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Are There Distinctive Inflammatory Flares After Hylan G-F 20 Intraarticular Injections?
SALLY PULLMAN-MOOAR, PEKKA MOOAR, MARIE SIECK, GILDA CLAYBURNE, and H. RALPH SCHUMACHER
ABSTRACT.
Methods. Eight patients with painful local reactions after intraarticular hylan G-F 20 injections for knee osteoarthritis were evaluated clinically, with detailed synovial fluid analysis, and followed for outcome. Results. Leukocyte counts ranged from 3150 to 103,000/mm3. Crystals were seen in one patient. Inflammatory knee effusions occurred from 1 to 48 h after injections, but never with first injections. Synovial fluid volumes were 30 to 71 mm3. Three patients had shiny clumps (not further characterized) that were noted in leukocytes on Wright stained smears. Most patients were treated with aspiration and depot steroids. Five of the 8 patients had moderate or greater improvement at 6 months. Conclusion. The majority of the occasional dramatic episodes of inflammation after hylan G-F 20 injection do not seem to be related to crystals. No detrimental lasting results were noted. The absence of post-hylan flares following the first intraarticular injection in this small series suggests that sensitization to or accumulation of hylan G-F 20 or its breakdown products may play an etiologic role in these flares. (J Rheumatol 2002;29:2611-4) Key Indexing Terms:
HYALURONIC ACID INJECTIONS
From the MCP/Hahneman University School of Medicine and the Veteran's Affairs Medical Center, Philadelphia, Pennsylvania, USA. S. Pullman-Mooar, MD, VA Medical Center; P.A. Mooar, MCP/Hahneman University School of Medicine; M. Sieck, MLT; G. Clayburne, MLT, VA Medical Center; H.R. Schumacher Jr, VA Medical Center, University of Pennsylvania, Philadelphia, PA. Address reprint requests to Dr. S. Pullman-Mooar, VA Medical Center (151), University and Woodland Avenues, Philadelphia, PA 19104. Submitted October 29, 2001; revision accepted June 12, 2002. |