Abstract
Intra-articular administration of hyaluronic acid is an alternative to the treatment of hip and knee osteoarthritis recommended by EULAR, ACR and OARSI. It's mechanism of action acts in re-establish of normal rheological conditions in synovial fluid and restoration of synovial fluid viscoelastic properties, which allows tissue and proper joint function.
Further mechanism of action may exist: inhibition of inflammatory mediators, analgesic function obtained by reduction of sensitivity of pain receptors, decrease of cartilage degradation and promotion of cartilage matrix synthesis, stimulation of natural hyaluronic acid synthesis. Results from clinical studies suggest possible disease modifying effect.
Use of viscosupplementation by hyaluronic acid is well documented by number of clinical studies. There are a number of products on the Czech market from different producers.
These products are differentiate in hyaluronic acid origin, its concentration, molecular weight and presence of chemical modification (non cross-linked vs. cross-linked). Sinovial is registered in several European countries as a medical device.
It is a sterile, non-pyrogenic, buffered solution of highly purified hyaluronic acid, with a molecular weight 8 - 1,2 mio Da. It's obtained by fermentation from Streptococci Lancefield A and C and not modified chemically (non cross-linked).
In observational evaluation were involved patients, which were indicated for viscosupplementation regarding standard recommendations. Patiens were involved from October 2004 till December 2005.
Evaluation was without comparator group and multicentric. The standard dose of 5 weekly injections of hyaluronic acid was administered.
The total number of involved patients was 865 (426 woman and 353 man). Clinical improvement was noted by 97% of patients.
The average decrease of pain intensity (VAS) between 1st and 5th injection was by 63%. Sinovial was well tolerated by majority of patients.