Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammation in Knee Osteoarthritis: A Pilot Study

Abstract

Objective:This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) treatment in adults and elderly adults with knee osteoarthritis (OA).Design:This was a prospective, repeated-measures study design in which patients with knee OA were administered 1% sodium hyaluronate. Patients (N=28) were stratified by age (adults, 50-64 years and elderly adults, ≥65 years). Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six.Materials and Methods:Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for pro-inflammatory cytokines (interleukins 1β, 6,8,12, tumor necrosis factor-α, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz.Results:HA improved ambulatory knee pain in adults and elderly groups by month six, but adults reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-α occurred in adults compared to elderly adults (-95.8% ± 7.1% vs 19.2% ± 83.8%, respectively; p=.044). Fluid tended to improve at both shear speeds in adults compared to the elderly adults. The reduction in pain severity correlated with the change in IL-1β levels by month six (r= -.566; p=.044).Conclusion: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time.

Intralesional hyaluronic acid: an innovative treatment for Peyronie’s disease

“…Hyaluronic acid is commonly used to treat osteoarthritis (OA) [29], in which catabolic-stressed chondrocytes produce excess reactive oxygen species (ROS), pro-inflammatory cytokines, and chemokines. HA counteracts the effect of inflammatory cytokines [22,23], in addition to reducing oxidative stress [30].…”

Emerging regulators of the inflammatory process in osteoarthritis

“…These treatments include glucocorticosteroids, NSAIDs and coxibs (100), and other FDA-approved medical treatments such as intra-articular hyaluronan (101,102). Moreover, certain nutraceuticals can modulate proteostasis or inflammatory processes, or both (102–104).…”

Combination of High-Molecular-Weight Hyaluronic Acid and Cytokine Inhibitor Potently Inhibits Expression of Joint-Damage-Related Genes Induced By Synovial Fluid of RA Patients

“…HA is a major component of synovial fluid and cartilage matrix, and it is responsible for the viscoelastic qualities of synovial fluid, acting as both a lubricant and shock absorber. However, in joints affected by OA and RA, high-molecular-weight HA is cleaved into low-molecularweight HA which has low viscoelasticity [13]. Therefore, intra-articular injection of HA makes up for the loss of viscoelasticity of synovial fluid and protects against degradation of cartilage.…”

“…The main mechanism through which HA prevents cartilage destruction and disease progression is thought to be its action in maintaining the viscoelastic properties of the synovial fluid [13]. In addition to this, we and others have reported that HA down-regulates the expressions of MMP (Matrix Metalloproteinase) and ADAMTS (A Disintegrin And Metalloproteinase With Thrombospondin Motifs), which are involved in the degradation of cartilage, and RANKL (Receptor Activator of NF-κBLigand), which is related to osteoclastogenesis, induced in synovial fibroblasts and chondrocytes by pro-inflammatory cytokines [14][15][16].…”