Modern tendencies and concepts in treatment of knee osteoarthritis using hyaluronic acid

Abstract

Pharmacological treatment of knee osteoarthritis (OA) supposes to use drugs of symptomatic action (with immediate and prolonged effect) and structure-modifying action. Goal: to analyse modern concepts (visco-elastic protection and visco-analgesic effect) and modern tendencies (enlargement of molecular weight and concentration) in the using of hyaluronic acid (HA) agents to treat OA. Methods: information sources which provide the results of clinical investigation of HA using are studied. Results: in the concept of viscosupplementation the molecular weight and concentration of HA in normal synovial fluid are considered asa reference standard. Exogenous intake of HA with high molecular weight and concentration increases the suspension properties of synovial fluid and prevent further degenerative changes in joint structures. In the concept of viscoanalgisation that also bases on the biomechanical properties of synovial fluid biological aspects are emphasized. Synolis VA became an innovation; it contents viscoelastic, sterile, apyretic, isotonic 2 % solution of sodium hyaluronate (molecular weight 2 000 000 Da) that placed in sorbitol matrix. Synolis VA is recommended to use under the conditions of knee OA on early stages (I–II according to Kellgren-Lawrence), when OA is accompanied by pain, despite other drug and drug-free therapy, with minor radiological signs; in case of OA with severe synovitis - anti-inflammatory therapy should be added (corticosteroids, NSAIDs and so on). There are some other indications: severe pain syndrome on the end-stages of knee OA (III–IV) in cases when joint replacements are contraindicated or patient refuse to perform it; alternative therapy, when NSAIDs are contraindicated, had some side-effects or no effect. Conclusion: the use of sodium hyaluronate cross-linked with sorbitol (Synolis VA) is prospective to treat all the stages of OA due to intense analgesic effect.