Pseudo-septic arthritis developed after hyaluronic acid injection: A case report

Yıl 2019, , 278 - 279, 15.03.2019

Özlem Karataş , Tiraje Tuncer

https://doi.org/10.28982/josam.538939

Cited By: 1

Öz

One of the most frequent causes of knee pain is knee osteoarthritis. Intra-articular hyaluronic acid (HA) injection is one of the preferred treatment methods. Although, systemic side effects are not seen, rarely local side effects as pain and swelling can be seen. Following HA injection, some cases with pseudo-septic manifestations unrelated to crystal formation have been reported. In this case report, a patient with knee pain which aggravated with medial tibio-femoral osteoarthritis refractory to conservative treatment methods including administration of non-steroidal anti-inflammatory drugs and others is presented. After intra-articular HA injection, her preexisting knee pain worsened, and swelling, and increase in local temperature were added to the clinical picture. Based on clinical, and laboratory examinations, and analysis of synovial fluid, diagnosis of pseudo- septic arthritis which mimicked manifestations of septic arthritis was made. Clinical, and laboratory improvement was achieved with early treatment. If following intra-articular HA injection, knee pain of the patient aggravates suddenly with local swelling and heat, then the possibility of pseudoseptic arthritis of the affected knee should be always kept in mind.

Anahtar Kelimeler

Knee, Pseudoseptic arthritis, Hyaluronic acid, Knee osteoarthritis

Hylarunoik asid enjeksiyonu sonrası gelişen psödo-septik artrit: Olgu sunumu

Öz

Diz ağrısının en sık nedenlerinden biri diz osteoartritidir. İntraartiküler hyaluronik asit (HA) enjeksiyonları sık tercih edilen tedavi yöntemlerinden biridir. HA enjeksiyonlarından sonra sistemik yan etkiler neredeyse hiç görülmemekle birlikte, seyrek olarak ağrı ve şişlik gibi lokal yan etkiler görülebilmektedir. HA enjeksiyonu sonrası, kristal oluşumuna bağlı olmayan pseudoseptik artrit tablosu literatürde çok az sayıda olguda bildirilmiştir. Bu olguda medial tibia-femoral osteoartrite bağlı yürümekle şiddetlenen, nonsteroidal antiinflamatuar ve diğer konservatif tedavi yöntemlerine yanıtsız diz ağrısı olan ve intraartiküler HA enjeksiyonu uygulandıktan sonra dizinde mevcut olan ağrının artması, şişlik ve ısı artışı eklenmesi nedeniyle yapılan klinik muayene, laboratuvar tetkikleri ve sinoviyal sıvı analizi sonucu hastaya septik artrit tablosunu taklit eden psödoseptik artrit tanısı kondu. Erken tedavi ile klinik ve laboratuvar iyileşme sağlandı. Dize intraartiküler HA enjeksiyonu sonrası bir hastada aniden diz ağrısında artma, şişlik ve ısı artışı olursa, etkilenen eklemde psödoseptik artrit olasılığı her zaman akılda tutulmalıdır.

Anahtar Kelimeler

Diz, Psödoseptik artrit, Hyaluronik asit, Diz osteoartrit

Kaynakça

• 1. Wen DY. Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis. Am Fam Physician. 2000;62:565-70.
• 2. Tuncer T, Çay HF, Kaçar C, Altan L, Atik OŞ, Aydın AT, et al. Evidence-based recommendations for the management of knee osteoarthritis: A consensus report of the turkish league against rheumatism. Turk J Rheumatol. 2012;27(1):1-17.
• 3. Tahiri L, Benbouazza K, Amine B, Hajjaj-Hassouni N. Acute pseudo-septic arthritis after viscosupplementation of the knee: a case report. Clinical Rheumatology. 2007;26(11):1977-9.
• 4. Brandt Kenneth D, Gerald NS, Simon LS. Intra-articular injection of hyaluronan as treatment for knee osteoarthritis. Arthritis Rheum. 2000;43(6):1132-203.
• 5. Goldberg, Victor M., and Richard D. Coutts. Pseudo-septic reactions to hylan visco supplementation: diagnosis and treatment. Clinical Orthopaedics and Related Research. 2004;419:130-7.
• 6. Wen DY. Intra-articular hyaluronic acid injections for knee osteoarthritis. Am Fam Physician. 2000;62(3):565-70,572.
• 7. Leopold SS, Warme WJ, Pettis PD, Shott S. Increased frequency of acute local reaction to intra-articular hylan GF-20 (synvisc) in patients receiving more than one course of treatment. J Bone Joint Surg Am. 2002;84-A(9):1619–23.
• 8. Puttick MP, Wade JP, Chalmers A, Connell DG, Rangno KK. Acute local reactions after intra-articular hylan for osteoarthritis of the knee. J Rheumatol. 1995;22(7):1311–4.
• 9. Idrissi Z, Benbouazza K, Fourtassi M, Raissouni H, El Aadmi M, Zanat F, Hajjaj-Hassouni N. Acute pseudo-septic arthritis following viscosuplementation of the knee. Pan African Medical Journal. 2012;12(1):44.
• 10. Roos J, Epaulard O, Juvin R, Chen C, Pavese P, Brion JP. Acute pseudo-septic arthritis after intra-articular sodium hyaluronan. Joint Bone Spine. 2004;71(4):352–4.
• 11. Michou L, Job-Deslandre C, de Pinieux G, Kahan A. Granulomatous synovitis after intra-articular Hylan GF-20: A report of two cases. Joint Bone Spine. 2004;71(5):438–40.