Hyaluronic acid supplementation

Abstract

As evidenced by publication of a new set of guidelines for the treatment of osteoarthritis (OA) by the American College of Rheumatology after only 5 years, modalities available for the management of OA have undergone significant changes. New therapeutic approaches include the use of cyclo-oxygenase-2 inhibitors, and intra-articular hyaluronans (HA). HA, found in a number of body tissues, is altered in the presence of osteoarthritis with decreased molecular weight and concentration resulting in impaired viscoelasticity. Hyaluronan preparations have been shown to decrease pain and increase function in patients with osteoarthritis of the knee. Mechanisms of therapeutic effect include restoration of more normal synovial fluid with improved viscoelasticity, effects on cartilage biosynthesis and degradation, anti-inflammatory effects, and direct analgesic effects. Studies in animal models, and preliminary studies in humans suggest that hyaluronans may have a structure-modifying effect in OA. Hyaluronans represent a substantive addition to the therapeutic armamentarium in osteoarthritis.

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References and Recommended Reading

  1. 1.

    Altman RD, Hochberg MC, Moskowitz RW, Schnitzer TJ: Recommendations for the medical management of osteoarthritis of the hips and knee: 2000 update. Arthritis Rheum 2000, 43:1905–1915. An update on American College of Rheumatology guidelines for the treatment of osteoarthritis, including state-of-the-art recommendations.

    Article  Google Scholar 

  2. 2.

    Crofford LJ, Lipsky PE, Brooks P, et al.: Basic biological and clinical application of specific cyclooxygenase inhibitors. Arthritis Rheum 2000, 43:4–13.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Smith TJ: Cyclooxygenases as the principal targets for the action of NSAIDs. Rheum Dis Clin North Am 1998, 24:501–523.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Altman RD, Moskowitz R: Hyalgan study group: Intra-articular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. J Rheumatol 1998, 25:2203–2212. A key, well-designed study on efficacy and safety of sodium hyaluronan (Hyalgan).

    PubMed  CAS  Google Scholar 

  5. 5.

    Wobig M, Dickhut A, Maier R, Vetter G: Viscosupplementation with hylan GF-20, a 26 week controlled trial for efficacy and safety in the osteoarthritis knee. Clin Ther 1998, 20:410–423. A controlled trial of GF-20, Synvisc, in osteoarthritis of the knee, demonstrating safety and efficacy.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Toole BP: Hyaluronan is not just a goo! J Clin Invest 2000, 106(303):335–336. An excellent commentary on the importance of hyaluronans in human physiology.

    PubMed  CAS  Google Scholar 

  7. 7.

    Larsen NE, Lombard KM, Parent EG, Balazs EA: Effect of hylan on cartilage and chondrocyte cultures. J Orthop Res 1992, 10:23–32.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Mensiteri M, Ambrosio L, Innace S, et al.: Viscoelastic evaluation of different knee osteoarthritis therapies. J Mat Sci Mat Med 1995, 6:130–137.

    Article  Google Scholar 

  9. 9.

    Abatangelo G, O’Regan M: Hyaluronan: biological role and function in articular joints. Eur J Rheumatol Inflamm 1995, 15:9–16.

    Google Scholar 

  10. 10.

    Kang Y, Eger W, Koepp H, et al.: Hyaluronan suppresses fibronectin fragment-mediated damage to human cartilage explant cultures by enhancing proteoglycan synthesis. J Orthop Res 1999, 6:858–869.

    Article  Google Scholar 

  11. 11.

    Yasui T, Adatsuka M, Tobetto K, et al.: The effect of hyaluronan on interleukin-1-a-induced prostaglandin-E2 production in human osteoarthritis synovial cells. Agents Actions 1992, 37:155–156.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Presti D, Scott JE: Hyaluronan medicated protective effect against cell damage caused by enzymatically generated hydroxyl radicals is dependent on hyaluronan molecular mass. Cell Biochem Funct 1994, 12:281–288.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Poza MA, Balazs EA, Helmonte C: Reduction of sensory responses to passive movements of inflamed knee joint by hylan, a hyaluronan derivative. Exp Brain Res 1997, 116(1):3–9.

    Article  Google Scholar 

  14. 14.

    Gotah S, Onaya J, Abe M, et al.: Effects of the molecular weight of hyaluronic acid and its action mechanisms on experimental joint pain in rats. Ann Rheum Dis 1993, 52:817–822.

    Article  Google Scholar 

  15. 15.

    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, 7:113–122.

    PubMed  Article  Google Scholar 

  16. 16.

    Lynch TM, Caron JP, Amoczky SP, et al.: Influence of exogenous hyaluronan on synthesis of hyaluronan and collagenease by equine synoviocytes. Am J Vet Res 1998, 59:888–892.

    PubMed  CAS  Google Scholar 

  17. 17.

    Takahashi K, Goomer RS, Harwod F, et al.: The effects of hyaluronan on matrix metalloproteinase-3 (MMP-3), interleukin-1b (IL-1b), and tissue inhibitor of metalloproteinase-1 (TIMP-1) gene expression during the development of osteoarthritis. Osteoarthritis Cartilage 1999, 7:182–190.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Ghosh P: The role of hyaluronic acid (hyaluronan) in health and disease: interactions with cells, cartilage and components of the synovial fluid. Clin Exp Rheumatol 1994, 12:75–82.

    PubMed  CAS  Google Scholar 

  19. 19.

    Takahashi K, Hashimoto S, Kuho T, et al.: Effect on hyaluronan on chondrocyte apoptosis and nitric oxide production in experimentally induced osteoarthritis. J Rheumatol 2000, 27(7):1713–1720. Studies illustrate mechanisms by which hyaluronans affect vital metabolic processes.

    PubMed  CAS  Google Scholar 

  20. 20.

    Han F, Ishiguor N, Ito T, et al.: Effects of sodium hyaluronate on experimental osteoarthritis in rabbit knee joints. Nagoya J Med Sci 1999, 62(3-4):15–26.

    Google Scholar 

  21. 21.

    Balazs EA, Watson D, Duff IF: Hyaluronic acid in synovial fluid: Molecular parameters of hyaluronic acid in normal and arthritic human fluids. Arthritis Rheum 1967, 10:357–376.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Peyron JF, Balazs EA: Preliminary clinical assessment of Na-hyaluronate injection into the human knee. Pathol Biol 1974, 22:731–736.

    PubMed  CAS  Google Scholar 

  23. 23.

    Kawcak CE, Frisbie DD, Trotter GW, et al.: Effect of intravenous administration of sodium hyaluronate on carpal joints in exercising horses after arthroscopic surgery and osteochondral fragmentation. Am J Vet Res 1997, 58:1132–1140.

    PubMed  CAS  Google Scholar 

  24. 24.

    Frizziero L, Govoni E, Bacchini P: Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee: clinical and morphological study. Clin Exp Rheumatol 1998, 16:441–449.

    PubMed  CAS  Google Scholar 

  25. 25.

    Huskission EC, Donnelly S: Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology 1999, 38:602–607.

    Article  Google Scholar 

  26. 26.

    Leardini G, et al.: Intra-articular sodium hyaluronate (Hyalgan) in gonarthrosis. Clin Trials J 1987, 24(4):341–350.

    Google Scholar 

  27. 27.

    Dougados M, Nguyen M, Listrat V, Armor B: High molecular weight sodium hyaluronan (Hyalectin) in osteoarthritis of the knee. A 1-year placebo controlled trial. Osteoarthritis Cartilage 1993, 1:97–103.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Kotz R, Kolarz G: Intra-articular hyaluronic acid: duration of effect and results of repeated treatment cycles. Am J Orthop 1999, 28:5–7.

    PubMed  CAS  Google Scholar 

  29. 29.

    Listrat V, Ayral X, Patarnello F, et al.: Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthritis Cartilage 1997, 5:153–160. Preliminary data suggesting a structure-modification effect of hyaluronan on OA cartilage.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Carrabba M, Paresce E, Angelini M, Perbellini A: The safety and efficacy of different dose schedules of hyaluronic acid in the treatment of painful osteoarthritis of the knee with joint effusion. Eur J Rheumatol Inflamm 1995, 15:25–31.

    Google Scholar 

  31. 31.

    Scali JJ: Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee: a long term study. Eur J Rheumatol Inflamm 1995, 15(1):57–62.

    Google Scholar 

  32. 32.

    Adams Atkinson MH, Lussier AJ, et al.: The role of viscosupplementation with hylan GF-20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan GF-20 alone, hylan GF-20 with NSAIDs, and NSAIDs alone. Osteoarthritis Cartilage 1995, 3:213–225.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Puttick MP, Wade JP, Chalmers A, et al.: Acute local reactions after intra-articular hylan for osteoarthritis of the knee. J Rheumatol 1995, 22:1311–1314.

    PubMed  CAS  Google Scholar 

  34. 34.

    Adams ME: Acute local reactions after intra-articular hylan for osteoarthritis of the knee. J Rheumatol 1996, 23:944–945.

    PubMed  CAS  Google Scholar 

  35. 35.

    Ohanolon D: Acute local reactions after intra-articular hylan for osteoarthritis of the knee. J Rheumatol 1996, 23:946.

    Google Scholar 

  36. 36.

    Pullman-Monar S, Mooer P, Sieck M, et al.: Are there distinctive inflammatory flares of synovitis after hylan GF intra-articular injections? Arthritis Rheum 1999, 42(suppl 9):S295.

    Google Scholar 

  37. 37.

    Allen E, Krohn K: Adverse reaction to hylan GF-20. J Rheumatol 2000, 27(6):1572.

    PubMed  CAS  Google Scholar 

  38. 38.

    Maillefert JF, Hirschhorn P, Pascaud F, et al.: Acute attack of chondrocalcinosis after intra-articular hyaluronic acid injection. Rev Rhum Engl Ed 1997, 64:593–594.

    PubMed  CAS  Google Scholar 

  39. 39.

    Lusar MJ, Altawil B. Pseudogout following intraarticular injection of sodium hyaluronate. Arthritis Rheum 1998, 41:939–940.

    Article  Google Scholar 

  40. 40.

    Disla E, Infante R, Fahmy A, et al.: Recurrent acute calcium pyrophosphate dihydrate arthritis following intraarticular hyaluronate injection. Arthritis Rheum 1999, 42:1302–1303.

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Kroesen S, Schmid W, Theiler R: Induction of an acute attack of calcium pyrophosphate dihydrate arthritis by intraarticular injection of hylan G-F 20 (Synvisc). Clin Rheumatol 2000, 19(2):147–149.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Belizikian JP, Connor TB, Aptekar R, et al.: Pseudogout after parathyroidectomy. Lancet 1973, 1:445–447.

    Article  Google Scholar 

  43. 43.

    Daumen-Legre V, Pham T, Acquaviva PC, Lafforgue P: Evaluation of safety and efficacy of viscosupplementation in knee osteoarthritis with chondrocalcinosis [abstract]. Arthritis Rheum 1999, 42(suppl_9):S158.

    Google Scholar 

  44. 44.

    Jones AC, Pattrie JM, Doherty S, et al.: Intra-articular hyaluronic acid compared to intra-articular triamcinolone hexacetonide in inflammatory knee osteoarthritis. Osteoarthritis Cartilage 1995, 3:269–273.

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Kikuchi T, Yamanda H, Shimmei M: Effect of high molecular weight hyaluronan on cartilage degeneration in a rabbit model of osteoarthritis. Osteoarthritis Cartilage 1996, 298:296–304.

    Google Scholar 

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Moskowitz, R.W. Hyaluronic acid supplementation. Curr Rheumatol Rep 2, 466–471 (2000). https://doi.org/10.1007/s11926-000-0022-x

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Keywords

  • Osteoarthritis
  • Hyaluronic Acid
  • Rheumatol
  • Hyaluronan
  • Sodium Hyaluronate