Impact of Hyaluronic Acid Treatment on Rhizarthrosis: a Systematic Review.

PURPOSE: Trapeziometacarpal (TMC) joint osteoarthritis (OA) is a common disabling condition. Current treatments do not have a significant impact on symptom relief or disease progression and the benefit of visco-supplementation remains uncertain. We aim to evaluate the efficacy of hyaluronic acid (HA) intra-articular injection in rhizarthrosis. METHODS: A systematic review of the literature addressing the efficacy of HA on pain reduction, functional capacity or pinch strength in patients with rhizarthrosis was performed. Pain at rest, functional capacity and pinch strength were assessed at baseline, 4th, 12th and 24th weeks Results: Sixteen trials were included with a total of 587 patients treated with HA injections (9 randomized controlled trials (RCTs), 5 single-arm studies and 2 non-randomized comparative trials). Despite important heterogeneity among trials, HA injections lead to a reduction in pain at rest (decrease of 0.65-3.5 points and 0.8-4.03 points on Visual Analogue Score after 4th and 24th weeks respectively, compared to baseline). Regarding disability, as assessed by functional scales, all studies reported improvement on functionality. An increase in pinch strength of 0.1-1.4 kg and 0.4-2kg was also reported at 4th and 24th weeks respectively. CONCLUSION: HA injections can be a valid therapeutic option inducing remission of pain with improvement of functionality and strength in patients suffering from TMC joint AO.

Spinal cord infarction in children: Can gymnastics be a cause?

INTRODUCTION: Spinal cord infarction (SCI) in children is rare and difficult to diagnose. Fibrocartilaginous embolism (FCE) is probably the underlying cause for some unexplained cases of spinal cord infarcts. Abrupt back pain followed by a progressive syndrome of myelopathy appears to be the typical presentation, with a close temporal relationship between the onset of symptoms and preceding minor trauma. Supportive care and rehabilitation are essential in the treatment of children with SCI. CASE REPORT: A previously healthy 12-year-old girl who practiced acrobatic gymnastics was admitted to a rehabilitation centre 14 days after being diagnosed with an acute anterior SCI with no identified cause. Sensory modality of pin prick and light touch were impaired, with the former more significantly affected. She was not able to run and had difficulty on monopodal standing and performing motor sequencing. Additionally, she mentioned ineffective cough along with flatus incontinence and normal bladder function. After a 4-week multidisciplinary rehabilitation program her neurologic deficits improved. DISCUSSION: Given the patient's age and clinical presentation, a literature review led to the consideration of FCE as the most likely definitive diagnosis. It should be recognized as a cause of SCI especially in those involved in sport activities, even if previous trauma is denied.

Hip osteoarthritis treatment with intra-articular injections: hyaluronic acid versus glucocorticoid - a systematic review.

OBJECTIVE: To compare the effects of intra-articular injection of glucocorticoid (GC) and hyaluronic acid (HA) on pain and disability caused by hip osteoarthritis (HO). MATERIALS AND METHODS: A systematic review of the literature was carried out within MEDLINE (via PubMed), Web of Science, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases, using the keywords (MeSH words): "hip osteoarthritis", "glucocorticoid", "corticosteroid", "corticoid", "hyaluronic acid" and "viscosupplementation". Two independent authors applied inclusion and exclusion criteria, selecting randomized clinical trials with direct comparison between intra-articular injection of GC and HA in patients with HO. RESULTS: 157 articles were found in the initial search. After applying the exclusion criteria, 36 articles were read, with final selection of 3 randomized clinical trials (n = 484). Two studies compared the administration of these products with placebo (saline) - and one also compared it with a fourth group of patients undergoing only physical therapy. Qvistgaard et al. demonstrated clinical superiority of GC (moderate clinical benefit) and HA (marginal clinical benefit) in pain, at 4 weeks, both compared to placebo; however, there was no statistically significant difference between GC and HA during the 12-week follow-up. Atchia et al. reported a statistically significant improvement in pain and function in patients treated with GC during 8 weeks. Spitzer et al. demonstrated an overall clinical response in patients in both groups throughout the study, with a faster response for those treated with GC. However, the authors highlight the superiority in all outcome measures of HA compared to GC in cases of moderate HO, at 26 weeks. DISCUSSION: Few studies directly compare the clinical effect between intra-articular injections of GC and HA in HO, showing heterogeneity in the type of population, number of administrations, formulation of HA and follow-up period. The analyzed studies had a short follow-up time. The results obtained seem to demonstrate a superiority of GC compared to HA in managing pain, namely in the speed of clinical response. However, Spitzer et al. demonstrated an overall superiority of HA in patients with moderate HO, which suggests that optimal selection of patients remains to be defined.