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In Reply: Dr Band states that the effect size reported in our study should be interpreted with the knowledge that the controls in the studies included were not "simple placebo[s]." He also states that arthrocentesis, without any injection of medication, affords some efficacy in patients who have effusions. We agree that there is likely efficacy related to intra-articular placebo treatments. In fact, we found that 80% of the effect of intra-articular hyaluronic acid was accounted for by its placebo effect. The effect of an intra-articular treatment, such as hyaluronic acid, should only be attributed the effect that it affords in excess that of an intra-articular placebo.

Band also states that there is value in evaluating effectiveness of a treatment (ie, whether it works in practice) in addition to efficacy (ie, whether it works better than placebo in a trial). He cited this as a reason to consider the data provided . . . [Full Text of this Article]

Grace H. Lo, MD
grace.lo@bmc.org

David Felson, MD, MPH
Clinical Epidemiology Research and Training Unit and Arthritis Center
Boston University School of Medicine

Michael LaValley, PhD
Department of Biostatistics
Boston University School of Public Health
Boston, Mass

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