Sonographic criteria for therapy follow-up in the course of ultrasound-guided intra-articular injections of hyaluronic acid in hand osteoarthritis

Eur J Radiol. 2012 Jul;81(7):1607-11. doi: 10.1016/j.ejrad.2011.04.073. Epub 2011 Jun 25.


Objective: To assess the value of sonographic criteria, based on measurements of joint capsule distension and synovial hyperemia, during the course of repeated ultrasound (US)-guided intra-articular injections of hyaluronic acid (HA) in hand osteoarthritis (OA).

Materials and methods: Thirty-three patients (28 females/5 males), with hand OA in 78 joints, were included in this study. Patients underwent sonographic evaluation at baseline and consecutively for 4 weeks at weekly US-guided intra-articular injections of HA (Hyalgan(®)). Measurements of joint thickening and joint inflammation were performed with Grey-scale and semi-quantitative Power-Doppler US (PDUS). Sonographic values were correlated with weekly patients self-assessment of pain for each treated joint.

Results: The mean (SD) patients self-assessment of pain statistically significantly (p<0.0001) decreased from the first [68.3(22.3)] to the last week [37.3(30.34)]. A steady pain relief could be noticed in 67 (86%) of all treated joints. Over the whole observation period, the mean (SD) joint thickening of all joints markedly decreased from 15.6mm (5.3) to 13.1mm (6.4) (p<0.0001). The PDUS-score before initiation of HA treatment was statistically significantly higher than at the end of therapy (p<0.0001). The decrease in pain statistically significantly correlated with the decrease of joint thickening and PDUS-score between baseline and the end of therapy (p<0.001).

Conclusion: In this study, we demonstrate the meaningfulness of sonographic evaluation criteria including measurements of joint capsule distension and PDUS vascularization, both significantly correlating with the decrease of pain, during the therapy follow-up of US-guided intra-articular HA-injections in patients with hand OA.

MeSH terms

  • Adjuvants, Immunologic / administration & dosage*
  • Aged
  • Female
  • Hand*
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Injections, Intra-Articular*
  • Male
  • Middle Aged
  • Osteoarthritis / diagnostic imaging*
  • Osteoarthritis / drug therapy*
  • Pain Measurement
  • Statistics, Nonparametric
  • Treatment Outcome
  • Ultrasonography, Doppler*
  • Ultrasonography, Interventional*


  • Adjuvants, Immunologic
  • Hyaluronic Acid