Viscosupplementation for the treatment of osteoarthritis of the knee: Difference between revisions
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A wide variety of treatments for osteoarthritis of the knee are possible. Guidelines have been drawn up by the American College of Rheumatology (ACR) and the European League against Rheumatism (EULAR). <ref name="1">Petrella R J, Decaria J, Petrella M J. Long term efficacy and safety of a combined low and high molecular weight hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology Reports 2011; 3:16-21.</ref> In a first group, known as the non-pharmacological interventions we find treatments such as education, exercise, life style changes and physical therapy. <ref name="2">Dennis Y, Wen M.D. Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis. Am Fam Physician 2000; 1:565-570.</ref> A second group comprises the pharmacological treatments like pain killers and non-steroidal anti-inflammatory drugs (NSAIDs). <ref name="1" /> <ref name="2" /> Intra-articular corticosteroid injections are also an option and are often used for transient symptom relief. When the more conservative measures fail, there is another option when surgery is to be avoided: viscosupplementation. <ref name="1" /><ref name="2" /> Viscosupplementation belongs in the category of localized therapy, more precisely intra-articular pharmacological therapy. <ref name="3">Huskin J.P., Vandekerckhove B. et al. Multicentre, prospective, open study to evaluate the safety and efficacy of hylan G-F 20 in knee osteoarthritis subjects presenting with pain following arthroscopic meniscectomy. Knee Surg Sports Traumatol Arthrosc. 2008; 16: 747–752.</ref> | A wide variety of treatments for osteoarthritis of the knee are possible. Guidelines have been drawn up by the American College of Rheumatology (ACR) and the European League against Rheumatism (EULAR). <ref name="1">Petrella R J, Decaria J, Petrella M J. Long term efficacy and safety of a combined low and high molecular weight hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology Reports 2011; 3:16-21.</ref> In a first group, known as the non-pharmacological interventions we find treatments such as education, exercise, life style changes and physical therapy. <ref name="2">Dennis Y, Wen M.D. Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis. Am Fam Physician 2000; 1:565-570.</ref> A second group comprises the pharmacological treatments like pain killers and non-steroidal anti-inflammatory drugs (NSAIDs). <ref name="1" /> <ref name="2" /> Intra-articular corticosteroid injections are also an option and are often used for transient symptom relief. When the more conservative measures fail, there is another option when surgery is to be avoided: viscosupplementation. <ref name="1" /><ref name="2" /> Viscosupplementation belongs in the category of localized therapy, more precisely intra-articular pharmacological therapy. <ref name="3">Huskin J.P., Vandekerckhove B. et al. Multicentre, prospective, open study to evaluate the safety and efficacy of hylan G-F 20 in knee osteoarthritis subjects presenting with pain following arthroscopic meniscectomy. Knee Surg Sports Traumatol Arthrosc. 2008; 16: 747–752.</ref> | ||
Viscosupplementation is actually the injection of Hyaluronic Acid (HA). <ref name="2" /> HA is a major component of the synovial fluid and of the cartilage and is one of the most important components of the extracellular matrix.<ref name="1" /> HA is a high-molecular-weight glycosaminoglycan composed of repeating disaccharides of glucuronic acid and N-acetylglucosamine. <ref name="2" /> <ref name="4">Gossec L, Dougados, M. Do intra-articular therapies work and who will benefit most? Best Practice & | Viscosupplementation is actually the injection of Hyaluronic Acid (HA). <ref name="2" /> HA is a major component of the synovial fluid and of the cartilage and is one of the most important components of the extracellular matrix.<ref name="1" /> HA is a high-molecular-weight glycosaminoglycan composed of repeating disaccharides of glucuronic acid and N-acetylglucosamine. <ref name="2" /> <ref name="4">Gossec L, Dougados, M. Do intra-articular therapies work and who will benefit most? Best Practice & Research Clinical Rheumatology 2006;1:131–144.</ref> | ||
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Revision as of 10:57, 6 June 2017
Description[edit | edit source]
A wide variety of treatments for osteoarthritis of the knee are possible. Guidelines have been drawn up by the American College of Rheumatology (ACR) and the European League against Rheumatism (EULAR). Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In a first group, known as the non-pharmacological interventions we find treatments such as education, exercise, life style changes and physical therapy. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title A second group comprises the pharmacological treatments like pain killers and non-steroidal anti-inflammatory drugs (NSAIDs). Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Intra-articular corticosteroid injections are also an option and are often used for transient symptom relief. When the more conservative measures fail, there is another option when surgery is to be avoided: viscosupplementation. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Viscosupplementation belongs in the category of localized therapy, more precisely intra-articular pharmacological therapy. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Viscosupplementation is actually the injection of Hyaluronic Acid (HA). Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title HA is a major component of the synovial fluid and of the cartilage and is one of the most important components of the extracellular matrix.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title HA is a high-molecular-weight glycosaminoglycan composed of repeating disaccharides of glucuronic acid and N-acetylglucosamine. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
When a person has osteoarthritis of the knee, the quality of the synovial fluid decreases, but also the concentration and Molecular Weight of HA. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title This can lead to pain and loss of function in the joint of the knee.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Therefore, hyaluronic acid is injected so that de concentration, molecular weight characteristics in the extracellular matrix and the visco-elasticity of the synovial fluid can recover.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title This results in improved pain control, articular function and mobility.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
There are different hyaluronic acid preparations and we can classify them in two categories: low molecular weight and high molecular weight. Two examples of hyaluronic acid products are naturally occurring hyaluronan (Hyalgan) and synthetic hylan G-F 20 (Synvisc). Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Who?[edit | edit source]
The majority of patients chooses for viscosupplementation after they failed in a program of non-pharmacological therapy, pharmacological therapy, are intolerant to these therapies or don’t want surgery. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
However the ideal person for viscosupplementation of hyaluronic acid has not yet been found. They are still searching for the ideal age, the best level of osteoarthritis as defined radio-graphically, level of symptoms and level of physical activity to get the best results from the treatment. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Viscosupplementation proved to reduce the pain and being safe[edit | edit source]
There are many studies that compare hyaluronic acid to placebo. Some of these studies concluded that viscosupplementation of HA is effective in improving symptoms and function and decreases the pain with a modest difference versus placebo. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Viscosupplementation has been found a safe treatment, most of the patients were satisfied with this treatment. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
But there are also studies that did not find or doubt this difference. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Further research is needed to confirm that there is a certain difference in efficacy of viscosupplementation versus placebo. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Difference in molecular weight hyaluronic acid[edit | edit source]
The difference between an intra-articular viscosupplementation with a lower (LMW), higher (HMW) and combined lower and higher molecular weight (DMW) sodium hyaluronate in osteoarthritis in the knee versus placebo has been researched. Also the long-term clinical outcome of pain at rest and following walking activities were investigated. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The outcome of this study was a significant improvement in pain and function for patients who received randomly the DMW hyaluronic acid compared to both LMW and HMW. Patients who received DMW, reduction of walking pain was significantly greater than either with the LMW or HMW groups. The DMW group experienced less pain at rest compared to LMW and HMW. Patients in the DMW group had significantly greater improvement at 16, 52 and 104 weeks compared to the other active treatment groups. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
This can be explained by two examples: naturally occurring hyaluronan (Hyalgan) and synthetic hylan G-F 20 (Synvisc). Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Hylans are cross-linked hyaluronic acids, which give them a higher molecular weight and increased elastoviscous properties. 6 Because hylan has a higher molecular weight, it is more efficacious than hyaluronic acid. This is due to its enhanced elastoviscous properties and its longer period of residence in the knee joint space. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The safety and efficacy of viscosupplementation with Hylan G-F 20 has been researched by many studies, prospective clinical trials and large retrospective studies. Hylan G-F 20 is a high molecular weight, cross-linked derivative of hyaluronan. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Period of efficacy[edit | edit source]
There is ignorance about the period of efficacy. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Some studies say less than 34 weeks Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, some say between 34 weeks and 52 weeks 3 and some studies who searched for the long term efficacy concluded that HA was still efficacious and safe at 104 weeks and more. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title So, here also further research is required.
Adverse events[edit | edit source]
Adverse events of the viscosupplementation of HA are mild and are resolved in a short time. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The adverse events reported in the literature are fugitive pain or effusion and swelling at the injection site, erythema at the injection site and stiffness of the knee. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Further there are also rarely reported adverse events like local skin reaction, itch (pruritus), headache and fever. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
There is little evidence of a difference between the different injections of hyaluronic acid. Two studies found that adverse events occur more frequently with injections with a high molecular weight cross-linked hylan (hylan G-F 20) than with injections of a non-cross-linked low molecular weight hyaluronic acid (hyaluronic acid of bacterial origin). Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Comparison between other treatments[edit | edit source]
It is said that a therapy of viscosupplementation of HA is more effective than NSAID therapy and painkillers. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
An exercise program is a possible treatment for osteoarthritis of the knee. Many studies suggest that exercise programs are effective to improve function, reduce the pain, decrease disability and are good to maintain range of motion, muscle strength and general health. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title These exercise programs can contain a strength-training, an intensive short-term exercise training, a Disabled Arthritis Patients Post-hospitalization Intensive Exercise Rehabilitation (DAPPER) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, aerobic exercise programs such as walking or swimming and quadriceps-strengthening exercise. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The best is to compare different programs, so that not only the range of motion improves but also the aerobic capacity and walking speed. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
No study is found about the efficacy of the combination of exercise and viscosupplementation.
Resources[edit | edit source]
Pubmed and BIB/website vub.ac.be/BIBLIO
References[edit | edit source]
