Abstract
Osteoarthritis (OA) is the most common disease of the musculoskeletal system, which is characterized by persistent pain, joint dysfunction, and early disability. The incidence of OA has now increased, and, according to the data obtained by the V.A. Nasonova Research Institute of Rheumatology, amounts to about 13%, which is 5 times higher than official statistics. The major goals of OA treatment are aimed at reducing pain, improving the functional state of the joint, preventing the development of joint deformity, improving the quality of life of patients, and minimizing the side effects of pharmacotherapy. Intra-articular hyaluronic acid (HA) injections have been long used as a synovial fluid prosthesis; however, recently published studies have provided new data on the mechanisms of action of these drugs and the role of this method in the treatment of patients with OA. Numerous meta-analyses have shown that HA therapy does not substantially differ from placebo in tolerance, thereby ensuring significantly reduced pain and improved joint function. This review deals with some issues of intra-articular HA administration in patients with OA, with the mechanisms of action of HA preparations, with the problems of choosing a drug according to its source, molecular weight, administration methods, and the efficiency of the therapy compared to other drugs.
Highlights
Osteoarthritis (OA) is the most common disease of the musculoskeletal system, which is characterized by persistent pain, joint dysfunction, and early disability
The major goals of OA treatment are aimed at reducing pain, improving the functional state of the joint, preventing the development of joint deformity, improving the quality of life of patients, and minimizing the side effects of pharmacotherapy
Intra-articular hyaluronic acid (HA) injections have been long used as a synovial fluid prosthesis; recently published studies have provided new data on the mechanisms of action of these drugs and the role of this method in the treatment of patients with OA
Summary
Многочисленные исследования, проведенные за последние 20 лет, доказали хондропротективный эффект препаратов ГНК при ОА. Противовоспалительное действие ГНК в результате связывания с рецепторами CD44 на поверхности хондроцитов проявляется снижением секреции ИЛ1β – провоспалительного цитокина, что, в свою очередь, уменьшает выработку ММП [12]. При ОА снижаются концентрация и средняя молекулярная масса эндогенной ГНК, вязкоэластические свойства синовиальной жидкости, что становится причиной более выраженного трения суставных поверхностей, чем у здоровых людей [14]. Что ГНК на клеточном уровне, связываясь с хондроцитами, способствует подавлению действия различных провоспалительных медиаторов, ADAMTS, уменьшает окислительный стресс в клетках хряща при ОА, а также повышает синтез различных структур хрящевого матрикса, что ведет к замедлению прогрессирования заболевания. В табл. 2 представлены различные препараты ГНК, зарегистрированные в Российской Федерации
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