Is there evidence in support of the use of intra-articular hyaluronate in treating rheumatoid arthritis of the knee? A meta-analysis of the published literature

Mod Rheumatol. 2009;19(5):493-501. doi: 10.1007/s10165-009-0189-6. Epub 2009 Jun 23.


Intra-articular hyaluronate (HA) injections for treating rheumatoid knee are still debatable, and this meta-analysis aims to elucidate the effectiveness of HA injection for rheumatoid knee. The meta-analysis comprised randomized clinical trials (RCTs) that compared the efficacy of HA injections with that of a placebo. The articles were retrieved after systematic searches of databases, including MEDLINE, EMBASE, and Japana Centra Revuo Medicina. The outcomes were classified into four categories: evaluation of reduction in the intensity of pain, evaluation of reduction in the intensity of inflammation, overall evaluation of therapeutic efficacy, and evaluation of adverse effects. Effect sizes were calculated from the risk ratio (RR) of each of the above-mentioned outcome categories. Five RCTs (720 participants) were pooled for the meta-analysis. The pooled effect sizes were 1.64 (p = 0.01) for pain reduction, 1.61 (p = 0.001) for reduction in inflammation, and 1.50 (p = 0.004) for the overall evaluation of treatment effectiveness. No serious side-effects were reported, while minor adverse effects were reported in patients after HA treatment (RR 0.98, p = 0.32). The results indicated that intra-articular HA is an effective and safe alternative therapy for the rheumatoid knee.

Publication types

  • Meta-Analysis

MeSH terms

  • Adjuvants, Immunologic / administration & dosage
  • Adjuvants, Immunologic / adverse effects
  • Arthritis, Rheumatoid / drug therapy*
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hyaluronic Acid / adverse effects
  • Injections, Intra-Articular / methods*
  • Knee Joint*
  • Treatment Outcome


  • Adjuvants, Immunologic
  • Hyaluronic Acid