作者：Maheu E, et al. 翻译：北医三院李常虹 摘要（法国）：对于使用非甾体抗炎药治疗但仍有症状的骨关节炎患者，欧洲ESCEO协会推荐把关节腔注射透明质酸作为膝骨关节炎的二线治疗方案。该推荐意见的制定是基于大量的累积证据——关节腔内注射透明质酸能够给膝骨关节炎患者带来益处。良好的证据表明，关节腔内注射透明质酸可减轻膝骨关节炎患者的疼痛、增加关节功能，且与关节腔内注射糖皮质激素相比，注射透明质酸的益处是长期的。来自真实世界的研究表明，重复关节腔内注射透明质酸可改善患者疼痛或关节功能长达40个月，减少50%的止痛药使用，提示该治疗方式可延缓全膝关节置换手术约2年。关节腔内注射透明质酸可带来两方面的临床获益：（1）关节内机械性补充透明质酸可起到润滑和减震的作用；（2）通过诱导内源性透明质酸的产生来重塑关节内稳态，可在停止治疗后持续很长时间。不同透明质酸类产品给患者带来的临床益处可能不同，但至今缺乏证据，仍需要进一步去探索。尽管有报道显示关节腔内注射高分子量的透明质酸可轻度增加局部反应和注射后非化脓性关节炎的风险，但总体来说，关节腔内注射透明质酸还是很安全的。ESCEO工作组推荐轻中度膝关节炎患者、或更为推荐严重的骨关节炎患者接受关节腔内注射透明质酸治疗，以期延迟全膝关节置换时间。进一步研究哪部分骨关节炎患者能够从该治疗方式中获益是十分必要的。关节腔内注射透明质酸是治疗膝骨关节炎多模式中的安全有效的方式。

附全文：The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends intra-articular (IA) hyaluronic acid (HA) for management of knee osteoarthritis (OA) as second-line treatment in patients who remain symptomatic despite use of non-steroidal anti-inflammatory drugs (NSAIDs). This recommendation is based upon accumulating evidence that IA HA provides a significant benefit in knee OA. There is good evidence that IA HA injections reduce pain and increase function in knee OA, and the benefits are long-lasting as compared with IA corticosteroids. Evidence from real-life studies of repeat courses of IA HA demonstrates an improvement in pain or function lasting up to 40 months (12 months after the last injection cycle), a reduction in use of concomitant analgesia by up to 50%, and suggests that there may be a delay in the need for total knee replacement (TKR) of around 2 years. The clinical benefit of IA HA on knee OA may be 2-fold: (i) mechanical viscosupplementation of the joint (allowing lubrication and shock absorption) and (ii) the re-establishment of joint homeostasis through induction of endogenous HA production, which continues long after the exogenous injection has left the joint. The magnitude of the clinical effect may be different for different HA products, but this has not been proven so far and requires further investigation. IA HA injections are generally considered to be safe, although a slightly higher number of cases of local reactions and post-injection non-septic arthritis has been reported with high molecular weight cross-linked HAs. The use of IA HA in knee OA patients with mild-moderate disease, and for more severe patients wishing to delay TKR surgery, is recommended by the ESCEO task force. Further investigation into the OA patient types most likely to benefit from IA HA is warranted. Viscosupplementation with IA HA is a safe and effective component of the multi-modal management of knee OA.

引自：Maheu E, Rannou F, Reginster JY. Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum， 2016，45(4 Suppl):S28-33.