Local treatments

Applied locally, NSAIDs are effective in mild osteoarthritis.
They have fewer side effects and better tolerance than oral NSAIDs.

Analgesic treatments administered in intra-articular injections may also be used.

Corticosteroids
Used as symptomatic treatment for all osteoarthritic joints, they can be injected directly into the painful joint in the event of a painful flare-up to give fast relief to the patient.

Their effects usually fade within a few weeks. In some osteoarthritic locations (deep joint such as the hip or small distal joint) the injection can be performed under "scopic" or ultrasound control to ensure the intra-articular character of the injection, the result of injections being better when they are intra-articular. The risk of infectious complications is low. Rest of the injected joint is recommended for 24-48 hours after the procedure.

Hyaluronic acid
Treatment with hyaluronic acid is indicated in knee osteoarthritis of moderate severity. It consists of three intra-articular injections spaced one week apart. Single injection treatments have recently been developed showing no difference in efficacy compared to those requiring three injections. This therapeutic effect is significantly greater than that of a placebo.

The analgesic effect is prolonged in the medium term (3 to 6 months to 12 months). The treatment is well tolerated and has few side effects. Studies regarding potential structural effects are contradictory and do not currently enable using these molecules with structural effects.

Apart from knee osteoarthritis, the efficacy studies are inconclusive, but their use is however proposed in the treatment of digital osteoarthritis and hip osteoarthritis by professional consensus (EULAR 2006 recommendations for digital osteoarthritis and EULAR 2004 for hip osteoarthritis).

There are many hyaluronic acids (HA) indicated in knee osteoarthritis commercialised in France. Their main difference lies in their molecular weight. There is no formal proof of the superiority of high molecular weight HA in relation to low weight.

Bibliography
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