Hylan Versus Corticosteroid Versus Placebo for Treatment of Basal Joint Arthritis: A Prospective, Randomized, Double-Blinded Clinical Trial

Benton E. Heyworth, Jonathan H. Lee, Paul D. Kim, Carter B. Lipton, Robert J. Strauch, Melvin P. Rosenwasser

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Purpose: Conservative, nonsurgical therapies for basal joint osteoarthritis, such as thumb spica splinting and intra-articular corticosteroid injections, remain the mainstays for symptomatic treatment. This study compares intra-articular hylan, corticosteroid, and placebo injections with regard to pain relief, strength, symptom improvement, and metrics of manual function in a randomized, controlled, double-blinded study. Methods: Sixty patients with basal joint arthritis were randomized to receive 2 intra-articular hylan injections 1 week apart, 1 placebo injection followed by 1 corticosteroid injection 1 week later, or 2 placebo injections 1 week apart. Patients were evaluated at 2, 4, 12, and 26 weeks and assessed with Visual Analog Scale pain scores, strength measures, difference scores, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and range of motion measurements. Results: All groups reported pain relief at 2 weeks. The steroid and placebo groups had significantly less pain at week 4 compared with baseline, but this effect disappeared by week 12. Only hylan injections continued to provide pain relief at 12 and 26 weeks compared with baseline. There were no significant differences in pain between groups at any time. At 12 and 26 weeks, the hylan group had improved grip strength compared with baseline, whereas the steroid and placebo groups were weaker. At 4 weeks, the steroid group reported in the difference score a greater improvement in symptoms (68%) compared with the hylan (44%) and placebo (50%) groups. Whereas at 26 weeks the hylan group reported the largest improvement in symptoms (68%), this was not statistically different from the placebo (47%) and steroid (58%) groups. There were no significant differences in Disabilities of the Arm, Shoulder, and Hand scores or range of motion among the groups. There were no complications from any injection. Conclusions: There were no statistically significant differences among hylan, steroid, and placebo injections for most of the outcome measures at any of the follow-up time points. However, based on the durable relief of pain, improved grip strength, and the long-term improvement in symptoms compared with preinjection values, hylan injections should be considered in the management of basal joint arthritis of the thumb. Type of study/level of evidence: Therapeutic I.

Original languageEnglish (US)
Pages (from-to)40-48
Number of pages9
JournalJournal of Hand Surgery
Volume33
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

Fingerprint

Arthritis
Adrenal Cortex Hormones
Joints
Placebos
Clinical Trials
Injections
Pain
Steroids
Intra-Articular Injections
Thumb
Hand Strength
Therapeutics
Articular Range of Motion
Arm
Hand
hylan
Pain Measurement
Osteoarthritis
Outcome Assessment (Health Care)

Keywords

  • Basal joint arthritis
  • corticosteroid
  • hylan
  • osteoarthritis
  • viscosupplementation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Hylan Versus Corticosteroid Versus Placebo for Treatment of Basal Joint Arthritis : A Prospective, Randomized, Double-Blinded Clinical Trial. / Heyworth, Benton E.; Lee, Jonathan H.; Kim, Paul D.; Lipton, Carter B.; Strauch, Robert J.; Rosenwasser, Melvin P.

In: Journal of Hand Surgery, Vol. 33, No. 1, 01.2008, p. 40-48.

Research output: Contribution to journalArticle

Heyworth, Benton E. ; Lee, Jonathan H. ; Kim, Paul D. ; Lipton, Carter B. ; Strauch, Robert J. ; Rosenwasser, Melvin P. / Hylan Versus Corticosteroid Versus Placebo for Treatment of Basal Joint Arthritis : A Prospective, Randomized, Double-Blinded Clinical Trial. In: Journal of Hand Surgery. 2008 ; Vol. 33, No. 1. pp. 40-48.
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abstract = "Purpose: Conservative, nonsurgical therapies for basal joint osteoarthritis, such as thumb spica splinting and intra-articular corticosteroid injections, remain the mainstays for symptomatic treatment. This study compares intra-articular hylan, corticosteroid, and placebo injections with regard to pain relief, strength, symptom improvement, and metrics of manual function in a randomized, controlled, double-blinded study. Methods: Sixty patients with basal joint arthritis were randomized to receive 2 intra-articular hylan injections 1 week apart, 1 placebo injection followed by 1 corticosteroid injection 1 week later, or 2 placebo injections 1 week apart. Patients were evaluated at 2, 4, 12, and 26 weeks and assessed with Visual Analog Scale pain scores, strength measures, difference scores, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and range of motion measurements. Results: All groups reported pain relief at 2 weeks. The steroid and placebo groups had significantly less pain at week 4 compared with baseline, but this effect disappeared by week 12. Only hylan injections continued to provide pain relief at 12 and 26 weeks compared with baseline. There were no significant differences in pain between groups at any time. At 12 and 26 weeks, the hylan group had improved grip strength compared with baseline, whereas the steroid and placebo groups were weaker. At 4 weeks, the steroid group reported in the difference score a greater improvement in symptoms (68{\%}) compared with the hylan (44{\%}) and placebo (50{\%}) groups. Whereas at 26 weeks the hylan group reported the largest improvement in symptoms (68{\%}), this was not statistically different from the placebo (47{\%}) and steroid (58{\%}) groups. There were no significant differences in Disabilities of the Arm, Shoulder, and Hand scores or range of motion among the groups. There were no complications from any injection. Conclusions: There were no statistically significant differences among hylan, steroid, and placebo injections for most of the outcome measures at any of the follow-up time points. However, based on the durable relief of pain, improved grip strength, and the long-term improvement in symptoms compared with preinjection values, hylan injections should be considered in the management of basal joint arthritis of the thumb. Type of study/level of evidence: Therapeutic I.",
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AU - Kim, Paul D.

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AU - Strauch, Robert J.

AU - Rosenwasser, Melvin P.

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N2 - Purpose: Conservative, nonsurgical therapies for basal joint osteoarthritis, such as thumb spica splinting and intra-articular corticosteroid injections, remain the mainstays for symptomatic treatment. This study compares intra-articular hylan, corticosteroid, and placebo injections with regard to pain relief, strength, symptom improvement, and metrics of manual function in a randomized, controlled, double-blinded study. Methods: Sixty patients with basal joint arthritis were randomized to receive 2 intra-articular hylan injections 1 week apart, 1 placebo injection followed by 1 corticosteroid injection 1 week later, or 2 placebo injections 1 week apart. Patients were evaluated at 2, 4, 12, and 26 weeks and assessed with Visual Analog Scale pain scores, strength measures, difference scores, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and range of motion measurements. Results: All groups reported pain relief at 2 weeks. The steroid and placebo groups had significantly less pain at week 4 compared with baseline, but this effect disappeared by week 12. Only hylan injections continued to provide pain relief at 12 and 26 weeks compared with baseline. There were no significant differences in pain between groups at any time. At 12 and 26 weeks, the hylan group had improved grip strength compared with baseline, whereas the steroid and placebo groups were weaker. At 4 weeks, the steroid group reported in the difference score a greater improvement in symptoms (68%) compared with the hylan (44%) and placebo (50%) groups. Whereas at 26 weeks the hylan group reported the largest improvement in symptoms (68%), this was not statistically different from the placebo (47%) and steroid (58%) groups. There were no significant differences in Disabilities of the Arm, Shoulder, and Hand scores or range of motion among the groups. There were no complications from any injection. Conclusions: There were no statistically significant differences among hylan, steroid, and placebo injections for most of the outcome measures at any of the follow-up time points. However, based on the durable relief of pain, improved grip strength, and the long-term improvement in symptoms compared with preinjection values, hylan injections should be considered in the management of basal joint arthritis of the thumb. Type of study/level of evidence: Therapeutic I.

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