Intraarticular hyaluronan injections in the treatment of osteoarthritis: state-of-the-art review.
Abstract: Viscosupplementation (restoring the rheological properties of a tissue matrix) by injection of hyaluronan into the joints has been in use for 2 decades, mostly for osteoarthritis (OA) of the knee, using doses of 20-25 mg of hyaluronan of 500,000 to 2,500,000 M(r), in sequences of 2 to 10 weekly injections. Pain relief appears in a few days, progresses over a few weeks, and often lasts several months. Some data suggest the benefit can last 6 months to one year. Tolerance is universally reported as very good. Those responding to hyaluronan are 65-80%, compared to 30-35% responding to control. Compared to local steroid injections, the effect of hyaluronan appears significantly more lasting. More highly viscoelastic preparations of hyaluronan can be expected to make this therapy even more attractive.
Publication Date: 1993-08-01 PubMed ID: 8410878
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- Journal Article
- Review
Summary
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This study investigates the use of hyaluronan injections for osteoarthritis treatment, particularly focusing on their impact on reducing pain and increasing joint functionality, and compares them with other treatments like local steroid injections.
Study Context
- Intraarticular injections of hyaluronan, also known as viscosupplementation, have been used as a treatment method for osteoarthritis for the past two decades. They are most commonly used for osteoarthritis in the knee.
- The normal dosage for this treatment ranges from 20 to 25 mg of hyaluronan with molecular rates from 500,000 to 2,500,000 M(r) and is administered through a series of 2 to 10 weekly injections.
Study Findings
- The treatment results in pain relief within a few days, with the effects progressing over a span of a few weeks. The relief is often long-lasting, usually remaining for several months. There’s evidence that the benefits of the injections can last from 6 months to a year.
- Patients typically tolerate the hyaluronan injections well, with the effectiveness rate being between 65% to 80%. This is noticeably higher than the 30% to 35% response rate in the control group who didn’t receive the hyaluronan injections.
- The study found the effect of hyaluronan to be significantly longer lasting compared to local steroid injections, the other popular treatment option for osteoarthritis.
- The researchers suggest that using even more viscoelastic preparations of hyaluronan could potentially produce better results, making the treatment more appealing.
Study Implications
- This study underscores the potential effectiveness of hyaluronan injections in alleviating the symptoms of osteoarthritis. As a treatment option, they seem to provide substantial pain relief, have a higher response rate than other treatments like local steroid injections, and have the potential for an even longer-term benefit.
- The positive reception of hyaluronan injections among patients speaks well to its tolerance and points to it as a viable and preferable treatment solution.
- Further research into making hyaluronan more viscoelastic might result in even more effective osteoarthritis treatments in the future.
Cite This Article
APA
Peyron JG.
(1993).
Intraarticular hyaluronan injections in the treatment of osteoarthritis: state-of-the-art review.
J Rheumatol Suppl, 39, 10-15.
Publication
Researcher Affiliations
- Centre de Rhumatologie, Hopital de la Pitie, Paris, France.
MeSH Terms
- Animals
- Dose-Response Relationship, Drug
- Drug Evaluation
- Follow-Up Studies
- Horses
- Humans
- Hyaluronic Acid / administration & dosage
- Injections, Intra-Articular
- Multicenter Studies as Topic
- Osteoarthritis / therapy
- Randomized Controlled Trials as Topic
- Single-Blind Method
References
This article includes 34 references
Citations
This article has been cited 14 times.- Satin AM, Norelli JB, Sgaglione NA, Grande DA. Effect of Combined Leukocyte-Poor Platelet-Rich Plasma and Hyaluronic Acid on Bone Marrow-Derived Mesenchymal Stem Cell and Chondrocyte Metabolism. Cartilage 2021 Dec;13(2_suppl):267S-276S.
- Lu L, Dai C, Zhang Z, Du H, Li S, Ye P, Fu Q, Zhang L, Wu X, Dong Y, Song Y, Zhao D, Pang Y, Bao C. Treatment of knee osteoarthritis with intra-articular injection of autologous adipose-derived mesenchymal progenitor cells: a prospective, randomized, double-blind, active-controlled, phase IIb clinical trial. Stem Cell Res Ther 2019 May 21;10(1):143.
- Oliveira MZ, Albano MB, Namba MM, da Cunha LA, de Lima Gonçalves RR, Trindade ES, Andrade LF, Vidigal L. Effect of hyaluronic acids as chondroprotective in experimental model of osteoarthrosis. Rev Bras Ortop 2014 Jan-Feb;49(1):62-8.
- Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 2014 Jul 18;5(3):351-61.
- Park CW, Ma KW, Jang SW, Son M, Kang MJ. Comparison of piroxicam pharmacokinetics and anti-inflammatory effect in rats after intra-articular and intramuscular administration. Biomol Ther (Seoul) 2014 May;22(3):260-6.
- Bannuru RR, Natov NS, Dasi UR, Schmid CH, McAlindon TE. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis. Osteoarthritis Cartilage 2011 Jun;19(6):611-9.
- Benke M, Shaffer B. Viscosupplementation treatment of arthritis pain. Curr Pain Headache Rep 2009 Dec;13(6):440-6.
- Park YS, Lim SW, Lee IH, Lee TJ, Kim JS, Han JS. Intra-articular injection of a nutritive mixture solution protects articular cartilage from osteoarthritic progression induced by anterior cruciate ligament transection in mature rabbits: a randomized controlled trial. Arthritis Res Ther 2007;9(1):R8.
- Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006 Apr 19;2006(2):CD005321.
- Dentener MA, Vernooy JH, Hendriks S, Wouters EF. Enhanced levels of hyaluronan in lungs of patients with COPD: relationship with lung function and local inflammation. Thorax 2005 Feb;60(2):114-9.
- Cubukçu D, Ardiç F, Karabulut N, Topuz O. Hylan G-F 20 efficacy on articular cartilage quality in patients with knee osteoarthritis: clinical and MRI assessment. Clin Rheumatol 2005 Aug;24(4):336-41.
- Calvillo O, Skaribas I, Turnipseed J. Anatomy and pathophysiology of the sacroiliac joint. Curr Rev Pain 2000;4(5):356-61.
- Kawakami M, Suzuki K, Matsuki Y, Ishizuka T, Hidaka T, Konishi T, Matsumoto M, Kataharada K, Nakamura H. Hyaluronan production in human rheumatoid fibroblastic synovial lining cells is increased by interleukin 1 beta but inhibited by transforming growth factor beta 1. Ann Rheum Dis 1998 Oct;57(10):602-5.
- Sack KE. Osteoarthritis. A continuing challenge. West J Med 1995 Dec;163(6):579-86.
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