EUROVISCO Consensus Guidelines for the Use of Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis Based on Patient Characteristics.

Objectives: Viscosupplementation with hyaluronic acid (HA) is a commonly used intra-articular treatment for osteoarthritis (OA). We performed a Delphi consensus process to formulate guidelines for the use of intra-articular hyaluronic acid (IAHA) knee injection according to the patient's characteristics.
Methods: The EUROVISCO group consists of 12 members who had expertise in clinical and/or research in the field of OA and IAHA treatment. This group drafted issues through an iterative process and subsequently voted according to a Delphi process on their level of agreement (LoA) on these recommendations. The scores were pooled to generate a median agreement score for each recommendation. The strength of the recommendation (SOR) was classified as strong if the median agreement score was ≥8. The level of consensus (LOC) was also obtained. The level of evidence was given for each recommendation.
Results: A total of 34 statements were evaluated by the expert group. A unanimous or high LoA was obtained in 16. IAHA can be considered irrespective of the age in patients with symptomatic knee OA. It can be used in patients with diabetes and/or moderate to severe obesity. It can also be used in knee OA patients with a history of gout, meniscocalcinosis and with mild-to-moderate varus/valgus malalignment. The group recommended against the use of VS in pregnant women and in OA flare.
Conclusion: In summary, the working group provided strong recommendations for the use of IAHA injection that will facilitate individualized treatment decision algorithms in the management of knee OA.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: We wish to draw the attention of the Editor to the following facts that may be considered as potential conflicts of interest related to the subject and to significant financial contributions to this work. Yves Henrotin: received honorarium from Menarini, Flexion Therapeutics, IBSA, Bioiberica, Expanscience, Royal Canin, Magpharm, Pfizer, Fidia, LABRHA, and Tilman SA and Grunenthal, Artialis, KiOmed Pharma, and Genequine for consultant services. Pascal Richette received fees from BioIbérica, Fidia, IBSA, Expanscience, Genévrier, Sanofi, Rottapharm, Servier, Flexion Therapeutics, and Ménarini. Hervé Bard received speaker and expert fees from Sanofi, Pfizer, Labrha, Expanscience, and TRB Chemedica. Thierry Conrozier received honorarium from Sanofi, MEDAC, Fidia, and Labrha for expert or consultant services. Xavier Chevalier received fees as a Genevrier Board member, Sanofi-Aventis expert, member of the IBSA foundation, speaker in IBSA and Labrha meetings, and Moebius and Flexion Therapeutics consultant. Alberto Migliore received consulting fees from AbbVie, BMS, MSD, Fidia, Sanofi, IBSA, Pfizer, and Labrha, for national and international studies and courses. Jordi Montfort received consulting fees from Sanofi and Bioiberica. Dominique Baron received speaker fees from LCA and Expanscience. Demirhan Diraçoglu received speaker fees from LABRHA. Mats Brittberg is a Member Advisory board of Episurf Medical AB, Xintela AB, Magellan Stem Cells PTY Ltd, Cline Scientific AB, Askel Healthcare Ltd, and Vanarix SA; Participation Speaker’s bureau for Arthrex and for Anika Therapeutics; and Member editorial board Osteoarthritis & Cartilage, Editor-in-Chief CARTILAGE.