BACKGROUND: Intra-articular hyaluronic acid (IAHA) products are often used in the treatment of adults with mild-to-moderate knee osteoarthritis (KOA). The International Symposium on Intra-Articular Treatment (ISIAT) convened a multidisciplinary technical expert panel to define characteristics for an innovative IAHA product that should answer unmet needs in the clinical management of adults with mild-to-moderate KOA. METHODS: An initial set of evidence-based statements was developed based on data extracted from articles identified through a comprehensive literature search. A Delphi panel comprising 19 experts in KOA voted in 3 rounds to rate their degree of agreement with accepted statements. RESULTS: The final set of 13 accepted statements focus on the effect of an innovative IAHA across 5 key domains of nociceptive pain, joint function, quality of life, joint structure and integrity, and adverse effects. The statements set thresholds for clinically meaningful improvements that exceed those generally achievable by currently available IAHA products. CONCLUSION: The characteristics described by these statements from the ISIAT set new standards for what should be expected from an innovative IAHA. These statements should serve as a framework for driving the development of innovative IAHA products that will surpass the actual outcomes achieved by current viscosupplements in patients with mild-to-moderate KOA.

Center for Treatment Comparison and Integrative Analysis Tufts University School of Medicine Boston MA 02116 USA

Department of Experimental and Clinical Medicine University of Florence 50121 Florence Italy

Department of Family Practice and Division of Sport and Exercise Medicine University of British Columbia Vancouver BC V6Z 3B7 Canada

Department of Internal Medicine and Rheumatology University of Medicine and Pharmacy Carol Davila 050474 Bucharest Romania

Department of Medical and Surgical Specialties and Dentistry University of Campania 'Luigi Vanvitelli' 81100 Caserta Italy

Department of Metabolic Diseases of Bone and Joints VA Nasonova Research Institute of Rheumatology 115522 Moscow Russia

Department of Orthopaedics and Traumatology Fondazione Policlinico Tor Vergata 00133 Rome Italy

Department of Orthopaedics and Traumatology Fondazione Policlinico Universitario Campus Bio Medico of Rome 00128 Rome Italy

Department of Orthopaedics and Traumatology San Pietro Fatebenefratelli Hospital 00189 Rome Italy

Department of Orthopaedics and Traumatology University of Campinas Saint Paul 13083 Brazil

Department of Orthopedic Surgery Humanitas Research Hospital 20089 Milan Italy

Department of Orthopedic Surgery Johanna Etienne Hospital 41462 Neuss Germany

Department of Physical Medicine and Rehabilitation Istanbul Faculty of Medicine Istanbul University 34093 Istanbul Turkey

Department of Rheumatology Belorussian State Medical University 220116 Minsk Belarus

Department of Rheumatology Hôpital Henri Mondor Université UPEC Paris XII 94000 Paris France

EUPATI Graduate and Patient Advocate 1350 410 Brussels Belgium

Faculty Medicine University of Coimbra 3004 531 Coimbra Portugal

Institute of Rheumatology 12800 Prague Czech Republic

Joint and Bone Research Unit IIS Fundacion Jimenez Diaz UAM 28040 Madrid Spain

Physical Rehabilitation Medicine Department Medical Rehabilitation Centre Rovisco Pais 3060 586 Tocha Portugal

Rheumatology Department AP HP Saint Antoine Hospital 75012 Paris France

Rheumatology Unit San Pietro Fatebenefratelli Hospital 00189 Rome Italy

Service de Rhumatologie Hôpital Nord Franche 90400 Belfort France

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