DOI QR코드

DOI QR Code

Acute Pseudoseptic Inflammatory Local Reactions after Intra-articular Hyaluronic Acid Injections in Patients with Knee Osteoarthritis

퇴행성 슬관절염 환자에서 관절 내 Hyaluronic Acid 주입 후 발생한 비감염성 급성 염증반응 2예

  • Lee, Jun Yong (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Nahm, Francis Sahngun (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Park, Soo Young (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Lim, Kyoung Hoon (Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital) ;
  • Park, Chan Do (Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital) ;
  • Lee, Seung Jun (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Kim, Yong Chul (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital) ;
  • Lee, Sang Chul (Department of Anesthesiology and Pain Medicine, Seoul National University Hospital)
  • 이준용 (서울대학교병원 마취통증의학과) ;
  • 남상건 (서울대학교병원 마취통증의학과) ;
  • 박수영 (서울대학교병원 마취통증의학과) ;
  • 임경훈 (분당서울대학교병원 마취통증의학과) ;
  • 박찬도 (분당서울대학교병원 마취통증의학과) ;
  • 이승준 (서울대학교병원 마취통증의학과) ;
  • 김용철 (서울대학교병원 마취통증의학과) ;
  • 이상철 (서울대학교병원 마취통증의학과)
  • Received : 2009.07.10
  • Accepted : 2009.07.30
  • Published : 2009.08.01

Abstract

Knee osteoarthritis is a common, but difficult problem to manage in primary care. Intra-articular hyaluronic acid injection has recently been frequently used for treating knee osteoarthritis. The adverse local reactions, except septic arthritis, following intra-articular hyaluronic acid injections are generally transient and not severe. Pseudoseptic arthritis is an extreme form of inflammatory arthritis that is not due to bacterial infection and it is important to distinguish this from true septic arthritis. In this article, we report 2 cases of acute pseudoseptic local reactions after intra-articular hyaluronic acid injections in patients with knee osteoarthritis.

Keywords

References

  1. So KY, Lee HY: Septic arthritis after intra-articular hyaluronic acid injections in patients with knee osteoarthritis: A report of two cases. Korean J Pain 2002; 15: 80-3
  2. Noh SS, Lee JJ, Hwang SM, Lim SY, Chung IY, Choi YR: Efficacy of intra-articular sodium hyaluronate in patients with osteoarthritis of the knee. Korean J Pain 2004; 17: 170-4 https://doi.org/10.3344/jkps.2004.17.2.170
  3. Brandt KD, Smith GN Jr, Simon LS: Intraarticular injection of hyaluronan as treatment for knee osteoarthritis: what is the evidence? Arthritis Rheum 2000; 43: 1192-203 https://doi.org/10.1002/1529-0131(200006)43:6<1192::AID-ANR2>3.0.CO;2-L
  4. Smith MM, Ghosh P: The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatol Int 1987; 7: 113-22 https://doi.org/10.1007/BF00270463
  5. Sato H, Takahashi T, Ide H, Fukushima T, Tabata M, Sekine F, et al: Antioxidant activity of synovial fluid, hyaluronic acid, and two subcomponents of hyaluronic acid. Synovial fluid scavenging effect is enhanced in rheumatoid arthritis patients. Arthritis Rheum 1988; 31: 63-71 https://doi.org/10.1002/art.1780310110
  6. Takahashi K, Hashimoto S, Kubo T, Hirasawa Y, Lotz M, Amiel D: Hyaluronan suppressed nitric oxide production in the meniscus and synovium of rabbit osteoarthritis model. J Orthop Res 2001; 19: 500-3 https://doi.org/10.1016/S0736-0266(00)90024-X
  7. Kalaci A, Yilmaz HR, Aslan B, Sogut S, Yanat AN, Uz E: Effects of hyaluronan on nitric oxide levels and superoxide dismutase activities in synovial fluid in knee osteoarthritis. Clin Rheumatol 2007; 26: 1306-11 https://doi.org/10.1007/s10067-006-0504-y
  8. Wobig M, Beks P, Dickhut A, Maier R, Vetter G: Openlabel multicenter trial of the safety and efficacy of viscosupplementation with hylan G-F 20 (Synvisc) in primary osteoarthritis of the knee, J Clin Rheumatol 1999; 5: S24-31
  9. Henderson EB, Smith EC, Pegley F, Blake DR: Intra-articular injections of 750 kD hyaluronan in the treatment of osteoarthritis: a randomised single centre double-blind placebo- controlled trial of 91 patients demonstrating lack of efficacy. Ann Rheum Dis 1994; 53: 529-34 https://doi.org/10.1136/ard.53.8.529
  10. Lussier A, Cividino AA, McFarlane CA, Olszynski WP, Potashner WJ, De Medicis R: Viscosupplementation with hylan for the treatment of osteoarthritis: findings from clinical practice in Canada, J Rheumatol 1996; 23: 1579-85
  11. Puttick MP, Wade JP, Chalmers A, Connell DG, Rangno KK: Acute local reactions after intraarticular hylan for osteoarthritis of the knee, J Rheumatol 1995; 22: 1311-4
  12. Bernardeau C, Bucki B, Liotée F: Acute arthritis after intraarticular hyaluronate injection: onset of effusions without crystal. Ann Rheum Dis 2001; 60: 518-20 https://doi.org/10.1136/ard.60.5.518
  13. Chang JE, Cho YJ, Lee J: Local reactions after intraarticular hyaluronic acid injection for osteoarthritis of the knee. J Korean Rheum Assoc 2003; 10: 278-82
  14. Marshall KW: Intra-articular hyaluronan therapy. Curr Opin Rheumatol 2000; 12: 468-74 https://doi.org/10.1097/00002281-200009000-00022
  15. Disla E, Infante R, Fahmy A, Karten I, Cuppari GG: Recurrent acute calcium pyrophosphate dihydrate arthritis following intraarticular hyaluronate injection. Arthritis Rheum 1999; 42: 1302-3 https://doi.org/10.1002/1529-0131(199906)42:6<1302::AID-ANR33>3.0.CO;2-4
  16. Luzar MJ, Altawil B: Pseudogout following intraarticular injection of sodium hyaluronate. Arthritis Rheum 1998; 41: 939-40 https://doi.org/10.1002/1529-0131(199805)41:5<939::AID-ART24>3.0.CO;2-D
  17. Kurosaka N, Takagi T, Koshino T: Effects of hyaluronate on CD44 expression of infiltrating cells in exudate of rat air pouch, induced by sensitization with lipopolysaccharide. J Rheumatol 1999; 26: 2186-90
  18. Henderson EB, Grootveld M, Farrell A, Smith EC, Thompson PW, Blake DR: A pathological role for damaged hyaluronan in synovitis. Ann Rheum Dis 1991; 50: 196-200 https://doi.org/10.1136/ard.50.3.196
  19. Margaretten ME, Kohlwes J, Moore D, Bent S: Does this adult patient have septic arthritis? JAMA 2007; 297: 1478- 88 https://doi.org/10.1001/jama.297.13.1478
  20. Li SF, Cassidy C, Chang C, Gharib S, Torres J: Diagnostic utility of laboratory tests in septic arthritis. Emerg Med J 2007; 24: 75-7 https://doi.org/10.1136/emj.2006.037929