Case Report
Volume 12 Issue 6 - 2021
Acute Pseudogout Attack Precipitated by Intra-Articular Injection of a Cross-Linked Hyaluronate Combined with Triamcinolone Hexacetonide
Yoon Kam Hon*
Consultant Physician and Rheumatologist, El Shaddai Arthritis and Rheumatism Specialist Medical Centre, Singapore
*Corresponding Author: Yoon Kam Hon, Consultant Physician and Rheumatologist, El Shaddai Arthritis and Rheumatism Specialist Medical Centre, Singapore.
Received: April 30, 2021; Published: May 29, 2021




Abstract

Intra-articular hyaluronic acid (IAHA) injection is widely used in the day-to-day management of symptomatic osteoarthritis (OA) of the knees with good efficacy and minimal side effects. Occasionally OA and chondrocalcinosis can co-exist in some patients. IAHA injection is widely used in the day-to-day management of symptomatic OA knees with good efficacy and minimal side effects in my clinic. Induction of an acute attack of calcium pyrophosphate dihydrate (CPPD) arthritis by IAHA has been rarely reported. We report a patient who developed acute pseudogout after IA Cingal injection, despite the triamcinolone hexacetonide given in the IA, and also reviewed previous reports and discussed preventive and management approaches to avoid such an unpleasant but, thankfully, a rare occurrence.

Keyword: Pseudogout Trigger; Intra-articular Hyaluronic Acid; Injection

References

  1. Hamburger MI., et al. “Intra-articular hyaluronans: a review of product-specific safety profiles”. Seminars in Arthritis and Rheumatism 5 (2003): 296-309.
  2. Hangody L., et al. “Intraarticular Injection of a Cross-Linked Sodium Hyaluronate Combined with Triamcinolone Hexacetonide (Cingal) to Provide Symptomatic Relief of Osteoarthritis of the Knee: A Randomized, Double-Blind, Placebo-Controlled Multicenter Clinical Trial”. Cartilage3 (2018): 276-283.
  3. Sedrak P., et al. “Differential characteristics and management of pseudoseptic arthritis following hyaluronic acid injection is a rare complication: a systematic review”. Journal of ISAKOS 2 (2021): 94-101.
  4. Parperis K., et al. “Management of calcium pyrophosphate crystal deposition disease: A systematic review”. Seminars in Arthritis and Rheumatism 1 (2021): 84-94.
  5. Maillefert JF., et al. “Acute attack of chondrocalcinosis after an intraarticular injection of hyaluronan”. Revue du Rhumatisme (English Edition) 10 (1997): 593-594.
  6. Luzar MJ and Altawil B. “Pseudogout following intraarticular injection of sodium hyaluronate”. Arthritis and Rheumatology 5 (1998): 939-940.
  7. Pullman-Mooar S., et al. “Are there distinctive inflammatory flares of synovitis after hylan GF intraarticular injections?” Journal of Rheumatology 12 (2002): 2611-2614.
  8. Ali Y., et al. “Acute pseudogout following intra-articular injection of high molecular weight hyaluronic acid”. American Journal of Medicine 6 (1999): 641-642.
  9. Kroesen S., et al. “Induction of an acute attack of calcium pyrophosphate dihydrate arthritis by intra-articular injection of hylan G-F 20 (Synvisc)”. Clinical Rheumatology 2 (2000): 147-149.
  10. Disla E., et al. “Recurrent acute calcium pyrophosphate dihydrate arthritis following intraarticular hyaluronate injection”. Arthritis and Rheumatology 6 (1999): 1302-1303.
  11. Punzi L., et al. “Pseudogout and intraarticular hyaluronate injections: comment on the article by Disla et al”. Arthritis and Rheumatology 7 (2000): 1660-1661.
  12. Ryan T., et al. “Tramadol as an adjunct to intra-articular local anaesthetic infiltration in knee arthroscopy: a systematic review and meta-analysis”. ANZ Journal of Surgery 7-8 (2019): 827-832.
  13. Siró B. “The intraarticular and local administration of glucocorticosteroid preparations”. Orvosi Hetilap 6 (2009): 251-260.
  14. M Rull., et al. “Intra-articular corticosteroid preparations: different characteristics and their effect during inflammation induced by monosodium urate crystals in the rat subcutaneous air pouch”. Rheumatology (Oxford)9 (2003): 1093-100.
  15. Yoon KH. “Intraarticular Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the Treatment of Inflammatory Arthritis: Establishing a Role in Arthritis Patient Care Today”. EC Orthopaedics11 (2019): 52-63.
  16. Romera M. “Effect of intraarticular hyaluronate injections in chondrocalcinosis: comment on the article by Martens”. Arthritis and Rheumatology 3 (2002): 847.
  17. Mongkhon JM., et al. “Sorbitol-modified hyaluronic acid reduces oxidative stress, apoptosis and mediators of inflammation and catabolism in human osteoarthritic chondrocytes”. Inflammation Research 8 (2014): 691-701.
  18. Conrozier T. “Is the Addition of a Polyol to Hyaluronic Acid a Significant Advance in the Treatment of Osteoarthritis?” Current Rheumatology Reviews 3 (2018): 226-230.
Citation: Yoon Kam Hon. “Acute Pseudogout Attack Precipitated by Intra-Articular Injection of a Cross-Linked Hyaluronate Combined with Triamcinolone Hexacetonide”. EC Orthopaedics 12.6 (2021): 67-71.

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