IGeL kritisch betrachtet: Intraartikuläre Injektion von Hyaluronsäure bei Gonarthrose

Zusammenfassung

Hintergrund und Problemstellung: Die intraartikuläre Injektion von Hyaluronsäure und deren Derivaten wird im Rahmen der Therapie von degenerativen Gelenkerkrankungen (z. B. Gonarthrose) als individuelle Gesundheitsleistung (IGeL) angeboten. Es wurde die Frage untersucht, ob die intraartikuläre Injektion von Hyaluronsäurepräparaten im Vergleich zu anderen Behandlungsmethoden bei Gonarthrose effektiv ist.

Methode: Im Rahmen eines selektiven Reviews wurde eine intensive Literaturrecherche in den Datenbanken MEDLINE sowie in der Cochrane Database of Systematic Reviews und Cochrane CENTRAL durchgeführt.

Ergebnisse: Metaanalysen und systematische Übersichtsarbeiten zu diesem Themenkomplex sind rar und weisen eine hohe Heterogenität der Ergebnisse auf. Mögliche Hinweise auf einen Effekt intraartikulärer Injektionen von Hyaluronsäure im Sinne einer Verbesserung der Beschwerdeintensität und Beweglichkeit zeigten sich allenfalls bei Patienten mit mittelgradiger Gonarthrose. Viele diesbezügliche randomisierte kontrollierte Studien wurden jedoch von der Industrie finanziell unterstützt. Mögliche systematische Fehlerquellen (z. B. publication bias) sind daher nicht auszuschließen.

Schlussfolgerung: Eine eindeutige Überlegenheit der Effektivität von intraartikulär applizierter Hyaluronsäure bei Gonarthrose gegenüber anderen Therapieverfahren kann zurzeit aufgrund der heterogenen Ergebnisse der vorliegenden Studien nicht belegt werden. Daher kann eine intraartikuläre Injektionstherapie mit Hyaluronsäure bei Gonarthrose nicht generell empfohlen werden.

Abstract

Background and Problem: The intra-articular injection of hyaluronic acid and its derivatives is offered as a voluntary, non-covered health service (IGeL) to those undergoing therapy for degenerative joint illnesses (e.g. gonarthrosis). The question was examined whether the intra-articular injection of hyaluronic acid preparations is effective in the treatment of gonarthrosis in comparison to other methods.

Method: As part of a selective review, an intensive literature research was carried out in the MEDLINE database, as well as the Cochrane Database of Systematic Reviews and Cochrane CENTRAL.

Results: Meta-analyses and systematic overviews on this subject are rare and show widely differing results. Possible indications of the positive impact of intra-articular injections of hyaluronic acid in terms of discomfort relief and increased mobility were at best noticeable in patients with moderate gonarthrosis. However, many of the randomized controlled studies on the subject were financed by industry. Possible systematic error sources (e.g. publication bias) can therefore not be ruled out.

Conclusion: Judging by the heterogeneous results of the studies under review, intra-articular hyaluronic acid injections are not clearly more effective than other therapies in the treatment of gonarthrosis. An intra-articular hyaluronic acid injection therapy for the treatment of gonarthrosis can therefore not be generally recommended.

Hyaluronsäure - Osteoarthritis - Gonarthrose - Wirksamkeit - Nutzenbewertung

hyaluronic acid - osteoarthritis - gonarthrosis - efficacy - effectiveness

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