Abstract
Purpose
Osteoarthritis (OA) is a progressive, chronic and degenerative joint disease characterized by a loss of articular cartilage. Treatment of OA is largely palliative based on nonsteroidal anti-inflammatory drugs, opioids and injections of steroids. Regarding conservative treatment, intra-articular injections of hyaluronic acid (HA) can play a role in early symptomatic knee OA.
Materials and methods
Between August 2015 and September 2015, sixty patients (32 males and 28 females) between 40 and 70 years old were randomly allocated into two groups: Half were treated with three weekly intra-articular injections of hyaluronic acid 1.6 % (group A), while the others were treated with Syalox 300 Plus® (hyaluronic acid 300 mg + Boswellia serrata extract 100 mg) 1 tab/die for 20 days and afterward Syalox 150® (hyaluronic acid 150 mg) 1 tab/die for other 20 days (group B). All patients were evaluated clinically with American Knee Society Score (AKSS) and visual analogue scale (VAS) for the pain before the treatment and after 3 months.
Results
AKSS of the patients in both groups was significantly increased by the treatment, and VAS score was significantly reduced. In both groups, two subgroups were created with patients older than 60 years and patients younger than 60 years. Better results are reported in younger patients of group A and older subjects in group B.
Conclusions
Despite several limitations, the results of the study have shown that HA injection and oral administration may have beneficial therapeutic effects on patients with early osteoarthritis. Different outcomes in younger and older subject suggested a combined therapy first with local infiltrations and then with oral composition.
Similar content being viewed by others
References
Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G (2005) A metaanalysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthr Cartil 13(9):769–781
Loeser RF Jr (2000) Aging and the etiopathogenesis and treatment of osteoarthritis. Rheum Dis Clin N Am 26(3):547–567
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Poulet B, Staines KA (2016) New developments in osteoarthritis and cartilage biology. Curr Opin Pharmacol 28:8–13
Mayer K, Palemer J (1934) The polysaccharide of the vitreoushumor. J Biol Chem 107:629–637
(2000) Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American college of rheumatology subcommittee on osteoarthritis guidelines. Arthritis Rheum 43(9):1905–1915
Sato T, Iwaso H (2008) An effectiveness study of hyaluronic acid (Hyabest J) in the treatment of osteoarthritis of the knee. J New Remedies Clin 57(2):260–269 (Japanese)
Sato T, Iwaso H (2009) An effectiveness study of hyaluronic acid (Hyabest J) in the treatment of osteoarthritis of the knee on the patint in the United States. J New Remedies Clin 58(3):551–558 (Japanese)
Iwaso H, Sato T (2009) Examination of the efficacy and safety of oral administration of Hyabest J, highly pure hyaluronic acid, for knee joint pain. J Jpn Soc Clin Sports Med 17(3):566–572
Nagaoka I, Nabeshima K, Murakami S et al (2010) Evaluation of the effects of a supplementary diet containing chicken comb extract on symptoms and cartilage metabolism in patients with knee osteoarthritis. Exp Ther Med 1(5):817–827
Balazs EA, Denlinger JL (1993) Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl 39:3–9
Ghosh P, Guidolin D (2002) Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: are the effects molecular weight dependent? Semin Arthritis Rheum 32(1):10–37
Zhou PH, Liu SQ, Peng H (2008) The effect of hyaluronic acid on IL-1beta-induced chondrocyte apoptosis in a rat model of osteoarthritis. J Orthop Res 26(12):1643e8
Lurati A, Laria A, Mazzocchi D, Re KA, Marrazza M, Scarpellini M (2015) Effects of hyaluronic acid (HA) viscosupplementation on peripheral Th cells in knee and hip osteoarthritis. Osteoarthr Cartil 23(1):88–93
Jevsevar D, Donnelly P, Brown GA, Cummins DS (2015) Viscosupplementation for osteoarthritis of the knee: a systematic review of the evidence. J Bone Joint Surg Am 97(24):2047–2060
Kajimoto O, Odanaka Y, Sakamoto W, Yoshida K, Takahashi T (2001) Clinical effects of dietary hyaluronic acid on dry skin. J New Remedies Clin 50(4):548–560
Sato T, Sakamoto W, Odanaka W, Yoshida K, Urushibara O (2002) Clinical effects of dietary hyaluronic acid on dry, rough skin. Aesthet Dermatol 12:109–120
Balogh L, Polyak A, Mathe D, Kiraly R, Thuroczy J, Therez M et al (2008) Absorption, uptake and tissue affinity of high-molecular-weight hyaluronan after oral administration in rats and dogs. J Agric Food Chem 56(22):10582–10593
Nelson FR, Zyrbulis RA, Zonca B, Li KW, Turner SM, Pasierb M et al (2015) The effects of an oral preparation containing hyaluronic acid (Oralvisc®) on obese knee osteoarthritis patients determined by pain, function, bradykinin, leptin, infiammatory cytokines, and heavy water analyses. Rheumatol Int 35(1):43–52
Tashiro T, Seino S, Sato T, Matsuoka R, Masuda Y, Fukui N (2012) Oral administartion of plymer hyaluronic acid alleviates symptoms of knee osteartritis: a double-blind, placebo-controlled study over a 12-month period. Sci World J 167928
Kimmatkar N, Thawani V, Hingorani L, Khiyani R (2003) Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee: a randomized double blind placebo controlled trial. Phytomedicine 10:3–7
Grover AK, Samson SE (2016) Benefits of antioxidant supplements for knee osteoarthritis: rationale and reality. Nutr J 15(1):1
Sengupta K, Alluri KV, Satish AR, Mishra S, Golakoti T, Sarma KV et al (2008) A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther 10:R85
Sengupta K, Krishnaraju AV, Vishal AA, Mishra A, Trimurtulu G, Sarma KV et al (2010) Comparative efficacy and tolerability of 5-Loxin and Aflapin Against osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study. Int J Med Sci 7:366–377
Sengupta K, Kolla JN, Krishnaraju AV, Yalamanchili N, Rao CV, Golakoti T et al (2011) Cellular and molecular mechanisms of anti-inflammatory effect of Aflapin: a novel Boswellia serrata extract. Mol Cell Biochem 354:189–197
Vishal AA, Mishra A, Raychaudhuri SP (2011) A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of aflapin in subjects with osteoarthritis of knee. Int J Med Sci 8:615–622
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Ricci, M., Micheloni, G.M., Berti, M. et al. Clinical comparison of oral administration and viscosupplementation of hyaluronic acid (HA) in early knee osteoarthritis. Musculoskelet Surg 101, 45–49 (2017). https://doi.org/10.1007/s12306-016-0428-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-016-0428-x