Meta-analysis of hyaluronate injections for shoulder pain: Comment on the article by Saito et al

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Meta-Analysis of Hyaluronate Injections for Shoulder Pain: Comment on the Article by Saito et al

To the Editors:

We read with great interest the article by Saito et al, published recently in Arthritis Care & Research, regarding hyaluronate injections (Saito S, Furuya T, Kotake S. Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: a meta-analysis of randomized controlled trials. Arthritis Care Res [Hoboken] 2010;62:1009–18). Although we appreciate the effective study design and the clear exposure, we would like to comment on the variability of diagnosis of shoulder pain included in the meta-analysis.

First, “periarthritis” is an old and imprecise diagnosis. Today we are able to precisely identify the pathologic tendon involved in the disease. Therefore, in a scientific article, this term should be substituted with the precise diagnosis that represents the different pathologic situations and the different structures involved in the disease. Second, the hyaluronate injections in the analyzed studies were performed in different locations (e.g., subacromial space, intraarticular joint, etc.).

These facts, in our opinion, make the study by Saito et al less effective. In order to provide potentially useful information for therapeutic recommendations, the diagnosis and treatment must be more homogenous.

Roberto Padua MD* †, Federica Alviti MD‡, Luca Padua MD§, Alessandro Castagna MD¶, * Don Gnocchi Foundation and GLOBE, Evidence-Based, Orthopedics Working Group of Italian Society of Orthopedics and Traumatology Rome, Italy, † Nicola's Foundation, Arezzo, Italy, ‡ GLOBE, Evidence-Based Orthopedics Working Group of Italian Society of Orthopedics and Traumatology and Sapienza University of Rome, Rome, Italy, § Don Gnocchi Foundation and Neurology Institute, Catholic University, Rome, Italy, ¶ Instituto Clinico Humanitas, Milan, Italy.

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