Preview

Modern Rheumatology Journal

Advanced search

Intra-articular injections in the treatment of osteoarthritis

https://doi.org/10.14412/1996-7012-2022-1-97-102

Abstract

Local methods are widely used in the treatment of osteoarthritis (OA) and play a significant role in the complex therapy of this disease. A special place among them belongs to intra-articular (i/a) administration of drugs. The most widely used for this purpose are glucocorticoids (GC) and hyaluronic acid (HA) drugs. When comparing the effectiveness of these drugs, it was shown that during the 1st month, HA had more favorable results, after 3 months the results did not differ significantly, and after 6 months, the effectiveness of HA was higher. Some authors believe that the optimal result can be obtained with the combined use of HA and GC.
The efficacy and tolerability of HA drugs in patients with OA have been studied in numerous randomized controlled trials (RCTs), and the data obtained in these studies have been summarized in a number of meta-analyses. At the same time, both in RCTs and in meta-analyses, the results of such treatment were assessed differently. However, when summarizing the materials of various meta-analyses within the framework of a systematic review, it was shown that i/a injections of HA are an effective and safe method of local treatment of OA. However, there are no generally accepted recommendations for the use of HA in the treatment of OA, and the question of their administration in each case is decided individually, taking into account the history, clinical picture, OA phenotype, and tolerability of therapy. The Russian Association of Rheumatologists recommends the use of i/a HA injections in knee OA with synovitis and the use of HA injections to reduce pain and improve joint function.

About the Authors

Yu. A. Olyunin
V.A. Nasonova Research Institute of Rheumatology
Russian Federation

Yury Aleksandrovich Olyunin

34A, Kashirskoe shosse, Moscow 115522



I. N. Schendrigin
Stavropol Regional Clinical Hospital
Russian Federation

1, Semashko street, Stavropol 355030



References

1. Alekseeva LI, Taskina EA, Kashevarova NG. Osteoarthritis: epidemiology, classification, risk factors, and progression, clinical presentation, diagnosis, and treatment. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2019;13(2):9-21. (In Russ.). doi: 10.14412/1996-7012-2019-2-9-21

2. Lila AM, Tkacheva ON, Yakhno NN, et al. Comprehensive approach to the choice of therapy in patients with osteoarthritis at the first visit to the doctor. Expert consensus (literature review and resolution). Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2021;15(3):111-6. (In Russ.). doi: 10.14412/1996-7012-2021-3-111-116

3. Taskina EA, Kashevarova NG, Alekseeva LI. The place of nonsteroidal anti-inflammatory drugs in the current osteoarthritis guidelines. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2020;14(2):123-30. (In Russ.). doi: 10.14412/1996-7012-2020-2-123-130

4. Anikin SG, Alekseeva LI, Lila AM. Use of disease-modifying anti-rheumatic drugs in the therapy of osteoarthritis. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2019;13(2):90-5. (In Russ.). doi: 10.14412/1996-7012-2019-2-90-95

5. Jьni P, Hari R, Rutjes AW, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015 Oct 22; (10):CD005328. doi: 10.1002/14651858.CD005328.pub3.

6. McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017 May 16; 317(19):1967-75. doi: 10.1001/jama.2017.5283.

7. He WW, Kuang MJ, Zhao J, et al. Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis. Int J Surg. 2017 Mar;39: 95-103. doi: 10.1016/j.ijsu.2017.01.087.

8. Smith C, Patel R, Vannabouathong C, et al. Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6): 1974-83. doi: 10.1007/s00167-018-5071-7.

9. [Strebkova EA, Alekseeva LI. Efficiency of intra-articular hyaluronic acid therapy in patients with osteoarthritis. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2019;13(2):96-104. (In Russ.). doi: 10.14412/1996-7012-2019-2-96-104

10. Nasonov EL, editor. Rossiiskie klinicheskie rekomendatsii. Revmatologiya [Russian clinical guidelines. Rheumatology]. Moscow: GEOTAR-Media; 2020. 448 p.

11. Bowden DJ, Byrne CA, Alkhayat A, et al. Injectable Viscoelastic Supplements: A Review for Radiologists. AJR Am J Roentgenol. 2017 Oct;209(4):883-8. doi: 10.2214/AJR.17.17847.

12. Temple-Wong MM, Ren S, Quach P, et al. Hyaluronan concentration and size distribution in human knee synovial fluid: variations with age and cartilage degeneration. Arthritis Res Ther. 2016 Jan 21;18:18. doi: 10.1186/s13075-016-0922-4.

13. Band PA, Heeter J, Wisniewski HG, et al. Hyaluronan molecular weight distribution is associated with the risk of knee osteoarthritis progression. Osteoarthritis Cartilage. 2015 Jan;23(1):70-6. doi: 10.1016/j.joca.2014.09.017.

14. Yasuda T. Hyaluronan inhibits prostaglandin E2 production via CD44 in U937 human macrophages. Tohoku J Exp Med. 2010 Mar; 220(3):229-35. doi: 10.1620/tjem.220.229.

15. Sato E, Ando T, Ichikawa J, et al. High molecular weight hyaluronic acid increases the differentiation potential of the murine chondrocytic ATDC5 cell line. J Orthop Res. 2014 Dec;32(12):1619-27. doi: 10.1002/jor.22691.

16. Kawana H, Karaki H, Higashi M, et al. CD44 suppresses TLR-mediated inflammation. J Immunol. 2008 Mar 15;180(6):4235-45. doi: 10.4049/jimmunol.180.6.4235.

17. Campo GM, Avenoso A, Nastasi G, et al. Hyaluronan reduces inflammation in experimental arthritis by modulating TLR-2 and TLR-4 cartilage expression. Biochim Biophys Acta. 2011 Sep;1812(9):1170-81. doi: 10.1016/j.bbadis.2011.06.006.

18. Wang CT, Lin YT, Chiang BL, et al. High molecular weight hyaluronic acid down-regulates the gene expression of osteoarthritis-associated cytokines and enzymes in fibroblast-like synoviocytes from patients with early osteoarthritis. Osteoarthritis Cartilage. 2006 Dec;14(12):1237-47. doi: 10.1016/j.joca.2006.05.009.

19. Lokhnauth J, Driscoll KE, Bendele A, et al. Viscosupplementation may preserve tibial cartilage and collagen in osteoarthritis: findings from a preclinical model of osteoarthritis. J Exp Orthop. 2020 May 31;7(1):39. doi: 10.1186/s40634-020-00256-4.

20. Xing D, Wang B, Liu Q, et al. Intra-articular Hyaluronic Acid in Treating Knee Osteoarthritis: a PRISMA-Compliant Systematic Review of Overlapping Meta-analysis. Sci Rep. 2016 Sep 12;6:32790. doi: 10.1038/srep32790.

21. Bannuru RR, Natov NS, Dasi UR, et al. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis – meta-analysis. Osteoarthritis Cartilage. 2011 Jun;19(6):611-9. doi: 10.1016/j.joca.2010.09.014.

22. Richette P, Chevalier X, Ea HK, et al. Hyaluronan for knee osteoarthritis: an updated meta-analysis of trials with low risk of bias. RMD Open. 2015 May 14;1(1):e000071. doi: 10.1136/rmdopen-2015-000071.

23. Bannuru RR, Schmid CH, Kent DM, et al. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015 Jan 6;162(1):46-54. doi: 10.7326/M14-1231.

24. Petrella RJ, Wakeford C. Pain relief and improved physical function in knee osteoarthritis patients receiving ongoing hylan G-F 20, a high-molecular-weight hyaluronan, versus other treatment options: data from a large real-world longitudinal cohort in Canada. Drug Des Devel Ther. 2015 Oct 15;9: 5633-40. doi: 10.2147/DDDT.S88473.

25. Migliore A, Massafra U, Frediani B, et al. HyalOne® in the treatment of symptomatic hip OA - data from the ANTIAGE register: seven years of observation. Eur Rev Med Pharmacol Sci. 2017 Apr;21(7):1635-44. PMID: 28429341.

26. Lila AM, Gordeev AV, Olyunin YuA, Galushko EA. Multimorbidity in rheumatology. From comprehensive assessment of disease to evaluation of a set of diseases. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2019;13(3):4-9. (In Russ.. doi: 10.14412/1996-7012-2019-3-4-9

27. Dasa V, Lim S, Heeckt P. Real-World Evidence for Safety and Effectiveness of Repeated Courses of Hyaluronic Acid Injections on the Time to Knee Replacement Surgery. Am J Orthop (Belle Mead NJ). 2018 Jul;47(7). doi: 10.12788/ajo.2018.0058.

28. Altman R, Lim S, Steen RG, Dasa V. Hyaluronic Acid Injections Are Associated with Delay of Total Knee Replacement Surgery in Patients with Knee Osteoarthritis: Evidence from a Large U.S. Health Claims Database. PLoS One. 2015 Dec 22;10(12):e0145776. doi: 10.1371/journal.pone.0145776.

29. Etter K, Chitnis AS, Holy CE, et al. High-concentration nonavian high-molecular weight hyaluronan injections and time-tototal knee replacement surgery. J Comp Eff Res. 2020 Aug;9(11):795-805. doi: 10.2217/cer-2019-0128.

30. Migliore A, Bella A, Bisignani M, et al. Total hip replacement rate in a cohort of patients affected by symptomatic hip osteoarthritis following intra-articular sodium hyaluronate (MW 1,500-2,000 kDa) ORTOBRIX study. Clin Rheumatol. 2012 Aug;31(8): 1187-96. doi: 10.1007/s10067-012-1994-4

31. De Lucia O, Murgo A, Pregnolato F, et al. Hyaluronic Acid Injections in the Treatment of Osteoarthritis Secondary to Primary Inflammatory Rheumatic Diseases: A Systematic Review and Qualitative Synthesis. Adv Ther. 2020 Apr;37(4):1347-59. doi: 10.1007/s12325-020-01256-7.

32. Bowman EN, Hallock JD, Throckmorton TW, Azar FM. Hyaluronic acid injections for osteoarthritis of the knee: predictors of successful treatment. Int Orthop. 2018 Apr; 42(4):733-40. doi: 10.1007/s00264-017-3731-8.

33. Pelletier JP, Raynauld JP, Abram F, et al. Exploring determinants predicting response to intra-articular hyaluronic acid treatment in symptomatic knee osteoarthritis: 9-year follow-up data from the Osteoarthritis Initiative. Arthritis Res Ther. 2018 Mar 1;20(1):40. doi: 10.1186/s13075-018-1538-7.

34. Chen YP, Huang YY, Wu Y, et al. Depression negatively affects patient-reported knee functional outcome after intraarticular hyaluronic acid injection among geriatric patients with knee osteoarthritis. J Orthop Surg Res. 2019 Nov 27;14(1):387. doi: 10.1186/s13018-019-1419-z.

35. Kianmehr N, Hasanzadeh A, Naderi F, et al. A randomized blinded comparative study of clinical response to surface anatomy guided injection versus sonography guided injection of hyaloronic acid in patients with primary knee osteoarthritis. Int J Rheum Dis. 2018 Jan; 21(1):134-9. doi: 10.1111/1756-185X.13123.


Review

For citations:


Olyunin YA, Schendrigin IN. Intra-articular injections in the treatment of osteoarthritis. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2022;16(1):97-102. (In Russ.) https://doi.org/10.14412/1996-7012-2022-1-97-102

Views: 767


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1996-7012 (Print)
ISSN 2310-158X (Online)