTATION In this case report, we present a 61-year-old African American female patient who presented with bilateral knee pseudoseptic arthritis in the setting of viscosupplementation. She presented 3 days after bilateral viscosupplementation injections with bilateral knee swelling, discomfort, and pain with micromotion. Her white blood cell count (WBC) was 12.83 (4.5-11 normal), her C-reactive protein (CRP) level was 159 mg/L (0-10 normal), and her erythrocyte sedimentation rate (ESR) was 79 mm/hour (0-40 normal). Her left knee aspirate yielded 38,580 WBC with a negative gram stain and negative cultures. Her right knee aspirate yielded 29,670 WBC with a negative gram stain and negative cultures. Through the utilization of careful clinical monitoring, ice therapy, and non-steroidal inflammatory medication, we were able to successfully treat this patient while maintaining proper antibiotic stewardship. CONCLUSION Pseudoseptic arthritis in the setting of viscosupplementation can be adequately treated and monitored without the use of antibiotics.
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Affiliation(s)
- Rae Tarapore
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital 201 E. University Pkwy, Baltimore, MD, 21218, USA.
| | - Sierra Lindsey
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital 201 E. University Pkwy, Baltimore, MD, 21218, USA
| | - Paige Strickland
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital 201 E. University Pkwy, Baltimore, MD, 21218, USA
| | - Robert McKinstry
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital 201 E. University Pkwy, Baltimore, MD, 21218, USA
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Miller AV, Carney PC, Markmann A, Frye CW. Retrospective analysis describes safety of therapeutic joint injections in dogs. J Am Vet Med Assoc 2023; 261:397-402. [PMID: 36595365 DOI: 10.2460/javma.22.11.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To retrospectively investigate the safety of canine therapeutic IA injections, describing and correlating adverse events with the number of injections per visit, joint injected, signalment, body condition score, type, and volume of injectate. SAMPLE There were 505 joint injections across 283 visits for 178 client-owned dogs, including the shoulder, elbow, carpus, hip, stifle, tarsus, and metacarpophalangeal. PROCEDURES A search was performed of the Cornell University Hospital for Animals medical records for relevant data, identifying dogs treated with therapeutic joint injections and rechecked between 2010 and 2022. RESULTS Minor complications were noted in 70 of 283 visits and included transient soreness (18.4%, lasting a median of 2 days; range, 1 to 20 days) and gastroenteritis (6.8%). One case of septic arthritis (1/505 joints), which possessed risks of a hematogenous source, was the only potential major complication. Soreness was not correlated with the number of joints injected per visit. Larger volumes of injectate normalized to body size were more likely to be associated with transient soreness in the stifle and tarsus. Across injectates, only stem cells had significantly increased odds of soreness. Gastroenteritis was not associated with the type of injectate. CLINICAL RELEVANCE Therapeutic joint injections in dogs are safe, with an extremely low risk of major adverse effects. Transient soreness is a commonly expected minor adverse event. The use of stem cells or larger injectate volumes (confined to the stifle and smaller distal joints) may be more likely to invoke discomfort.
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Kurtz SM, Mont MA, Chen AF, Valle CD, Sodhi N, Lau E, Ong KL. Intra-Articular Corticosteroid or Hyaluronic Acid Injections Are Not Associated with Periprosthetic Joint Infection Risk following Total Knee Arthroplasty. J Knee Surg 2022; 35:983-996. [PMID: 33389729 DOI: 10.1055/s-0040-1721128] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study evaluated whether the preoperative use and timing of the use of hyaluronic acid (HA) and/or corticosteroid (CS) injections were associated with an increased risk of periprosthetic joint infections (PJIs) following primary total knee arthroplasty (TKA). We tested the hypothesis that preoperative injection of HA or CS within 3 months prior to primary TKA was associated with an increased risk of PJI by specifically evaluating the association between PJI risk and (1) injection type; (2) timing; (3) patient demographic factors; and (4) surgery-related factors, such as surgeon injection volume, knee arthroscopy (pre- and postoperative), and hospital length of stay. The 5% Medicare part B claims database was queried for patients who received CS and/or HA injections. Cox proportional hazards regressions evaluated the risk of PJIs after TKA, adjusting for patient and clinical factors, as well as propensity scores. The unadjusted incidence of PJI at 2-year post-TKA was 0.75% for the CS group, 0.89% for the HA group, 0.96% for both CS and HA group, and 0.75% for those who did not use HA or CS in the 12 months before TKA. For patients who used HA and/or CS within 3 months prior to TKA, the unadjusted incidence of PJI at 2-year post-TKA was 0.75% for the CS group, 1.07% for the HA group, and 1.00% for both CS and HA group, compared with 0.77% for those who did not use HA or CS. The number of injections performed per year was inconsistently associated with PJI risk. Overall, we found that intra-articular injections given within the 4-month period prior to TKA were not associated with elevated PJI risk (evaluated at 1, 3, 12, and 24 months after the index TKA) within the elderly Medicare patient population.
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Affiliation(s)
- Steven M Kurtz
- Department of Biomedical Engineering, Exponent Inc., Philadelphia, Pennyslavania
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lennox Hill Hospital, Northwell Health, New York City, New York
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Craig Della Valle
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lennox Hill Hospital, Northwell Health, New York City, New York
| | - Edmund Lau
- Department of Biomedical Engineering, Exponent, Inc., Menlo Park, California
| | - Kevin L Ong
- Department of Biomedical Engineering, Exponent Inc., Philadelphia, Pennyslavania
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Hynes JP, Kavanagh EC. Complications in image-guided musculoskeletal injections. Skeletal Radiol 2022; 51:2097-2104. [PMID: 35622087 PMCID: PMC9463191 DOI: 10.1007/s00256-022-04076-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
Complications in musculoskeletal interventions are rare and where they do occur tend to be minor, and often short-lived or self-limiting. Nonetheless, the potential for significant complications exists, and a thorough understanding of both the mechanisms which contribute and the manner in which they may clinically present is of critical importance for all musculoskeletal radiologists involved in performing procedures, both to mitigate against the occurrence of complications and to aid rapid recognition. The purpose of this review is to analyse the relevant literature to establish the frequency with which complications occur following musculoskeletal intervention. Furthermore, we highlight some of the more commonly discussed and feared complications in musculoskeletal intervention, such as the risk of infection, potential deleterious articular consequences including accelerated joint destruction and the poorly understood and often underestimated systemic effects of locally injected corticosteroids. We also consider both extremely rare but emergent scenarios such as anaphylactic reactions to medications, and much more common but less significant complications such as post-procedural pain. We suggest that meticulous attention to detail including strict adherence to aseptic technique and precise needle placement may reduce the frequency with which complications occur.
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Affiliation(s)
- John P. Hynes
- Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Republic of Ireland
| | - Eoin C. Kavanagh
- Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Republic of Ireland
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Ong KL, Farr J, Gudeman AS, Murray IR, McIntyre LF, Hummer CD, Ngai W, Lau E, Altman RD, Sherman SL. Risk of Severe Acute Localized Reactions for Different Intraarticular Hyaluronic Acid Knee Injections in a Real-World Setting. Cartilage 2021; 13:376S-386S. [PMID: 34515539 PMCID: PMC8808888 DOI: 10.1177/19476035211025815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Case reports of severe acute localized reactions (SALR) following intraarticular (IA) hyaluronic acid (HA) injections for knee osteoarthritis (OA) have been described. We compared surrogate SALR measures between patients using hylan G-F 20 and specific non-hylan G-F 20 HA products. DESIGN Knee OA patients were identified from the Optum Clinformatics dataset (January 2006 to June 2016), stratified into hylan G-F 20 and non-hylan G-F 20 HA users, matched by single or multiple injection products. Occurrences of surrogate SALR measures including inflammation/infection, intraarticular corticosteroid (CS) injections, arthrocentesis/aspiration, arthrotomy/incision and drainage, and arthroscopy were evaluated within 3 days post-HA. RESULTS Based on 694,404 HA injections, inflammation/infection rate was rare within 3 days of HA (up to 0.03%), with no statistical differences between hylan G-F 20 and non-hylan G-F 20 groups (matched by single or multiple injection products). The risk of knee arthrotomy/incision and drainage, arthroscopy, or arthrocentesis for hylan G-F 20 (2 mL) 3 weekly injection patients was lower than Hyalgan/Supartz and Orthovisc patients, but greater than Euflexxa patients. Overall, we found that Hylan G-F 20 (2 mL) 3 weekly injection had lower SALR rates compared to Hyalgan/Supartz and Orthovisc. However, Hylan G-F 20 (2 mL) 3 weekly injection had slightly higher rates of SALR when compared to Euflexxa. Among the single injection products, Hylan G-F 20 (6 mL) single injection had lower rates of SALR than Monovisc and Gel-One. CONCLUSIONS This study shows no clear correlation between avian-derived or cross-linked products and SALR and provides evidence against avian-derived products or crosslinking as a source for these reactions.
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Affiliation(s)
| | - Jack Farr
- Indiana University Department of
Orthopaedic Surgery, Indianapolis, IN, USA
| | - Andrew S. Gudeman
- Indiana University Department of
Orthopaedic Surgery, Indianapolis, IN, USA
| | - Iain R. Murray
- Department of Orthopaedics, The
University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Roy D. Altman
- David Geffen School of Medicine,
University of California, Los Angeles, CA, USA
| | - Seth L. Sherman
- Department of Orthopaedic Surgery,
Stanford University School of Medicine, Stanford, CA, USA
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6
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Ong KL, Runa M, Xiao Z, Ngai W, Lau E, Altman RD. Severe Acute Localized Reactions Following Intra-Articular Hyaluronic Acid Injections in Knee Osteoarthritis. Cartilage 2021; 13:1474S-1486S. [PMID: 32063023 PMCID: PMC8808807 DOI: 10.1177/1947603520905113] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Concerns have been raised about severe acute localized reactions (SALR) following intra-articular (IA) hyaluronic acid (HA) injections for knee osteoarthritis (OA). We compared surrogate SALR measures between hylan G-F 20 and non-hylan G-F 20 HA patients and evaluated corresponding SALR risk factors for hylan G-F 20 patients. DESIGN Knee OA patients were identified from the Optum Clinformatics dataset (January 2006 to June 2016), stratified into hylan G-F 20 and non-hylan G-F 20 HA users. Occurrences of surrogate SALR measures including inflammation/infection, intra-articular corticosteroid (CS) injections, arthrocentesis/aspiration, and office visits were evaluated within 3 days of HA use. Risk factors were evaluated using logistic regression. RESULTS The cohort involved 748,428 HA patients (23.2% in the hylan G-F 20 group). Inflammation/infection rate was 0.001% for hylan G-F 20 and 0.002% for non-hylan G-F 20 HA groups. Risk of CS injection (any diagnosis) was greater for hylan G-F 20 patients by 28% (P < 0.001). Combined rates of CS injection and arthrocentesis/aspiration (any diagnosis) were comparable for both groups (hylan G-F 20, 2.2%; non-hylan G-F 20 HA, 2.6%). The risk of any visit or studied responses was lower for the hylan G-F 20 cohort by 12% (P < 0.001). Clinical characteristics, such as CS injections within 1 week before HA and fluoroscopic imaging, were associated with the outcomes. CONCLUSIONS The diagnosis of inflammations or infections within 3 days of the HA injection was extremely rare. The overall risk of surrogate SALR measures was similar for hylan G-F 20 and non-hylan G-F 20 HA patients.
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Affiliation(s)
- Kevin L. Ong
- Exponent, Inc., Philadelphia, PA,
USA,Kevin L. Ong, Exponent, Inc., 3440 Market
Street, Suite 600, Philadelphia, PA 19104, USA.
| | | | | | | | | | - Roy D. Altman
- School of Medicine, University of
California, Los Angeles, CA, USA
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Jang KM, Park YG, Choi WK, Chung YY, Kim KK, Lee JW, Lee SJ, Eom Y, Yang JH. Safety of a single intra-articular injection of LBSA0103 hyaluronic acid in patients with osteoarthritis of the knee: a multicenter, single-arm, prospective, cohort study. Curr Med Res Opin 2021; 37:1573-1580. [PMID: 34192989 DOI: 10.1080/03007995.2021.1950132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE LBSA0103 is a recently developed high-molecular-weight, cross-linked, non-animal hyaluronic acid (HA). The safety of LBSA0103 has been investigated only in a limited number of patients, therefore this prospective study was designed. This study sought to assess the safety including injection-site reactions and adverse drug reactions after a single intra-articular injection of LBSA0103 in patients with osteoarthritis (OA) of the knee joint. METHODS This study was a multicenter, single-arm, prospective cohort study. After screening, eligible patients with OA of the knee joint (Kellgren-Lawrence grades I-III) were enrolled, received a single intra-articular HA (LBSA0103) injection, and were followed up for two weeks. Any adverse events including injection-site reactions and adverse drug reactions were evaluated by the investigators. RESULTS A total of 1949 subjects (2976 knee joints) was enrolled, all of whom received a single intra-articular injection of LBSA0103. Injection-site reactions occurred in 5.59% of enrolled subjects (109/1949), and the most frequently reported injection-site reaction was pain (4.87%), followed by swelling (1.03%). Most of the injection-site reactions were transient and resolved within 14 days without additional treatment. The incidence of adverse drug reactions other than injection-site reactions was 0.67% (13/1949). Most adverse events were of mild severity. No serious adverse events related to the study drug were reported. CONCLUSIONS A single intra-articular injection of LBSA0103 in patients with OA of the knee joint was safe, and no significant safety concerns were observed. As such, LBSA0103 could be safely applied as an intra-articular injection for the management of knee OA. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (identifier: NCT04369261).
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Affiliation(s)
- Ki-Mo Jang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Won Kee Choi
- Department of Orthopedic Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Young Yool Chung
- Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Republic of Korea
| | - Kwang Kyoun Kim
- Department of Orthopedic Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Jang Woo Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yunae Eom
- Life Sciences R&D, LG Chem, Ltd, Seoul, Republic of Korea
| | - Jae-Hyuk Yang
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
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8
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Sedrak P, Hache P, Horner NS, Ayeni OR, Adili A, Khan M. Differential characteristics and management of pseudoseptic arthritis following hyaluronic acid injection is a rare complication: a systematic review. J ISAKOS 2020; 6:94-101. [PMID: 33832983 DOI: 10.1136/jisakos-2020-000438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/05/2020] [Accepted: 09/19/2020] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Acute pseudoseptic arthritis is a rare complication of hyaluronic acid (HA) injections that is not well documented in the literature. Practitioners initially suspect the symptoms of this complication to represent septic arthritis, cautiously prescribing antibiotics. This review identifies that time to presentation of symptoms postinjection, negative cell cultures and lack of crystallisation could be used as differentials to suspect pseudoseptic arthritis and to prescribe anti-inflammatory drugs while closely monitoring change of symptoms. OBJECTIVE The purpose of this study was to describe the presentation, diagnosis and treatment of pseudoseptic arthritis. EVIDENCE REVIEW A systematic review of the literature was conducted for studies reporting the use of HA injections for osteoarthritis resulting in pseudoseptic arthritis using the electronic databases MEDLINE, Embase and PubMed. Pertinent data were abstracted from the search yield. A unique case of a pseudoseptic reaction is also presented. FINDINGS A total of 11 studies (28 cases), all of level IV and V evidence were included in this review. Reported cases of pseudoseptic arthritis in the literature present with severe joint pain (100%), effusion (100%), inability to weight-bear, functional impairment, and occasionally fever (22.2%). C reactive protein and erythrocyte sedimentation rate are generally elevated (71.4% and 85.7%, respectively), and leucocytosis above 10 000 was less common (50%). All reported cases in the literature identified aseptic growth on arthrocentesis, despite four cases (15.4%) reporting synovial leucocyte counts above 50 000. The presented case is the highest reported leucocyte count at 1 74 960 cells/mm3. CONCLUSIONS AND RELEVANCE Acute pseudoseptic arthritis is rare, but a number of cases have been reported in the literature. A high degree of suspicion for pseudoseptic arthritis may be maintained in patients who present under 72 hours following HA injection. Initial antibiotic treatment, along with anti-inflammatory medications until cultures are confirmed to be negative at 5 days, is a cautious approach. However, the strength of this conclusion is limited by the few reported cases. Ultimately, this review is intended to inform practitioners of the symptoms, diagnosis and treatment of this complication, such that it could be safely differentiated from septic arthritis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Phelopater Sedrak
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Philip Hache
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Nolan S Horner
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Anthony Adili
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
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More S, Kotiya A, Kotia A, Ghosh SK, Spyrou LA, Sarris IE. Rheological properties of synovial fluid due to viscosupplements: A review for osteoarthritis remedy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105644. [PMID: 32645531 DOI: 10.1016/j.cmpb.2020.105644] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
The synovial fluid is a transparent electrolyte solution included in joints to provide lubrication helping the proper movement. It exhibits complex rheological properties due to the interaction among its constituents i.e. hyaluronic acid, albumin, lubricin and phospholipids. In degenerative osteoarthritis and inflammatory rheumatoid arthritis diseases, the quantity of synovial fluid and lubrication efficiency significantly deteriorates. In that case, viscosupplementation with intra-articular hyaluronic acid may be prescribed to replenish the concentration, the molecular weight and the rheological properties of natural synovial fluid. The present review concentrates on the recent advancements in viscosupplementation with emphasis into their rheological properties, its effects on the rheological behavior of synovial fluid, and finally its clinical effectiveness. Initially, the properties of synovial fluid are summarized, and then a discussion on commercial viscosupplements, the role of polymeric properties and their rheological properties are reviewed. Moreover, a detailed discussion on the clinical effectiveness and challenges of viscosupplements are provided.
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Affiliation(s)
- S More
- School of Mechanical Engineering, Lovely Professional University, Punjab, India
| | - A Kotiya
- Central Research Institute (H), Noida, India
| | - A Kotia
- School of Mechanical Engineering, Lovely Professional University, Punjab, India
| | - S K Ghosh
- Indian Institute of Technology (Indian School of Mines) Dhanbad, India
| | - L A Spyrou
- Institute for Bio-Economy and Agri-Technology, Center for Research and Technology Hellas, 38333 Volos, Greece
| | - I E Sarris
- Department of Mechanical Engineering, University of West Attica, 12210 Athens, Greece.
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Guermech I, Lassoued MA, Abdelhamid A, Sfar S. Development and Assessment of Lipidic Nanoemulsions Containing Sodium Hyaluronate and Indomethacin. AAPS PharmSciTech 2019; 20:330. [PMID: 31677079 DOI: 10.1208/s12249-019-1543-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/18/2019] [Indexed: 11/30/2022] Open
Abstract
The present work attempts to develop and optimize the formula of a lipidic nanoemulsion (NE) containing sodium hyaluronate (HNa) and indomethacin (Ind) as HNa-Ind for enhanced transdermal antiarthritic activity. NEs were prepared by the spontaneous emulsification method and characterized by Fourier-transform infrared (FTIR) spectroscopy. The composition of the optimal formulation was statistically optimized using Box-Behnken experimental design method with three independent factors and was characterized for particle size, polydispersity index, and percent transmittance. The selected formula was tested for its in vitro antioxidant activity and in vivo anti-inflammatory activity. The optimized HNa-Ind NE formula was characterized and displayed a particle size of 12.87 ± 0.032 nm, polydispersity index of 0.606 ± 0.082, and 99.4 ± 0.1 percentage of transmittance. FTIR showed no interaction between HNa and Ind as a physical mixture. In addition, the optimized HNa-Ind NE was able to preserve the antioxidant ability of the two drugs, as evidenced through a 2,2-diphenyl-1-picrylhydrazyl (DPPH) inhibition assay used to assess free radical scavenging ability. The cell viability was increased while the free radical scavenging activity was decreased (94.28% inhibition at higher concentrations compared with vitamin C as a reference with an inhibition of 100%). Moreover, the pharmacological anti-inflammatory potential of the optimized HNa-Ind NE formulation was assessed using an in vivo model. Compared with reference drugs (ibuprofen gel 5%), the remarkable activity of the optimized formulation was established using xylene-induced ear edema in mice model, in which the inflamed region reduced by 92.5% upon treatment. The optimized HNa-Ind NE formulation showed considerably higher skin permeation and drug deposition capability compared with the HNa-Ind solution. HNa-Ind NE was demonstrated to be a successful carrier with enhanced antioxidant and anti-inflammatory potential while showing better skin penetration, thus being a promising vehicle for transdermal drug delivery.
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11
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Pseudo-septic arthritis developed after hyaluronic acid injection: A case report. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.538939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Muramatsu K, Tajima Y, Kaneko R, Yanagita Y, Hirai H, Hiura N. Characterization of poly(L-glutamic acid)-grafted hyaluronan as a novel candidate medicine and biomedical device for intra-articular injection. J Biomed Mater Res A 2017; 105:3006-3016. [DOI: 10.1002/jbm.a.36155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Kazuaki Muramatsu
- Division of Life Science and Engineering; School of Science and Engineering, Tokyo Denki University, Ishizaka, Hatoyama-cho, Hiki-gun; Saitama 350-0394 Japan
| | - Yuya Tajima
- Division of Life Science and Engineering; School of Science and Engineering, Tokyo Denki University, Ishizaka, Hatoyama-cho, Hiki-gun; Saitama 350-0394 Japan
| | - Rin Kaneko
- Division of Life Science and Engineering; School of Science and Engineering, Tokyo Denki University, Ishizaka, Hatoyama-cho, Hiki-gun; Saitama 350-0394 Japan
| | - Yuta Yanagita
- Division of Life Science and Engineering; School of Science and Engineering, Tokyo Denki University, Ishizaka, Hatoyama-cho, Hiki-gun; Saitama 350-0394 Japan
| | - Hiroyuki Hirai
- Division of Life Science and Engineering; School of Science and Engineering, Tokyo Denki University, Ishizaka, Hatoyama-cho, Hiki-gun; Saitama 350-0394 Japan
| | - Nana Hiura
- Division of Life Science and Engineering; School of Science and Engineering, Tokyo Denki University, Ishizaka, Hatoyama-cho, Hiki-gun; Saitama 350-0394 Japan
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13
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Aydın M, Arıkan M, Toğral G, Varış O, Aydın G. Viscosupplementation of the knee: Three cases of acute Pseudoseptic Arthritis with painful and irritating complications and a literature review. Eur J Rheumatol 2017; 4:59-62. [PMID: 28293455 DOI: 10.5152/eurjrheum.2016.15075] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/01/2016] [Indexed: 11/22/2022] Open
Abstract
Acute pseudoseptic arthritis is a very rare complication that is associated with intra-articular hyaluronic acid injections, which normally involve minimal risk. The most common adverse events that are caused by hyaluronic acid injections are inflammatory reactions or flares at the injection site. In this study, we described three cases of acute pseudoseptic arthritis that was caused by hyaluronic acid; the symptoms in these cases were reminiscent of acute septic arthritis. Moreover, we performed a literature review on pseudoseptic arthritis following hyaluronic acid injections to determine the manner in which this condition can be described, diagnosed, and treated.
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Affiliation(s)
- Murat Aydın
- Department of Orthopedics and Traumatology, Afyonkarahisar Suhut Public Hospital Medicine, Afyonkarahisar, Turkey
| | - Murat Arıkan
- Department of Orthopaedics and Traumatology, Oncology Training and Research Hospital, Ankara, Turkey
| | - Güray Toğral
- Department of Orthopaedics and Traumatology, Oncology Training and Research Hospital, Ankara, Turkey
| | - Onur Varış
- Department of Orthopedics and Traumatology, Trabzon of Public Hospital Medicine, Trabzon, Turkey
| | - Güle Aydın
- Department of Clinical Microbiology and Infectious Diseases, Zübeyde Hanım Obstetrics and Gynecology Public Hospital, Afyonkarahisar, Turkey
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Late hemorrhagic pseudoseptic arthritis encountered during total knee arthroplasty due to hyaluronic acid viscosupplementation. Arthroplast Today 2016; 2:165-169. [PMID: 28326422 PMCID: PMC5247559 DOI: 10.1016/j.artd.2016.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/14/2016] [Accepted: 08/17/2016] [Indexed: 11/21/2022] Open
Abstract
Osteoarthritis (OA) is the most common form of arthritis and affects approximately one-third of people in the United Sates aged 65 years and older. Since 2013, the American Academy of Orthopaedic Surgeons has not been able to recommended using hyaluronic acid for patients with symptomatic OA of the knee. Subsequent publications have also cautioned against the use of viscosupplementation based on lack of efficacy and the potential for harm. We present a case of late hemorrhagic pseudoseptic arthritis encountered during TKA due to hyaluronic acid viscosupplementation. Our triad of findings includes (1) acute and chronic inflammatory cells on frozen section, (2) synovitis with hemosiderin deposition, and (3) blackened cartilage with iron deposition on permanent histopathology. Our case is unique in that it shows a previously undescribed late complication of viscosupplementation.
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15
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Page F, Chadwick S, Banerjee B. Pseudoseptic arthritis resulting in joint destruction. BMJ Case Rep 2015; 2015:bcr-2014-208269. [PMID: 25948848 DOI: 10.1136/bcr-2014-208269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudoseptic arthritis is an increasingly recognised entity. It is an inflammatory arthritis that mimics septic arthritis; however, Gram stain and cultures are persistently negative. It is a diagnosis of exclusion. We present the first case, to date, in which pseudoseptic arthritis led to such severe joint degeneration that joint replacement surgery was required. A 54-year-old truck driver with rheumatoid arthritis, on immunosuppressive therapy, presented with acute onset severe left hip pain. He was given a clinical diagnosis of septic arthritis and treated with two prolonged courses of antibiotics despite persistently negative synovial fluid cultures. He experienced progressive joint destruction necessitating a two-stage total hip replacement. A retrospective diagnosis of pseudoseptic arthritis was made. This case demonstrates the difficulties inherent in differentiating between septic and pseudoseptic arthritis. This case also highlights the importance of accurate diagnosis and treatment for pseudoseptic arthritis to avoid accelerated joint destruction.
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Affiliation(s)
- Felicity Page
- Department of Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Brian Banerjee
- Department of Trauma and Orthopaedics, Good Hope Hospital, Birmingham, UK
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16
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Abstract
This article provides physicians specializing in nonsurgical sports medicine with an overview of viscosupplementation as a treatment for osteoarthritis (OA) pain. Osteoarthritis is a painful, disabling condition that is becoming more prevalent in patients and is generally treated using conservative nonpharmacologic measures. If conservative measures are unsuccessful at alleviating pain, current recommendations include prescribing acetaminophen and nonsteroidal anti-inflammatory drugs to patients. However, long-term use of these agents increases the risk for liver, cardiovascular, gastrointestinal, and/or renal complications in patients. Viscosupplementation is the term used for intra-articular injection of hyaluronic acid/hylans. Intra-articular injections of these agents have good safety profiles and have shown efficacy for treating knee OA pain. Viscosupplementation injections relieve pain for ≤ 26 weeks, which is longer than the short-term pain relief derived from nonsteroidal anti-inflammatory drugs and corticosteroid injections. Additionally, viscosupplementation administered to patients in earlier stages of OA may be more beneficial than when given later in the treatment of OA. As part of a multimodal algorithm, viscosupplementation combined with conventional therapy or other pharmacologic agents has been shown to be more effective at managing OA than conventional care alone. This article reviews the evidence for using viscosupplementation as part of a comprehensive program for managing OA in patients.
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17
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Chevalier X, Migliore A. Safety and Tolerability of Intra-Articular Hyaluronic Acid Injection (Sinovial®) in Experimental and Clinical Practice. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Osteoarthritis (OA) requires long-term treatment, therefore, tolerability is a key factor in treatment choice. Hyaluronic acid (HA), a glycosaminoglycan with viscoelastic properties, a major component of synovial fluid and the extracellular matrix of the joint cartilage, plays key roles in synovial fluid viscosity and maintaining normal cartilage. Viscosupplementation is an intra-articular (IA) injection of exogenous HA in an effort to delay joint mobility loss. Commercially available viscosupplementation includes HA of different average molecular weight (MW), concentration and origins, with varying tolerability. This review describes the tolerability and safety profile of Sinovial® in knee and hip OA. A literature search of PubMed using the search queries [Sinovial® OR hyaluronic acid OR hyaluronan] and [intra-articular OR osteoarthritis] was performed using terms as medical subject headings and free text searches. Studies were selected manually for inclusion in this review. Sinovial® is a low-medium MW HA of non-avian origin, produced by biofermentation to ensure the product is pure and free of allergenic animal proteins. We analyzed data regarding the tolerability of Sinovial® in OA patients. This formulation has a favorable tolerability profile; no systemic reactions have been reported and most adverse events (AEs) are mild, transient and easily managed local injection site reactions. Reactions — pain and burning at the injection site - are typical of IA injections. AEs with Sinovial® used in the hip are similar to knee OA.
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Affiliation(s)
- X. Chevalier
- Department of Rheumatology, Hôpital Henri Mondor University Paris XII, UPEC, Créteil, France
| | - A. Migliore
- Department of Rheumatology, Ospedale S. Pietro FBF, Rome, Italy
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18
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Baeva LF, Lyle DB, Rios M, Langone JJ, Lightfoote MM. Different molecular weight hyaluronic acid effects on human macrophage interleukin 1β production. J Biomed Mater Res A 2013; 102:305-14. [PMID: 23533059 DOI: 10.1002/jbm.a.34704] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 02/01/2013] [Accepted: 02/19/2013] [Indexed: 02/04/2023]
Abstract
This study examined the effect of hyaluronan (HA) molecular weight on immune response. HA with molecular weights ranging from the unitary disaccharide unit (400 Da) up to 1.7 × 10(6) Da and with very low endotoxin contamination level (less than 0.03 EU/mg) was used. Primary human monocyte/macrophage cultures were assayed for IL-1β production under a variety of inflammatory conditions with or without HA. Under the highest inflammatory states, production of interleukin 1β (IL-1β) was suppressed in the presence of high molecular weight hyaluronan (HMW-HA) and in the presence of low molecular weight hyaluronan (LMW-HA) at mg/mL concentrations. There was variability in the sensitivity of the response to HA fragments with MW below 5000 Da at micromolar concentrations. There was variability in IL-1β cytokine productions from donor to donor in unstimulated human cell cultures. This study supplements our previous published study that investigated the immunogenic effect of HA molecular weights using murine cell line RAW264.6, rat splenocytes, and rat adherent differentiated primary macrophages. These data support the hypothesis that if the amount of endotoxin is reduced to an extremely low level, LMW-HA may not directly provoke normal tissue macrophage-mediated inflammatory reactions.
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Affiliation(s)
- Larissa F Baeva
- Division of Biology, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, FDA, 10903 New Hampshire Ave, Silver Spring, Maryland, 20993-002
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19
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Strand V, Baraf H, Lavin P, Lim S, Hosokawa H. Effectiveness and Safety of a Multicenter Extension and Retreatment Trial of Gel-200 in Patients with Knee Osteoarthritis. Cartilage 2012; 3:297-304. [PMID: 26069640 PMCID: PMC4297150 DOI: 10.1177/1947603512451024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the continued effectiveness and safety of Gel-200 following observation and open-label retreatment in an extension protocol following a randomized, double-blind, phosphate buffered saline (PBS)-controlled trial (initial treatment trial). DESIGN Patients who completed initial blinded treatment were allowed to enroll into this extension protocol that permitted retreatment with Gel-200 when eligibility criteria were met. Retreatment was administered with a Gel-200 injection, without knowledge of initial treatment assignment (Gel-200 or PBS). Retreated patients were followed for up to 13 weeks. In the extension phase, durability of response following the first injection was analyzed by time to retreatment eligibility. During separate extension and retreatment phases, responses were assessed by WOMAC pain, stiffness, and physical function subscores, total score, and global assessments of disease activity (patient, physician) as well as safety of Gel-200. RESULTS In the extension phase, time-to-event analyses through 26 weeks following the initial injection showed statistically significantly longer times to retreatment in patients receiving Gel-200 compared with PBS (P < 0.05). Retreatment with Gel-200, e.g., a second injection, resulted in statistically significant improvements from retreatment baseline in all outcome measures (P < 0.0001). The incidence and type of adverse events after retreatment were comparable to those observed following initial injection of Gel-200 without allergic reactions, including "pseudosepsis" or unanticipated treatment-related serious adverse events. CONCLUSIONS These data demonstrate that a single injection of Gel-200 resulted in durable effectiveness through 26 weeks and that repeated treatment with Gel-200 relieved symptomatic osteoarthritis with a favorable safety profile.
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Affiliation(s)
- V. Strand
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - H.S.B. Baraf
- The Center for Rheumatology and Bone Research, Wheaton, MD, USA
| | - P.T. Lavin
- Boston Biostatistics Research Foundation, Framingham, MA, USA
| | - S. Lim
- Biostatistics & Data Management Group, Clinical Development Department, Research & Development Division, Seikagaku Corporation, Chiyoda-ku, Tokyo, Japan
| | - H. Hosokawa
- Clinical Development Department, Research & Development Division, Seikagaku Corporation, Chiyoda-ku, Tokyo, Japan
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Sifuentes Giraldo WA, Guillén Astete CA, Murillo Romero C, Amil Casas I, Rodríguez García AM, Bachiller Corral FJ. Refractory pseudoseptic arthritis in Behçet’s disease successfully treated with infliximab: a case report and literature review. Mod Rheumatol 2012. [DOI: 10.1007/s10165-012-0747-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Richette P. [Pharmacological therapies for osteoarthritis]. Therapie 2011; 66:383-90. [PMID: 22031681 DOI: 10.2515/therapie/2011060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/27/2011] [Indexed: 11/20/2022]
Abstract
According to international recommendations, acetaminophen should be used as a first-line therapy in patients with osteoarthritis, because of its safety and effectiveness. NSAIDs should be considered in patients unresponsive to acetaminophen, and should be prescribed at the lowest effective dose and for the shortest duration. The use of stronger analgesics, such as weak opioids and narcotic analgesics, is only indicated when other drugs, such as NSAIDs, have been ineffective or are contraindicated. Symptomatic slow acting drugs (avocado soybean unsaponifiable, chondroitin sulphate, diacerein, glucosamine sulphate, hyaluronan injections) have mild symptomatic effects and may reduce the consumption of NSAIDs. Intra-articular injections of glucocorticoids are indicated for flare of knee pain, especially if accompanied by effusion.
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22
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Peterson C, Hodler J. Adverse events from diagnostic and therapeutic joint injections: a literature review. Skeletal Radiol 2011; 40:5-12. [PMID: 19949787 DOI: 10.1007/s00256-009-0839-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/02/2009] [Accepted: 11/05/2009] [Indexed: 02/02/2023]
Abstract
This review article classifies the various adverse reactions arising from intra-articular injections by severity, diagnostic category, and whether they are due to corticosteroid, local anesthetic or viscosupplementation injections. Life-threatening and serious adverse events from intra-articular injections are rare and range from local complications to systemic afflictions. Measures to reduce the likelihood of an adverse event occurring are outlined and patients with significant features in their clinical histories, predisposing them to adverse events, are highlighted.
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Affiliation(s)
- Cynthia Peterson
- Radiology, Orthopaedic University Hospital of Balgrist, Forchstrasse 340, 8008, Zürich, Switzerland.
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23
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The efficacy of hyaluronic acid in the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Am 2009; 34:942-4. [PMID: 19411002 DOI: 10.1016/j.jhsa.2009.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/10/2009] [Indexed: 02/02/2023]
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Alijotas-Reig J, Garcia-Gimenez V. Delayed immune-mediated adverse effects related to hyaluronic acid and acrylic hydrogel dermal fillers: clinical findings, long-term follow-up and review of the literature. J Eur Acad Dermatol Venereol 2008; 22:150-61. [PMID: 18211407 DOI: 10.1111/j.1468-3083.2007.02354.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Implantation of dermal filler for cosmetic purposes is becoming increasingly common worldwide. It is thought that hyaluronic acid (HA) alone or combined with acrylic hydrogels (HA-AH) does not have severe nor persistent side-effects. However, recent evidence may show that major, local and/or systemic, immediate or delayed adverse effects may appear in relation with its use. OBJECTIVE To evaluate the clinical complaints, laboratory data, treatment and follow-up of patients with delayed adverse effects related to HA and HA-AH implant fillers. DESIGN Prospective, case-series study of patients filled with HA and HA-AH compounds. SETTING The study has been done in a tertiary, teaching university hospital. PATIENTS We report on a series of 25 patients, 15 of them in prospective manner, with severe, delayed side-effects related to HA-AH. Inclusion criteria have been drawn up. Patients with immediate side-effects were excluded. Patients were submitted to a clinical follow-up, battery of blood tests and thorax X-ray films. Besides, a review of the literature was made. We undertook a computed-assisted (MEDLINE), National Library of Medicine, Bethesda, MD, USA, search of the literature from 1996 up to December 2005. MAIN OUTCOME Clinical evaluation of granulomas, skin manifestations and other local and systemic immune-mediated disorders possibly related to HA and HA-AH fillers or their cumulative interaction with previously administered fillers. RESULTS Of 25 cases, 16 were filled with HA alone and 9 with a HA-AH compounds. Of 15 cases analysed and with long-term follow-up, 10 were filled with HA alone, and the remaining five were filled with a HA-AH. Time latency average up to beginning of symptoms was 13.7 months. Three of these 15 cases had been filled before with silicone and another one with Artecoll. Tender nodules were seen in 14 patients. Systemic manifestations appeared in three cases. Laboratory abnormalities were noted in all studied cases. After 16-month average follow-up, seven patients seem to be cured, and six have recurrent bouts. Two cases were lost during follow-up. CONCLUSION Although in some cases, these clinical complications might have been associated with previous fillers or with other unknown foreign bodies, we feel that, although infrequently, delayed and recurrent chronic inflammatory and granulomatous reactions may complicate HA and HA-AH implant fillers.
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Affiliation(s)
- J Alijotas-Reig
- Ageing Research and Autoimmune Diseases Unit, Department of Internal Medicine I, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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25
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Wendling D, Royer F, Chabroux A, Streit G, Bossert M, Toussirot E. Acute gouty arthritis after intraarticular hyaluronate injection. Joint Bone Spine 2007; 74:664-5. [PMID: 17900963 DOI: 10.1016/j.jbspin.2007.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 04/26/2007] [Indexed: 11/16/2022]
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Abstract
Prevention of complications is one of the most important aspects of patient care in pain management. The objective of this study is to review documented complications in medical literature that are associated with interventional pain management, specifically those associated with joint, tendon, and muscle injections. We conducted Medline research from 1966 to November 2006 using keywords complication, injection, radiofrequency, closed claim, facet, zygophyseal joint, sacroiliac joint, shoulder, hip, knee, carpel tunnel, bursa, and trigger point. We found over 35 relevant papers in forms of original articles, case reports, and reviews. The most common complications appear to be infections that have been associated with virtually all of these injections. These infections include spondylodiscitis, septic arthritis, epidural abscess, necrotizing fasciitis, osteomyelitis, gas gangrene, and albicans arthritis. Other complications include spinal cord injury and peripheral nerve injuries, pneumothorax, air embolism, pain or swelling at the site of injection, chemical meningism, granulomatous inflammation of the synovium, aseptic acute arthritis, embolia cutis medicamentosa, skeletal muscle toxicity, and tendon and fascial ruptures. We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the procedural techniques with a clear understanding of the relevant anatomies.
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Affiliation(s)
- Jianguo Cheng
- Department of Pain Management, Division of Anesthesiology, Critical Care, and Comprehensive Pain Management, Cleveland Clinic Foundation
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27
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Tahiri L, Benbouazza K, Amine B, Hajjaj-Hassouni N. Acute pseudoseptic arthritis after viscosupplementation of the knee: a case report. Clin Rheumatol 2007; 26:1977-9. [PMID: 17436053 DOI: 10.1007/s10067-007-0598-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Revised: 02/21/2007] [Accepted: 02/28/2007] [Indexed: 12/01/2022]
Abstract
Intra-articular injections of hyaluronan are generally well tolerated; the most common adverse event associated with their use is an inflammatory reaction or a flare at the injection site. Naturally derived sodium hyaluronates have not been associated with pseudosepsis; we describe a case of severe arthritis mimicking acute septic arthritis after naturally hyaluronan. A 70-year-old woman had a medial femorotibial and patellofemoral compartment knee osteoarthritis. Hyaluronic acid injection was indicated because of the persistence of a pain while walking and restricted ability to walk 100 m, as well as the installation of a flessum. She was admitted for an evaluation of a joint effusion occurring within 48 h after the first hyaluronic acid intra-articular injection (first course), with no fever or chills. Joint fluid was found to be cloudy and contained 24,000 cells per mm(3). A knee aspiration was performed to evaluate the possibility of a joint infection. The examination of synovial fluid under phase contrast and polarizing microscopes showed no crystals, and culture on standard media was negative. Acute septic arthritis was considered to be the most likely diagnosis, and probabilistic antibiotic therapy was started. The result of the bacteriological examinations also returned negative. The absence of general signs, particularly fever and chills, with fast effusion regression in less than 4 days did not plead in favor of a septic origin. In front of this beam of arguments, antibiotic therapy was stopped after 4 days. The nonsteroidal anti-inflammatory drug (Nimésulide) was given. The clinical and laboratory test abnormalities were normalized within 2 weeks. Our case has the particularity to occur after using Curavisc, which is known as producing no allergenic reactions. Moreover, the described reaction occurred with the very first infiltration within the very first course.
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Affiliation(s)
- L Tahiri
- Rheumatology B Department, El Ayachi Hospital, Sale, Morocco
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28
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Tehranzadeh J, Mossop EP, Golshan-Momeni M. Therapeutic arthrography and bursography. Orthop Clin North Am 2006; 37:393-408, vii. [PMID: 16846769 DOI: 10.1016/j.ocl.2006.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arthrography and bursography as therapeutic venues have found their place in the musculoskeletal procedure armamentarium. Therapeutic arthrography not only rules in and rules out the origin of pain but can provide 6 to 9 months of pain relief in diseased joints. Therapeutic arthrography allows injections of anesthetic, corticosteroid, or alternatively hyaluronic acid to be delivered accurately to the source of pain. Corticosteroids have a long history of use in osteoarthritis. Alternative therapy with hyaluronic acid is anew procedure. This article reviews the technique of arthrography in different joints and bursae and discusses the pros and cons of the use of corticosteroids versus viscosupplementation in therapeutic arthrography.
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Affiliation(s)
- Jamshid Tehranzadeh
- Department of Radiological Sciences, R 140, University of California Medical Center, 101 The City Drive, Orange, CA 92868-3298, USA.
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29
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30
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Schumacher HR, Paul C, Hitchon CA, El-Gabalawy H, Zonay L, Clayburne G, Sieck M, Schwab E. Hyaluronate effects on synovium and synovial fluid. A prospective blinded study in patients with osteoarthritis of the knee. Osteoarthritis Cartilage 2006; 14:501-3. [PMID: 16431141 DOI: 10.1016/j.joca.2005.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Accepted: 11/28/2005] [Indexed: 02/02/2023]
Affiliation(s)
- H R Schumacher
- VA Medical Center 151K, University and Woodland Avenues, Philadelphia, PA 19104, USA.
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31
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Albert C, Brocq O, Gerard D, Roux C, Euller-Ziegler L. Septic knee arthritis after intra-articular hyaluronate injection. Joint Bone Spine 2006; 73:205-7. [PMID: 16046172 DOI: 10.1016/j.jbspin.2005.03.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 03/02/2005] [Indexed: 11/30/2022]
Abstract
Intraarticular sodium hyaluronate injection to treat osteoarthritis is associated with minor side effects. Infections seem uncommon. We report two cases of septic knee arthritis. One patient was an 80-year-old woman who was admitted for Staphylococcus aureus knee arthritis after several intraarticular injections of sodium hyaluronate and corticosteroids. In the other patient, a 78-year-old woman, Neisseria mucosa knee arthritis occurred after a single sodium hyaluronate injection. Faultless aseptic technique is essential when administering hyaluronate viscosupplementation. Patients should be informed of the risk of septic arthritis.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/adverse effects
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Anti-Inflammatory Agents/therapeutic use
- Arthritis, Infectious/drug therapy
- Arthritis, Infectious/etiology
- Arthritis, Infectious/pathology
- Drug Therapy, Combination
- Female
- Glucocorticoids/therapeutic use
- Humans
- Hyaluronic Acid/administration & dosage
- Hyaluronic Acid/adverse effects
- Injections, Intra-Articular
- Knee Joint/drug effects
- Knee Joint/pathology
- Neisseria mucosa/isolation & purification
- Neisseria mucosa/physiology
- Neisseriaceae Infections/etiology
- Neisseriaceae Infections/pathology
- Osteoarthritis, Knee/complications
- Osteoarthritis, Knee/drug therapy
- Oxacillin/therapeutic use
- Staphylococcal Infections/etiology
- Staphylococcal Infections/pathology
- Staphylococcus aureus/isolation & purification
- Staphylococcus aureus/physiology
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Affiliation(s)
- Christine Albert
- Rheumatology Department, Archet 1 Teaching Hospital, CHU de Nice, 151 Rte St Antoine de Ginestière, BP 3079, 06202 Nice cedex 3, France.
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32
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Hamburger M, Settles M, Teutsch J. Identification of an immunogenic candidate for the elicitation of severe acute inflammatory reactions (SAIRs) to hylan G-F 20. Osteoarthritis Cartilage 2005; 13:266-8. [PMID: 15727894 DOI: 10.1016/j.joca.2004.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Accepted: 11/29/2004] [Indexed: 02/02/2023]
Affiliation(s)
- M Hamburger
- Rheumatology Associates of Long Island, Melville, NY 11787, USA.
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33
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Magilavy DB, McPherson JM, Polisson R. Pseudoseptic reactions to Hylan viscosupplementation: diagnosis and treatment. Clin Orthop Relat Res 2004:349-50; author reply 350-1. [PMID: 15577509 DOI: 10.1097/01.blo.0000150449.04711.f8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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