Background

Intra-articular Hyaluronic Acid (IAHA)

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Mechanism of action

  • Restore the physiologic function and integrity of synovial fluid
  • Stimulation of in vivo HA synthesis
  • May enhance the synthesis of extracellular matrix proteins
  • Reduces pain and inflammation
  • Cartilage synthesis and inhibition of cartilage degradation
  • Provides joint lubrication and shock absorbency

Additional Information

  • Hyaluronic acid (HA), a natural substance abundant in the fluids of synovial joints, provides joint lubrication and shock absorbency, and acts as the backbone for the proteoglycans of the extracellular matrix
  • Approved by the U.S. Food and Drug Administration in 1997 for the treatment of knee osteoarthritis, viscosupplementation with HA has been shown to improve both pain and function in some studies
  • Pain relief is slower, but appears to last longer compared to other treatment options
  • There are many viscosupplementation products that exist, which differ in characteristics such as molecular weight, dosing, and method of preparation
  • HA can be isolated from different sources, such as rooster comb, bacterial fermentation with or without biochemical modifications

References

  1. American College of Rheumatology Subcommittee (2000). Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthrisits Rheum, 43 (9), 1905-1915
  2. Kon, E., Filardo, G., Drobnic, M., Madry, H., Jelic, M., van Dijk, N., & DellaVilla, S. (2012). Non-surgical management of early knee osteoarthritis. Knee Surg Traumatol Arthrosc, 20 (3), 436-449
  3. Moreland, L.W. (2003). Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther, 5 (2), 54-67
  4. Pintan, G.F., de Oliveira, A.S., Jr., Lenza, M., Antonioli, E., & Ferretti, M. (2014). Update on biological therapies for knee injuries: osteoarthritis. Curr Rev Musculoskelet Med, 7 (3), 263-269
  5. Snibbe, J.C. ,& Gambardella, R.A. (2005). Treatment options for osteoarthritis. Orthopedics, 28 (2 Suppl), s215-220
  6. Tehranzadeh, J., Booya, F., & Root, J. (2005). Cartilage metabolism in osteoarthritis and the influence of visco supplementation and steroid: a review. Acta Radiol, 46 (3), 288-296
  7. Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015 Oct 26;16:321.
  8. Cutolo, M., Berenbaum, F., Hochberg, M., Punzi, L., & Reginster, J.Y. (2015). Commentary on recent therapeutic guidelines for osteoarthritis. Semin Arthritis Rheum 44 (6), 611-617
  9. Fraser, J.R., Laurent, T.C., & Laurent, U.B.(1997). Hyaluronan: its nature, distribution, functions and turnover. J Intern Med, 242 (1), 27-33
  10. Jordan, K.M., Arden, N.K., Doherty, M., Bannwarth, B., Bijlsma, J.W., Dieppe, P., ... Dougados, M. (2003). EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rhuem Dis, 62 (12), 1145-1155