Improvement of rhizarthrosis pain management with the infiltration of hyaluronic acid and corticosteroids versus corticosteroids alone.

Abstract

Objectives: The clinical management of rhizarthrosis relies on several pharmacological approaches, demonstrating variable efficacy. The present study aimed at assessing the potential benefit of the combined infiltration of corticosteroids and hyaluronic acid to reduce trapeziometacarpal osteoarthrisis pain at three months, as compared to the administration of corticosteroids alone.

Methods: We conducted a single-blind trial with two parallel groups and blinded evaluation. Eligible patients (n=150) were randomly assigned to receive hyaluronic acid and corticosteroid (n=74) or saline and corticosteroid infiltrations (n=76 Pain was evaluated one, three, six or twelve months (M1, M3, M6, M12) after infiltration.

Results: In total, 149 patients received the injection (mean age 62 years old; 83% females). When looking at the primary end point (M3), reduction of pain during activity was greater in the hyaluronic acid + corticosteroid group, as compared to the corticosteroids + placebo (difference -1.1 on a 0-10 points visual analogue scale, 95% confidence interval [-1.9; -0.2], p=0.012). For the secondary end points (visual analogue scores at rest and during activity at M1, M6 and M12), improvements were observed, although not statistically significant (except at M1). Finally, grip and opposition strength remained unchanged between groups along the follow-up.

Conclusions: In patients with painful rhizarthrosis, the infiltrations of hyaluronic acid and corticosteroids demonstrate better efficacy in reducing pain during activity 3 months after intervention, compared to injections with only corticosteroids. The present study brings new arguments in favour of the combination of these two drugs for the clinical management of trapeziometacarpal osteoarthrisis.