Viscosupplementation of the knee: Three cases of acute Pseudoseptic Arthritis with painful and irritating complications and a literature review

Aydın, Murat; Arıkan, Murat; Toğral, Güray; Varış, Onur; Aydın, Güle

doi:10.5152/eurjrheum.2016.15075

Cited by 26 publications

(36 citation statements)

References 6 publications

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“…Allergic reaction to avian proteins has been identified as a possible source of the reactions, 5,14 but this may be refuted by similar reactions following the use of non-animal derived HA. 3,8,16 Some have also speculated that the accumulation of HA material or sensitization may be involved due to patients tending to react after their second or later injection or course. 8,13 Leopold et al 9 reported that acute local reactions occurred more than 8 times more frequently in the patients who had received more than 1 course of hylan GF-20 (21%; 4 of 19) than those treated only once (2%; 1 of 42) (P = 0.029).…”

Section: Discussionmentioning

confidence: 99%

“…The safety profile of HA is well established, 1 but some concerns have been raised regarding reactions that follow in a limited number of HA patients. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] These symptoms are generally manifested within several hours to 72 hours after the HA injection, with some occurring 5 to 6 days later. [2][3][4]6,8,9,[12][13][14][17][18][19] Patients may present with severe pain, hot and/or swollen joint, effusion, and loss of function.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] These symptoms are generally manifested within several hours to 72 hours after the HA injection, with some occurring 5 to 6 days later. [2][3][4]6,8,9,[12][13][14][17][18][19] Patients may present with severe pain, hot and/or swollen joint, effusion, and loss of function. [2][3][4]8,9,[12][13][14][15]17,19 Some patients may also have a fever, 3,4,8 but others may have normal body temperatures.…”

Section: Introductionmentioning

confidence: 99%

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Severe Acute Localized Reactions Following Intra-Articular Hyaluronic Acid Injections in Knee Osteoarthritis

et al. 2020

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Objective Concerns have been raised about severe acute localized reactions (SALR) following intra-articular (IA) hyaluronic acid (HA) injections for knee osteoarthritis (OA). We compared surrogate SALR measures between hylan G-F 20 and non-hylan G-F 20 HA patients and evaluated corresponding SALR risk factors for hylan G-F 20 patients. Design Knee OA patients were identified from the Optum Clinformatics dataset (January 2006 to June 2016), stratified into hylan G-F 20 and non-hylan G-F 20 HA users. Occurrences of surrogate SALR measures including inflammation/infection, intra-articular corticosteroid (CS) injections, arthrocentesis/aspiration, and office visits were evaluated within 3 days of HA use. Risk factors were evaluated using logistic regression. Results The cohort involved 748,428 HA patients (23.2% in the hylan G-F 20 group). Inflammation/infection rate was 0.001% for hylan G-F 20 and 0.002% for non-hylan G-F 20 HA groups. Risk of CS injection (any diagnosis) was greater for hylan G-F 20 patients by 28% ( P < 0.001). Combined rates of CS injection and arthrocentesis/aspiration (any diagnosis) were comparable for both groups (hylan G-F 20, 2.2%; non-hylan G-F 20 HA, 2.6%). The risk of any visit or studied responses was lower for the hylan G-F 20 cohort by 12% ( P < 0.001). Clinical characteristics, such as CS injections within 1 week before HA and fluoroscopic imaging, were associated with the outcomes. Conclusions The diagnosis of inflammations or infections within 3 days of the HA injection was extremely rare. The overall risk of surrogate SALR measures was similar for hylan G-F 20 and non-hylan G-F 20 HA patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe Acute Localized Reactions Following Intra-Articular Hyaluronic Acid Injections in Knee Osteoarthritis

et al. 2020

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“…Serious adverse reactions following viscosupplementation are uncommon. Reports of local pain following injection vary from 1 to 33% of the patients and up to 3% experience a pseudoseptic reaction, with joint swelling and intense pain [9,10]. High molar mass compounds were more frequently associated to local flares.…”

Section: Introductionmentioning

confidence: 99%

“…High molar mass compounds were more frequently associated to local flares. Reasons for this pseudoseptic reaction are ascribed to immune sensitization since they usually occur after a first injection but their occurrence following a single injection questions this assumption [1,10]. Due to ethical reasons, it is hard to demonstrate whether viscosupplementation compounds promote synovitis after injection into human healthy joints.…”

Section: Introductionmentioning

confidence: 99%

Hylan G-F20 and galactomannan joint flares are associated to acute synovitis and release of inflammatory cytokines

et al. 2020

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Background: Injection of Hylan G-F20 (HY) into joints may provoke local flares, which mechanisms may involve reaction to protein contaminants. We have previously developed a protein-free saline-soluble galactomannan derived from guar gum (GM) that displays both analgesia and chondroprotection in experimental osteoarthritis (OA). We now demonstrate that both GM and Hylan G-F20 (HY) promote mild synovitis with cytokine release after intra-articular injection. Methods: Mice received 100 μg/25 μL GM or HY or saline into the knees. Joint pain was evaluated using von Frey test; cell influx, interleukin (IL)-1, IL-6, and CXCL-1 (pg/mL) levels were assessed in joint lavage at 6 h. Synovia were excised for histopathology. Results: Neither GM nor HY after being given into mice knee joints induced pain albeit promoting mild cell influx into joint washings as well as mild synovitis at histology, with no damage to the underlying cartilage. HY but not GM promoted IL-1 release into mice joints. Both compounds induced IL-6 and CXCL-1 release. Conclusion: Intra-articular injection of HY or GM promote acute transient synovitis whilst not provoking detectable significant joint damage. Local administration of these polysaccharides induces acute intra-articular release of inflammatory cytokines, which may account for joint flares following viscosupplementation.

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Pseudogout flare after platelet‐rich plasma injection: A case series

Schroeder

Johnson

Sellon

2021

PM&R

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Viscosupplementation of the knee: Three cases of acute Pseudoseptic Arthritis with painful and irritating complications and a literature review

Cited by 26 publications

References 6 publications

Severe Acute Localized Reactions Following Intra-Articular Hyaluronic Acid Injections in Knee Osteoarthritis

Severe Acute Localized Reactions Following Intra-Articular Hyaluronic Acid Injections in Knee Osteoarthritis

Hylan G-F20 and galactomannan joint flares are associated to acute synovitis and release of inflammatory cytokines

Pseudogout flare after platelet‐rich plasma injection: A case series

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