Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: Results of an extensive critical literature review.
OBJECTIVES:There is a discrepancy between evidence in support of the widespread use of intra-articular hyaluronic acid (IAHA) to treat knee osteoarthritis (OA) in clinical practice, and the often discordant recommendations from multiple international guideline committees, which requires further investigation. METHODS:
We conducted a literature review to determine the strength of evidence in support of the efficacy and safety of IAHA, from randomized controlled trials and meta-analyses. RESULTS: Our analysis shows that IAHA provides a moderate symptomatic benefit to knee OA patients and without major safety concerns. In fact, IAHA may offer one of the best benefit/risk ratios among pharmacologic options, as measured by improvements in knee OA health outcomes, overall gain in quality-adjusted life years and substantial delays in time to total knee replacement. CONCLUSIONS: We advocate for the consideration of recommending IAHA injection as a treatment option in the management of knee OA, tailored by disease stage and patient phenotype. Future research efforts should focus on identification of OA patient subgroups that demonstrate a more robust response to IAHA, determination of long-term effects of repeat IAHA injections on patient-reported outcomes and total knee replacement-sparing effect, further elucidation of disease-modifying effects, and the potential for combination therapy with other pharmacologic and non-pharmacologic therapies to optimize the management of knee OA (1).

Hyaluronic acid vs corticosteroids in symptomatic knee osteoarthritis: a mini-review of the literature.
INTRODUCTION: Although intra-articular injections of hyaluronic acid (HA) are common non-operative measures used in clinical practice in the management of symptomatic osteoarthritis, there is a great controversy on their efficacy and safety compared to corticosteroids (CSs). EFFICACY: Conflicting results have been reported in clinical trials and meta-analysis due to methodological differences in study design, along with collection, analysis, and interpretation of data. Even if some studies reported small or no differences of HA compared with CSs (or inferred that HA is not more effective than saline as a placebo), in general CSs have shown to be superior in the short term (especially on pain control), while better results have been reported with HA at subsequent evaluations, but with only a moderate effect after 26 weeks. SAFETY: Mild or moderate adverse events have generally been reported after HA injections, the most common being injection site pain. HA is generally considered safe compared to CSs or saline. Furthermore, HA has shown to be safe also after a previous course of injections.CONCLUSIONS: Conflicting results have been reported on the efficacy and safety of HA. Guidelines are controversial and in most of the cases "uncertain" recommendations are provided due to inconclusive evidence in literature. However, HA does not seem to have significantly higher side effects when compared to saline or CSs injections, and provides better medium-term control of symptoms in patients with mild to moderate knee osteoarthritis (2).

References______________________________

(1) Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: Results of an extensive critical literature review.
Maheu E, Bannuru RR, Herrero-Beaumont G, Allali F, Bard H, Migliore A.
Semin Arthritis Rheum. 2019 Feb;48(4):563-572. doi: 10.1016/j.semarthrit.2018.06.002. Epub 2018 Jun 19. Review.

(2) Hyaluronic acid vs corticosteroids in symptomatic knee osteoarthritis: a mini-review of the literature.
Bisicchia S, Tudisco C.
Clin Cases Miner Bone Metab. 2017 May-Aug;14(2):182-185. doi: 10.11138/ccmbm/2017.14.1.182. Epub 2017 Oct 25.

Hyaluronic acid (HA) is a polysaccharide belonging to the class of glycosaminoglycans, involved in tissue repair processes and in their regeneration. It is a fundamental component of the extracellular matrix, which contributes to an optimal performance of the repair processes by providing the appropriate degree of hydration, which facilitates cell migration (1).

Hydrolyzed hyaluronic acid, is a more soluble version of hyaluronic acid of which it retains all the characteristics.

Industrially it is in the form of a white, water-soluble powder.

The most well-known application by the public is that of anti-aging, to reduce wrinkles and the signs of aging.

 Hyaluronic acid is a natural component present in abundance in load-bearing joints of the human body (2), has the property of retaining skin moisture (3), has anti-inflammatory, antioxidant, and antibacterial effects for the treatment of periodontal diseases ( 4). However, the lubricating effect of hyaluronic acid is generally of short duration and the duration of its biological effects is not predictable (5).

For more information:

Hyaluronic acid studies

FMolecular Formula    C₂₈H₄₄N₂O₂₃

Molecular Weight     776.6

CAS  9004-61-9

UNII    

EC Number   

DSSTox Substance ID  

IUPAC  (2S,3S,4S,5R,6R)-6-[(2S,3R,5S,6R)-3-acetamido-2-[(2S,3S,4R,5R,6R)-6-[(2R,3R,5S,6R)-3-acetamido-2,5-dihydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-2-carboxy-4,5-dihydroxyoxan-3-yl]oxy-5-hydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-3,4,5-trihydroxyoxane-2-carboxylic acid

InChI=1S/C28H44N2O23/c1-5(33)29-9-18(11(35)7(3-31)47-25(9)46)49-28-17(41)15(39)20(22(53-28)24(44)45)51-26-10(30-6(2)34)19(12(36)8(4-32)48-26)50-27-16(40)13(37)14(38)21(52-27)23(42)43/h7-22,25-28,31-32,35-41,46H,3-4H2,1-2H3,(H,29,33)(H,30,34)(H,42,43)(H,44,45)/t7-,8-,9-,10-,11-,12-,13+,14+,15-,16-,17-,18?,19?,20+,21+,22+,25-,26+,27-,28-/m1/s1

InChl Key      KIUKXJAPPMFGSW-MNSSHETKSA-N

SMILES   CC(=O)NC1C(C(C(OC1O)CO)O)OC2C(C(C(C(O2)C(=O)O)OC3C(C(C(C(O3)CO)O)OC4C(C(C(C(O4)C(=O)O)O)O)O)NC(=O)C)O)O

Synonyms

• (2S,3S,4S,5R,6R)-6-[(2S,3R,5S,6R)-3-acetamido-2-[(2S,3S,4R,5R,6R)-6-[(2R,3R,5S,6R)-3-acetamido-2,5-dihydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-2-carboxy-4,5-dihydroxyoxan-3-yl]oxy-5-hydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-3,4,5-trihydroxyoxane-2-carboxylic acid
• (2S,3S,4S,5R,6R)-6-[(2S,3R,5S,6R)-3-acetamido-2-[(2S,3S,4R,5R,6R)-6-[(2R,3R,5S,6R)-3-acetamido-2,5-dihydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-2-carboxy-4,5-dihydroxyoxan-3-yl]oxy-5-hydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-3,4,5-trihydroxyoxane-2-carboxylic acid
• D-Glucopyranose, O(4ξ)-α-D-xylo-hexopyranuronosyl-(1->3)-O-2-(acetylamino)-2-deoxy-β-D-allopyranosyl-(1->4)-O(5ξ)-β-D-xylo-hexopyranuronosyl-(1->3)-2-(acetylamino)-2-deoxy-

References_________________________

(1) Laliscia C, Delishaj D, Fabrini MG, Gonnelli A, Morganti R, Perrone F, Tana R, Paiar F, Gadducci A. Acute and late vaginal toxicity after adjuvant high-dose-rate vaginal brachytherapy in patients with intermediate risk endometrial cancer: is local therapy with hyaluronic acid of clinical benefit? J Contemp Brachytherapy. 2016 Dec;8(6):512-517. doi: 10.5114/jcb.2016.64511.

(2) Correia CR, Moreira-Teixeira LS, Moroni L, Reis RL, van Blitterswijk CA, Karperien M, Mano JF. Chitosan scaffolds containing hyaluronic acid for cartilage tissue engineering. Tissue Eng Part C Methods. 2011 Jul;17(7):717-30. doi: 10.1089/ten.tec.2010.0467.

(3) Kablik J, Monheit GD, Yu L, Chang G, Gershkovich J. Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg. 2009 Feb;35 Suppl 1:302-12. doi: 10.1111/j.1524-4725.2008.01046.x.

(4)  Jentsch H, Pomowski R, Kundt G, Göcke R. Treatment of gingivitis with hyaluronan. J Clin Periodontol. 2003 Feb;30(2):159-64. doi: 10.1034/j.1600-051x.2003.300203.x. .

(5) Huang YC, Huang KY, Yang BY, Ko CH, Huang HM. Fabrication of Novel Hydrogel with Berberine-Enriched Carboxymethylcellulose and Hyaluronic Acid as an Anti-Inflammatory Barrier Membrane. Biomed Res Int. 2016;2016:3640182. doi: 10.1155/2016/3640182.