Abstract
Knee osteoarthritis (OA) is a progressive disease in which the cartilage (cushioning between joints) wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This causes rubbing of bones, resulting in pain, swelling, stiffness, decreased ability to move and formation of bone spurs. Osteoarthritis develops slowly and the pain it causes worsens over time. Although there is no cure, there are many treatment options available to help manage pain and keep people staying active. Intra-articular (IA) hyaluronic acid (HA) injection is one of the treatment options. Hyaluronic acid is a polysaccharide, an anionic, non-sulfated glycosaminoglycan and is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with knee osteoarthritis have lower concentration and altered volume of hyaluronic acid than normal in their joints. Due to lower concentration and volume, exogenous hyaluronic acid may be injected into the knee joint. Treatment with exogenous hyaluronic acid contributes to restore the elastic and viscous properties of the synovial fluid, pain reduction and functional improvement. It is indicated for patients who have failed to respond adequately to conservative non-pharmacological therapy and simple analgesic.
Highlights
OA is the most common disease of movable joints affecting mainly the knee, hip and hands
Chareancholvanich et al [34] concluded that patients who underwent high tibial osteotomy, suffering from primary medial compartment knee OA, intra-articular hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO
This study shows that single injection NASHA was well tolerated and non-inferior to methylprednisolone acetate (MPA) at 12 weeks
Summary
OA is the most common disease of movable joints affecting mainly the knee, hip and hands. This multifactorial and heterogeneous disease is mainly characterized by articular cartilage degradation, inflammation of the synovial membrane and sclerosis of subchondral bone associated with the formation of osteophytes [2]. The pharmacological treatment options include acetaminophen (paracetamol), avocado soybean unsaponifiables (ASU), capsaicin, corticosteroids (Intra-articular Injection), chondroitin, diacerein, duloxetine, glucosamine, hyaluronic acid (Intra-articular Injection), non-steroidal anti-inflammatory drugs (Oral Non-selective NSAIDs, Oral COX-2 Inhibitors, topical), opioids (transdermal, oral), risedronate and rosehip [2]. The surgical intervention should be considered only after pharmacological and non-pharmacological treatments have failed [3]
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