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Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis
Victor M Goldberg, Laura Goldberg
Journal of Pain Research , 2010, DOI: http://dx.doi.org/10.2147/JPR.S4733
Abstract: tra-articular hyaluronans: the treatment of knee pain in osteoarthritis Review (5447) Total Article Views Authors: Victor M Goldberg, Laura Goldberg Published Date May 2010 Volume 2010:3 Pages 51 - 56 DOI: http://dx.doi.org/10.2147/JPR.S4733 Victor M Goldberg1, Laura Goldberg2 1Department of Orthopaedics, Case Medical Center, Cleveland, Ohio, USA; 2Cleveland Clinic, Cleveland, Ohio, USA Abstract: The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. Intra-articular injections of hyaluronans (HAs) are indicated when non-pharmacological and simple analgesics have failed to relieve symptoms. The HAs appear to reduce pain by restoring both mechanical and biomechanical homeostasis in the joint. There are five FDA-approved injectable preparations of HAs: Hyalgan , Synvisc , Supartz , Orthovisc and Euflexxa . They all appear to relieve pain from 4 to 14 weeks after injection and may have disease-modification properties. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra-articular HA injections in the treatment of osteoarthritis.
Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis  [cached]
Victor M Goldberg,Laura Goldberg
Journal of Pain Research , 2010,
Abstract: Victor M Goldberg1, Laura Goldberg21Department of Orthopaedics, Case Medical Center, Cleveland, Ohio, USA; 2Cleveland Clinic, Cleveland, Ohio, USAAbstract: The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. Intra-articular injections of hyaluronans (HAs) are indicated when non-pharmacological and simple analgesics have failed to relieve symptoms. The HAs appear to reduce pain by restoring both mechanical and biomechanical homeostasis in the joint. There are five FDA-approved injectable preparations of HAs: Hyalgan , Synvisc , Supartz , Orthovisc and Euflexxa . They all appear to relieve pain from 4 to 14 weeks after injection and may have disease-modification properties. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra-articular HA injections in the treatment of osteoarthritis.Keywords: hyaluronans, knee, pain, osteoarthritis
Intra-articular use of hyaluronic acid in the treatment of osteoarthritis  [cached]
Alberto Migliore,Mauro Granata
Clinical Interventions in Aging , 2008,
Abstract: Alberto Migliore1,2, Mauro Granata31UOS of Rheumatology S. Pietro Fatebenefratelli Hospital, Rome, Italy; 2AFaR Research Center, S. Pietro, Rome, Italy; 3UOS of Rheumatology S. Filippo Neri Hospital, Rome, ItalyAbstract: Osteoarthritis is one of the leading causes of disability in the elderly. The changes in the lubricating properties of synovial fluid lead to significant pain and loss of function. More than ten years have passed from the first studies. Up till now many authors have supported intra-articular hyaluronan (HA) therapy as not only a symptom-modifying therapy but also a treatment which may significantly decrease the rate of deterioration of joint structure. In this review we report data relative to knee and hip treatment. The ongoing studies continue to further our understanding of the fundamental mechanisms that likely underlie the therapeutic benefits of this treatment but, despite recent progress, many unresolved issues require further study. Large scale double blind controlled studies must be carried out to confirm these promising data and produce meaningful guidelines.Keywords: osteoarthritis, hyaluronan, intra-articular injections, ultrasound-guided, viscosupplementation
Intra-articular injection of xanthan gum: A potential therapy for osteoarthritis  [PDF]
Huarong Shao, Guanying Han, Peixue Ling, Xiqiang Zhu, Fei Liu, Yan Jin, Lijuan Zhao, Tianmin Zhang
Advances in Bioscience and Biotechnology (ABB) , 2012, DOI: 10.4236/abb.2012.324063
Abstract: Osteoarthritis (OA) means inflammation of the joints, with the symptoms of joint pain, stiffness, and swelling of the joints. It is a degenerative disease that appears to be caused by both biomechanical and bio-chemical factors. Intra-articular (IA) injection treatment is one of the main treatment methods for OA because of its positive effect in reducing joint pain and increasing joint mobility. IA injection of xanthan gum (XG) could protect the joint cartilage, relieve the synovitis and reduce the OA progression in experiment OA. The injection of XG may have a long-lasting effect in the joint cavity, which could avoid frequent IA injections. However, for the development of this potential therapy, further studies such as the effective long-term pain relief properties, the detailed action mechanism and the pharmacokinetics of the XG injection will be conducted. This article briefly reviewed the preparation, safety evaluation, pharmacodynamics and possible action mechanism of XG injection, and come up with the ideas for further development of this potential therapy for OA.
Micro- and Nano-Carrier Mediated Intra-Articular Drug Delivery Systems for the Treatment of Osteoarthritis
Zhiyue Zhang,Guihua Huang
Journal of Nanotechnology , 2012, DOI: 10.1155/2012/748909
Abstract: The objective of this paper is to provide readers with current developments of intra-articular drug delivery systems. In recent years, although the search for a clinically successful ideal carrier is ongoing, sustained-release systems, such as polymeric micro- and nanoparticles, liposomes, and hydrogels, are being extensively studied for intra-articular drug delivery purposes. The advantages associated with long-acting preparations include a longer effect of the drug in the action site and a reduced risk of infection due to numerous injections consequently. This paper discusses the recent developments in the field of intra-articular sustained-release delivery systems for the treatment of osteoarthritis.
Intra-articular hyaluronic acid for treatment of osteoarthritis: a nationwide study among the older population of Taiwan
Hsiu-Yun Lai, Yu-Chun Chen, Tzeng-Ji Chen, Li-Fang Chou, Liang-Kung Chen, Shinn-Jang Hwang
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-24
Abstract: Taiwan'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.Among 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%).One 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.Osteoarthritis of the knee is one of the leading causes of disability among the older population. Beside functional activities, it affects social relationships, body image and emotional well-being [1,2]. In Western countries, 7–18% of older people have symptomatic osteoarthritis of the knee [3-5]. A population-based study in China also found that symptomatic osteoarthritis of the knee occurs in 15% of women and 6% of men aged 60 and older [6]. The pain arising from osteoa
The Antinociceptive Effect of Genicular Nerves Block Compared to Intra-Articular Dexamethasone in Grade III or IV Knee Osteoarthritis  [PDF]
Gabriela R. Lauretti, Davi L. R. Santos, Celia S. Oliveira, Carlos Trintade
Journal of Biomedical Science and Engineering (JBiSE) , 2019, DOI: 10.4236/jbise.2019.1210036
Abstract: Introduction: Knee pain secondary to osteoarthritis is a common pathology reflecting on the capacity of undertaking daily activities. Among non-surgical procedures, intra-articular corticosteroids represent an alternative complementary therapy. However, blocking the genicular nerves is a recently described technique, easily applied for clinical management. Objectives: To compare efficacy of both intra-articular corticosteroid and genicular block for chronic knee pain. Methods: 20 patients with osteoarthritis were evaluated for: 1) the intensity of pain; 2) the quality of sleep; 3) the capacity to undertake daily activities. Two groups were formed randomly, the first submitted to intra-articular blocking and the second to blocking the genicular nerves. A solution of plane 90 mg lidocaine 1%, and dexamethasone 10 mg was standard and used for intervention in both procedures to a final 10-ml volume. After a weekly appraisal for 12 consecutive weeks, the patients were recalled and submitted to another proposed procedure and in this way, all the patients acted as their own control (a “crossover” study design). In the following weeks, as also in the pretest, the intensity of pain, the quality of sleep and the capacity of undertaking daily activities were evaluated. Results: Both the intra-articular block and the genicular nerves block resulted equally in important reduction of pain during 11 weeks, with similar improvement in the quality of night sleep, and in the capacity of daily activities (p < 0.05). Conclusions: The blocking of the genicular nerves was a safe alternative, minimally invasive and highly efficient, similar to the intra-articular corticosteroid.
Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action
Larry W Moreland
Arthritis Research & Therapy , 2003, DOI: 10.1186/ar623
Abstract: Osteoarthritis (OA), the most common form of arthritis, is a chronic disease characterized by the slow degradation of cartilage, pain, and increasing disability. The disease can have an impact on several aspects of a patient's life, including functional and social activities, relationships, socioeconomic status, body image, and emotional well-being [1]. Currently available pharmacological therapies target palliation of pain and include analgesics (i.e. acetaminophen, cyclooxygenase-2-specific inhibitors, nonselective nonsteroidal anti-inflammatory drugs, tramadol, opioids), intra-articular therapies (glucocorticoids and hyaluronan [hyaluronic acid] [HA]), and topical treatments (i.e. capsaicin, methylsalicylate) [2].Intra-articular treatment with HA and hylans (see Table 1 for definitions) has recently become more widely accepted in the armamentarium of therapies for OA pain [2]. HA is responsible for the viscoelastic properties of synovial fluid. This fluid contains a lower concentration and molecular weight (MW) of HA in osteoarthritic joints than in healthy ones [3]. Thus, the goal of intra-articular therapy with HA is to help replace synovial fluid that has lost its viscoelastic properties. The efficacy and tolerability of intra-articular HA for the treatment of pain associated with OA of the knee have been demonstrated in several clinical trials [4-14]. Three (hylan G-F 20) to five (sodium hyaluronate) injections can provide relief of knee pain from OA for up to 6 months [6,7,11]. Intra-articular hylan or HA is also generally well tolerated, with a low incidence of local adverse events (from 0% to 13% of patients) [5,6,8,11,12] that was similar to that found with placebo [6,11].Because the residence time of exogenously administered HA in the joint is relatively short, HA probably has physiological effects in the joint that contribute to its effects in the joint over longer periods. The exact mechanism(s) by which intra-articular HA or hylans relieve pain is cur
Treatment of osteoarthritis knee pain: update on use of intra-articular hylan G-F 20
Alberto Migliore, Francesca Giovannangeli, Emanuele Bizzi, et al
Orthopedic Research and Reviews , 2010, DOI: http://dx.doi.org/10.2147/ORR.S5836
Abstract: eatment of osteoarthritis knee pain: update on use of intra-articular hylan G-F 20 Review (4978) Total Article Views Authors: Alberto Migliore, Francesca Giovannangeli, Emanuele Bizzi, et al Published Date November 2010 Volume 2010:2 Pages 107 - 118 DOI: http://dx.doi.org/10.2147/ORR.S5836 Alberto Migliore1, Francesca Giovannangeli1, Emanuele Bizzi1, Bruno Laganà2, Mauro Granata3 1Department of Rheumatology, S Pietro FBF Hospital, 2Department of Rheumatology, Second Medical School, Sapienza University, 3Rheumatology and Osteoporosis Center, San Filippo Neri Hospital, Rome, Italy Background: Osteoarthritis is a public health concern, particularly in modern society, and is the leading osteoarticular pathology in developed countries. The increased prevalence of osteoarthritis with aging, coupled with the aging of populations, makes osteoarthritis a high priority health care problem. Viscosupplementation is a well established treatment option in knee osteoarthritis that is included in the professional guidelines for treatment of this joint disease. Objective: This review assessed the efficacy and safety of viscosupplementation with hylan G-F 20 (Synvisc ) in the management of joint pain in knee osteoarthritis. Methods: Three databases were searched, ie, Medline (1970–2010), the Database of Abstract on Reviews and Effectiveness, and the Cochrane Database of Systematic Reviews. Reference lists of relevant articles were examined for additional references. Results: Eighteen studies were identified (six European, five Turkish, three US, two Canadian, one Swiss and one English), which reported efficacy of viscosupplementation in a total of 3689 patients undergoing viscosupplementation treatment with Synvisc for knee osteoarthritis compared with low molecular weight viscosupplementation, high molecular weight viscosupplementation, medium molecular weight viscosupplementation, placebo, corticosteroids, nonsteroidal anti-inflammatory drugs, and physical therapy. Conclusion: Synvisc viscosupplementation in the treatment of knee osteoarthritis is a safe and effective therapeutic option that could also reduce the direct and indirect costs related to this disease.
Treatment of osteoarthritis knee pain: update on use of intra-articular hylan G-F 20  [cached]
Alberto Migliore,Francesca Giovannangeli,Emanuele Bizzi,et al
Orthopedic Research and Reviews , 2010,
Abstract: Alberto Migliore1, Francesca Giovannangeli1, Emanuele Bizzi1, Bruno Laganà2, Mauro Granata31Department of Rheumatology, S Pietro FBF Hospital, 2Department of Rheumatology, Second Medical School, Sapienza University, 3Rheumatology and Osteoporosis Center, San Filippo Neri Hospital, Rome, ItalyBackground: Osteoarthritis is a public health concern, particularly in modern society, and is the leading osteoarticular pathology in developed countries. The increased prevalence of osteoarthritis with aging, coupled with the aging of populations, makes osteoarthritis a high priority health care problem. Viscosupplementation is a well established treatment option in knee osteoarthritis that is included in the professional guidelines for treatment of this joint disease.Objective: This review assessed the efficacy and safety of viscosupplementation with hylan G-F 20 (Synvisc ) in the management of joint pain in knee osteoarthritis.Methods: Three databases were searched, ie, Medline (1970–2010), the Database of Abstract on Reviews and Effectiveness, and the Cochrane Database of Systematic Reviews. Reference lists of relevant articles were examined for additional references.Results: Eighteen studies were identified (six European, five Turkish, three US, two Canadian, one Swiss and one English), which reported efficacy of viscosupplementation in a total of 3689 patients undergoing viscosupplementation treatment with Synvisc for knee osteoarthritis compared with low molecular weight viscosupplementation, high molecular weight viscosupplementation, medium molecular weight viscosupplementation, placebo, corticosteroids, nonsteroidal anti-inflammatory drugs, and physical therapy.Conclusion: Synvisc viscosupplementation in the treatment of knee osteoarthritis is a safe and effective therapeutic option that could also reduce the direct and indirect costs related to this disease.Keywords: viscosupplementation, knee osteoarthritis, hyaluronic acid, hyaluronan, sodium hyaluronate, hylan G-F 20, intra-articular injection
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