Hip osteoarthritis (OA) is usually managed with systemic treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) and/or symptomatic slow-acting drugs. Unfortunately, many patients either cannot tolerate NSAIDs or suffer serious, even fatal, NSAID-induced side effects, predominantly gastrointestinal ulceration and bleeding. Viscosupplementation, which aims to restore physiological and rheological features of the synovial fluid, is a well-accepted therapeutic option in knee OA patients, but limited data exist in the literature about its potential benefit for the treatment of hip OA. The purpose of this study is to observe the effects of hylan G-F 20 administered through ultrasound (US)-guided intra-articular (IA) injections in patients with symptomatic hip OA. We treated 30 patients with symptomatic hip OA. Under US guidance, 7 patients received one injection, 21 patients had two injections, and 2 patients received three injections, each with 2 ml of hylan G-F 20. Lequesne index, VAS scale of hip pain, and NSAID consumption were evaluated at baseline as well as 2 and 6 months after the beginning of the treatment. No systemic adverse events were observed. Lequesne index, VAS pain score, and NSAID consumption showed a reduction that was statistically significant to the baseline. The present observation suggests the potentiality for the safety and efficacy of hylan G-F 20 injected under US guidance in patients with symptomatic hip OA. Further controlled studies are needed.

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Symptomatic osteoarthritis (OA) patient management includes the use of non-pharmacological therapies, analgesics, physiotherapy and eventually surgery. Whereas local injections (e.g., corticosteroids, hyaluronan) are easily performed on the knee, hip injections are considerably more difficult 1 . Recent literature proves that ultrasound (US)-guided hip injections are safe and allow easy access to the hip joint space 2,3 . Steroids may be injected in this space, but the symptomatic benefit achieved by intra-articular administrations of hyaluronans appears to last longer.This open-label pilot study was aimed at investigating the safety and duration of benefit after the treatment of hip OA patients by US-guided intra-articular injections of 40 mg of Hyalgan Ò , equivalent to two 2-ml tubes. Hyalgan Ò is a natural hyaluronan with a molecular weight of 500e730 kDa that is able to reduce pain associated with OA and to ameliorate joint function. Recent clinical data have shown intra-articular hyaluronans to exert also a positive effect in reducing the progression of the joint disease 4 .

Inflammatory chronic diseases involving joints together with other organs are usually treated with a systemic approach. In a few cases, where arthritis is not responsive to traditional treatments, an intraarticular (I.A.) therapy could be useful. Furthermore, patients not eligible for systemic therapy with anti-TNF or other DMARDs, as well as patients with an initial arthritis with the involvement of a single joint, such as the knee or hip joint, could use the I.A. injection therapy. In this article we report our experience with five patients affected by rheumatic inflammatory diseases, not responding to traditional systemic DMARDs-based therapies or not eligible for systemic use of biological response modifiers who underwent ultrasound-guided I.A. injection of Infliximab. Three of 5 patients showed a positive and long-lasting response to treatment with local Infliximab. Safety profile was good according to literature data. Moreover, in this article we review the literature on this therapeutic approach. This is the first report of I.A. use of Infliximab in the hip joint.