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J. Karlsson, L. Sjögren and S. Lohmander

Department of Orthopaedics, Sahlgrenska University Hospital, Östra, SE-416 85 Göteborg, Sweden.

Correspondence to: J. Karlsson. E-mail: jon.karlsson{at}vgregion.se

We thank Drs Magilavy, Polisson and Parenti for their interesting letter concerning our trial comparing different intra-articular treatments with hyaluronan. They have put forward an interesting hypothesis to explain the comparative lack of differences in outcome between the treatment groups in our trial.

The earlier study they referred to, by Lohmander et al. [1], did not find a difference between placebo (saline) and hyaluronan for the whole treatment population. However, subgroup analysis showed an advantage for the hyaluronan-treated group when this was limited to those older than 65 yr and with more severe symptoms. Radiological stage of osteoarthritis (OA) was found not to influence outcome in this trial. With this knowledge, the subsequent trial was planned to focus on this particular subgroup of knee OA patients, and found only a small difference between hyaluronan and placebo, and no difference between the two different hyaluronan preparations. A subgroup analysis was not performed in this trial due to power limitations.

Comparison of outcome in different trials of OA is complex because of differences in outcome measures, study populations and other causes. While the explanation suggested by Dr Magilavy and colleagues remains a possibility, there may be many other possible reasons for the different outcomes and conclusions of these trials.

References

  1. Lohmander LS, Dalén N, Englund G et al. Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, double blind, placebo controlled multicentre trial. Ann Rheum Dis 1996;55:424–31[Abstract]
Accepted 10 February 2003





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