Viscosupplementation
Intra-articular injection of HA restores and maintains viscoelastic properties of synovial fluid, thus enables improved lubrication and reliefs pain5. HA exerts anti-inflammatory, analgesic and chondroprotective effects in synovial joints6. In long term, clinical benefits of viscosupplementation persist well beyond the intraarticular residence of HA since clinical benefits achieved by HA intra-articular injection occurs due to increase of naturally produced HA in synovial joint thus reestablishment of joint homeostasis3. In consequence, viscosupplementation can improve joint function, thus allow return to normal physical activity and improve patients quality of life7.
Importantly, many scientific comparisons and clinical investigations show that intra-articular HA injection is comprehensively safe, in contrast to steroid intra-articular injection that can lead to cartilage thinning and damage8.
HA intra-articular mechanism of action
- HA restores viscoelastic properties of OA-affected synovial fluid thus improves lubrication
- HA induces synthesis of natural hyaluronic acid thus contributes to recover of joint homeostasis9
- HA binds to special receptors- CD44 on cartilage and synovial cells in order to support matrix production10 and inhibit inflammation
- HA affects OA-related nerve oversensitivity and reduce hyperalgesia11
- HA diminishes inflammatory processes by reduction of proinflammatory mediators production and action12
Only high molecular weight HA is fully biologically functional
- Only optimally high molecular weight HA possess the ability to protect against articular cartilage damage by restoring joint lubrication and joint homeostasis9
- Only optimally high molecular weight HA is able to reduce OA-related pain13
- Only HA with optimally high molecular weight HA is able to reduce OA-related inflammation processes14
- Only optimally high molecular weight HA is able to protect articular cartilage from OA-related degenerative changes and show clinical benefits15
- Murray CJ, , Memish ZA. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2197-223
- Felson DT. Clinical practice. Osteoarthritis of the knee. N Engl J Med. 2006 Feb 23;354(8):841-8. doi: 10.1056/NEJMcp051726. Erratum in: N Engl J Med. 2006 Jun 8;354(23):2520.
- Balazs EA, Watson D, Duff IF, Roseman S. Hyaluronic acid in synovial fluid. I. Molecular parameters of hyaluronic acid in normal and arthritis human fluids. Arthritis Rheum. 1967 Aug;10(4):357-76.
- Creamer P, Sharif M, George E, Meadows K, Cushnaghan J, Shinmei M, Dieppe P. Intra-articular hyaluronic acid in osteoarthritis of the knee: an investigation into mechanisms of action. Osteoarthritis Cartilage. 1994 Jun;2(2):133-40.
- Ghosh P, Guidolin D. Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: are the effects molecular weight dependent? Semin Arthritis Rheum. 2002 Aug;32(1):10-37.
- Strauss EJ, Hart JA, Miller MD, Altman RD, Rosen JE. Hyaluronic acid viscosupplementation and osteoarthritis: current uses and future directions. Am J Sports Med. 2009 Aug;37(8):1636-44.
- Petrella RJ, Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee. J Rheumatol. 2006 May;33(5):951-6.
- McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017 May 16;317(19):1967-1975.
- 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(3):113-22.
- Chow G, Nietfeld JJ, Knudson CB, Knudson W. Antisense inhibition of chondrocyte CD44 expression leading to cartilage chondrolysis. Arthritis Rheum. 1998 Aug;41(8):1411-9.
- Pozo MA, Balazs EA, Belmonte C. Reduction of sensory responses to passive movements of inflamed knee joints by hylan, a hyaluronan derivative. Exp Brain Res. 1997 Aug;116(1):3-9.
- Takahashi K, Goomer RS, Harwood F, Kubo T, Hirasawa Y, Amiel D. The effects of hyaluronan on matrix metalloproteinase-3 (MMP-3), interleukin-1beta(IL-1beta), and tissue inhibitor of metalloproteinase-1 (TIMP-1) gene expression during the development of osteoarthritis. Osteoarthritis Cartilage. 1999 Mar;7(2):182-90.
- Gomis A, Pawlak M, Balazs EA, Schmidt RF, Belmonte C. Effects of different molecular weight elastoviscous hyaluronan solutions on articular nociceptive afferents. Arthritis Rheum. 2004 Jan;50(1):314-26.
- Gotoh S, Onaya J, Abe M, Miyazaki K, Hamai A, Horie K, Tokuyasu K. Effects of the molecular weight of hyaluronic acid and its action mechanisms on experimental joint pain in rats. Ann Rheum Dis. 1993 Nov;52(11):817-22.
- Altman RD, Bedi A, Karlsson J, Sancheti P, Schemitsch E. Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee. Am J Sports Med. 2016;44(8):2158-2165. doi:10.1177/0363546515609599