Acid In Treatment Of Osteoarthritis Research Articles

Outcome of intra-articular hyaluronic acid in treatment of osteoarthritis of knee at a tertiary care hospital in Kathmandu, Nepal

Background and Objectives: Intra-articular hyaluronic acid is widely used in the treatment of knee osteoarthritis. This study aimed to assess the efficacy of hyaluronic acid in moderate severity knee osteoarthritis.
 Material and Methods: Patients of knee osteoarthritis were administered single intra-articular injection of Hyaluronic Acid 25 mg (2.5 ml viscous solution) and were followed up at 4, 12, and 24 weeks. Functional improvement was assessed using Oxford Knee Score (OKS). Comparisons of pre- and post-intervention mean OKS scores were done by paired t test.
 Results: Total 50 patients (mean age 58.62±12.62 years) were studied. In the six months follow up, patients showed marked improvement in functional outcome from a mean OKS of 27 before injection to 39 at 4 weeks and remained constant up to 6months of follow up.
 Conclusion: Intra-articular hyaluronic acid injectionas a treatment modality for moderate grade knee osteoarthritis provides good functional outcome and pain control for up to six months.

PH-responsive poly(lactide-co-glycolide) nanoparticles containing near-infrared dye for visualization and hyaluronic acid for treatment of osteoarthritis

This study focuses on intra-articular (IA) drug delivery system for the treatment of knee osteoarthritis (OA). In osteoarthritic condition the synovial fluid presents pockets with lower pH environment. To take advantage of these pH differences, poly(lactic-co-glycolic acid (PLGA) nanoparticles (NPs) and pH– responsive PLGA NPs encapsulated with ammonium bicarbonate (NH4HCO3) were generated. The nanoparticles were loaded with hyaluronic acid (HA) as a possible model drug for OA and with near-infrared dye (NIR) that was used to visualize the NPs with molecular imaging techniques. These NPs were characterized by dynamic light scattering, transmission electron microscopy and compared in in vitro, in vivo and ex vivo experiments in the treatment of OA. The results indicate that the NPs were sufficiently small, displayed a uniform size distribution and were non-toxic both in vitro and in vivo. Both NPs treatment seem to induced a reduction in OA progression, with pH- responsive NPs showing the more pronounced effect. This is probably because the pockets of low pH environment in the synovial fluid trigger a burst release of the pH-responsive NPs. This result is corroborated by in vitro experiments since the pH- responsive NPs showed an extracellular burst release behavior and higher chondrocyte vitality than non-responsive NPs. This study demonstrates that PLGA NPs containing HA and NH4HCO3 are candidates for the treatment of knee OA.

An evaluation of role of intraarticular hyaluronic acid in treatment of osteoarthritis of knee

Objective: To evaluate the role of intraarticular hyaluronic acid in treatment of osteoarthritis of knee among the patients admitted in a north Indian hospital. Methods:This was a prospective study conducted on 80 patients attending the out patient department of the hospital with a diagnosis of osteoarthritis of one or both knees were enrolled in this study. All the patients were symptomatic for osteoarthritis of knee and did not respond adequately to conservative treatment for osteoarthritis. 3 patients were lost to follow-up. The results are finally presented on 96 knees of 77 patients who underwent series of 5 intraarticular injections of hyaluronic acid at weekly interval. Results:The mean age of patients was 59.13 ± 2.3 years. Duration of symptom ranged from 6 months to 5 years. Most of the knees (55.2%) had moderate grade of osteoarthritis. The pain at rest and joint tenderness were significantly (p=0.0001) lower among mild grade of osteoarthritis as compared to moderate and severe. There was significant effect of intraarticular myaluronic acid in decreasing VAS and joint tenderness from baseline to 6 month. Conclusion: Visco-supplementation with hyaluronicacid may be considered an alternative option to major surgical procedure in developing countries provided the injections are given before mechanical changes take place and patient complies with regular exercise, weight control and postural habits.

Viscosupplementation with Intra-Articular Hyaluronic Acid for Treatment of Osteoarthritis in the Elderly

Osteoarthritis (OA) is very disabling condition in the elderly. The current therapeutic approaches (analgesics, NSAIDs, COX-2 inhibitors, steroids) do not delay the OA progression or reverse joint damage. Moreover, they may cause relevant systemic side effects. Hyaluronic acid (HA) is a physiologic component of the synovial fluid and is reduced in OA joints. Therefore, intra-articular injection of HA, due to its viscoelastic properties and protective effect on articular cartilage and soft tissue surfaces of joints, can restore the normal articular homoeostasis. These effects are evident when HA is properly administered into the articular space; therefore, the use of "image-guided" infiltration techniques is mandatory. Viscosupplementation (VS), with different HA preparations (Low and High molecular weight), can be considered when the patient has not found pain relief from other therapies or is intolerant to analgesics or NSAIDs. A 3-5 doses regimen is usually recommended with 1 week interval between each injection. Several studies have shown the efficacy of HA for the treatment of knee OA, with positive effects on pain, articular function (Western Ontario and Mc Master Universities Osteoarthritis Index [WOMAC], Lequesne Index [LI], Range of Motion [ROM]), subjective global assessment and reduction in NSAIDs consumption. In general, the benefit is evident within 3 months and persists in the following 6-12 months. Encouraging but inconclusive results have also been observed for the treatment of shoulder, carpo-metacarpal, hip and ankle OA. However there is the need of better designed studies to prove the effectiveness of these medications, in order to rule out a placebo effect. The therapy is well tolerated with absence of systemic side effects and only with limited local discomfort.

Intra-articular hyaluronic acid for treatment of osteoarthritis: a nationwide study among the older population of Taiwan

BackgroundAlthough intra-articular treatment with hyaluronic acid (HA) for symptomatic osteoarthritis has become widely accepted in recent decades, the pattern of its use has seldom been reported. We have explored the epidemiology of intra-articular HA treatment in Taiwan by using the rich data source from nationwide insurance claims.MethodsTaiwan's National Health Insurance (NHI), which covers 97% of inhabitants, offers extensive hospitalisation and ambulatory care. We identified the beneficiaries aged 60 years and older who received intra-articular HA within the NHI during 2004. The number of visits in which HA was administered were analysed by patient's age and gender and by the physician's specialty and practice site.ResultsAmong the 73,410,777 ambulatory visits by 2,909,219 beneficiaries aged 60 years and older in 2004, 35,782 (1.2%) patients received intra-articular HA treatment in 205,012 (0.3%) visits. The highest prevalence of HA use was in the 70–79 year age group in both sexes. Women received intra-articular HA treatment more frequently than men in all age groups, especially in the 60–69 and 70–79 year groups (1.6% vs. 0.5%, 2.2% vs. 1.0%, respectively). Most intra-articular HA procedures were performed by orthopaedic surgeons (75.1%) and physical medicine and rehabilitation physicians (15.2%), and at metropolitan hospitals (34.5%) and local community hospitals (38.2%).ConclusionOne out of 100 older patients in Taiwan received intra-articular HA treatment for osteoarthritis of the knee during the course of the year. There were age-gender differences in use of HA treatment. The completion rate of this treatment in our study was high, and thus intra-articular HA might be a good alternative for patients for whom conventional treatment fails. Further research is needed to examine the age-gender differences in use of intra-articular HA in Taiwan.

Intra-articular Hyaluronic Acid for Treatment of Osteoarthritis of the Knee—Reply

Intra-articular Hyaluronic Acid for Treatment of Osteoarthritis of the Knee—Reply