Do you avoid hyaluronic acid injections in patients with chondrocalcinosis on imaging?

The association between viscosupplementation and CPPD flares is reported but not truly well studied. There is a nice case series by Bernardeau et al., PMID 11302877 entitled “Acute arthritis after intra-articular hyaluronate injection: onset of effusions without crystals” in Ann Rheum Dis 2001;60:518-520 where arthropathy occurs without clear explanation but may be associated the CPPD in the involved joint. This article again emphasizes the poor correlation between CPPD and viscosupplementation ...

I agree with @Dr. First Last and @Dr. First Last, as I offer the HA injections to patients even if there is evidence of CPPD on imaging or prior fluid aspirations.

I do not recall any of my patients reporting the swelling/reactions following HA since I stopped using Synvisc years ago - and switched exclusively to any of the 4 options for one-shot products listed by @Dr. First Last. I have not seen any convincing data showing better efficacy with the products that require 3-5 weekly visits.