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Category: Volume 09 Issue 08 August 2021
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Title: Role of Intra-Articular Hyaluronic Acid in the Medical Treatment of Osteoarthritis: A Prospective Study

Authors: M Moeiz Dijoo, Ibreez Rakshan, Tabish Kirmani

 DOI: https://dx.doi.org/10.18535/jmscr/v9i8.30

Abstract

The aim of this study was to determine the effectiveness of intra-articular hyaluronic acid in the patients with knee osteoarthritis. This study being a prospective controlled study included 86 patients with osteoarthritis of knee (Kellegren II & III). The effect of intraarticular hyaluronic acid (hyalgan 500-730kda) on the clinical parameters was noted. A total of 40 males and 46 females fulfilled the inclusion criteria with an age between 55–76 years .Of them 44 received five injections of hyaluronic acid (one injection per week) and 42 received intraarticular saline injection and served as control. A reduction in lequesne score from 13.68±1.25 to 7.85±3.63 was observed (P<0.01).The pain was recorded with the help of visual analog scale of 0-100. The VAS scores were reduced at rest from 43±3 to 16±2 and during weight beaing from 73±1 to 38±2 (P<0.01). This study concluded that hyaluronic acid is effective and well tolerated in the management of chronic primary osteoarthritis.

Keywords: osteoarthritis, viscosupplementation, hyaluronan, hyaluronic acid.

References

  1. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014;73:1323–30.
  2. Moskowitz RW (2009) The burden of osteoarthritis: clinical and qualityof- life issues. Am J Manag Care 15(8 Suppl):S223–S229
  3. Herrero-Beaumont G et al (2017) Clinical settings in knee osteoarthritis: pathop-hysiology guides treatment. Maturitas 96:54–57
  4. Brosseau L et al (2017) The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clin Rehabil 31(5):596–611
  5. Creamer P, Hochberg MC. Osteoarthritis. Lancet 1997;350:503–8.
  6. Bothner H, Wik O. Rheology of hyaluronate. Acta Otolaryngol 1987; 442:25–30.
  7. Fraser JR, Clarris BJ, Baxter E. Patterns of induced variation in the morphology, hyaluronic acid secretion, and lysosomal enzyme activity of cultured human synovial cells. Ann Rheum Dis 1979;38:287–94.
  8. Dahl LB, Dahl IM, Engstrom-Laurent A, Granath K. Concentration and molecular weight of sodium hyaluronate in synovial fluid from patients with rheumatoid arthritis and other arthropathies. Ann Rheum Dis 1985;44:817–22.
  9. Smith MM, Ghosh P. The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatol Int 1987;7:113–22. Engstrom-Laurent A. Hyaluronan in joint disease. J Intern Med 1997;242:57–60.
  10. Pietrogrande V, Melanotte PL, D’Agnolo B, Ulivi M, Benigni GA, Turchetto L, et al. Hyaluronic acid versus Methylprednisolone intrarticularly injected for treatment of osteoarthritis of the knee. Current therapeutic research 1991;5: 691–700.
  11. Carrabba M, Paresce E, Angelini M, Zamboni AM, Bragantini A, Paissan A, et al. The intraarticular treatment of the osteoarthritis of the knee: a comparative study between hyaluronic acid (Hyalgan®) and orgotein. Eur J Rheumatol Inflamm 1992; 12:47–57.
  12. Dougados M, Nguyen M, Listrat V, Amor B. High molecular weight sodium hyaluronate (hyalectin) in osteoarthritis of the knee: a 1 year placebo-controlled trial. Osteoarthritis Cart 1993;1:97–103.
  13. Graf J, Neusel E, Schneider E, Niethard FU. Intraarticular treatment with hyaluronic acid in osteoarthritis of the knee joint: a controlled clinical trial versus mucopolysaccharide polysulfuric acid ester. Clin Exper Rheumatol 1993;11:367–72.
  14. Jones AC, Pattrick M, Doherty S, Doherty M. Intraarticular hyaluronic acid compared to intraarticular triamcinolone hexacetonide in inflammatory knee osteoarthritis. Osteoarthritis Cart 1995;3:269–73.
  15. Listrat V, Ayral X, Patarnello F, Bonvarlet JP, Simonnet J, Amor B, et al. Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthritis Cart 1997;5:153–60.
  16. Altman RD, Moskowitz R. Intraarticular sodium hyaluronat (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. J Rheumatol 1998;25:2203–11.
  17. Lequesne MG, Mery C, Samson M, Gerard P. Indexes of severity for osteoarthritis of the hip and knee.Validation. Value in comparison with other assessment tests. Scand J Rheumatol 1987;65:85–9.
  18. Price DD, Harkins SW. Combined use of experimental pain and visual analogue scales in providing standardized measurement of clinical pain. Clin J Pain. 1987; 3:1-8.
  19. Shichikawa K, Maeda A, Ogawa N. [Clinical evaluation of sodium hyaluronate in the treatment of osteoarthritis of the knee]. Ryumachi 1983;23:280–90.
  20. Puhl W, Bernau A, Greiling H, et al. Intra-articular sodium hyaluronate in osteoarthritis of the knee: a multicenter, double-blind study. Osteoarthritis Cartilage 1993;1:233–41.
  21. Navarro-Sarabia F, Coronel P, Collantes E, et al. A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project. Ann Rheum Dis 2011;70:1957–62.
  22. Huskisson EC, Donnelly S. Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology 1999;38:602–7.
  23. Lohmander LS, Dalen N, Englund G, Haemaelaeinen M, Jensen EM, Karlson K, et al. Intraarticular hyaluronan injections in the treatment of osteoarthritis of the knee: A randomised, double blind, placebo controlled multicentre trial. Ann Rheum Dis 1996;55: 424–431.
  24. Lequesne MG. The algofunctional indices for hip and knee osteoarthritis. J Rheumatol 1997;24:779–81.
  25. Manfred Wobig, Adalbert Dickhut, Raimund Maier,and Georg Vetter; Viscosupplementation with Hylan G-F 20: A 26-Week Controlled trail of Efficacy and Safety in the Osteoarthritic Knee; CLINICAL THERAPEUTICS/VOL. 20, NO. 3, 1998.
  26. Miltner, U. Schneider, C. H. Siebert, C. Niedhart and F. Uwe Niethard; Efficacy of intraarticular hyaluronic acid in patients with osteoarthritis—a prospective clinical trial ;Osteoarthritis and Cartilage (2002) 10, 680–686 ; 2002

Corresponding Author

M Moeiz Dijoo

Post graduate Department of Orthopaedics, Bone and Joints Hospital Barzullah, Srinagar