Donald M. Marcus, MD
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=L15-0098.
Marcus D.; Pharmacologic Interventions for Knee Osteoarthritis. Ann Intern Med. 2015;162:672. doi: 10.7326/L15-5090
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Published: Ann Intern Med. 2015;162(9):672.
TO THE EDITOR:
In their complex review of pharmacologic interventions for treatment of knee osteoarthritis, Bannuru and colleagues (1) reported that intra-articular (IA) hyaluronic acid had the highest effect size for relief of pain compared with oral placebo. That comparison is misleading, because the appropriate control for IA hyaluronic acid is IA placebo injection.
Although the authors and the accompanying editorial (2) note that the apparent efficacy of hyaluronic acid may result from the stronger placebo effect of an injection, the comparison with oral placebo gives unwarranted credibility to the efficacy of hyaluronic acid and is subject to misinterpretation. For example, a commentary by a physician in an online medical newsletter (3) ignored the issue of placebo effects and questioned recommendations against the use of hyaluronic acid. Another online newsletter (4) cited the biggest benefit from hyaluronic acid and failed to consider data from other reviews and guidelines.
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