Bilateral symmetric inflammatory reaction to hylan G-F 20 injection

Martens, Peter

doi:10.1002/1529-0131(200104)44:4<978::aid-anr156>3.0.co;2-n

Cited by 53 publications

(28 citation statements)

References 7 publications

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“…These adverse events consisted of pain and/or transient swelling of the injected joint, mostly mild or moderate in intensity [43-45]. The adverse reactions observed upon intra-articular treatment of human osteoarthritis are not comparable with the biphasic effects in the present study, since they were only short-lasting and limited to a period immediately following injection.…”

Section: Discussioncontrasting

confidence: 58%

Intra-articular injections of high-molecular-weight hyaluronic acid have biphasic effects on joint inflammation and destruction in rat antigen-induced arthritis

et al. 2005

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To assess the potential use of hyaluronic acid (HA) as adjuvant therapy in rheumatoid arthritis, the anti-inflammatory and chondroprotective effects of HA were analysed in experimental rat antigen-induced arthritis (AIA). Lewis rats with AIA were subjected to short-term (days 1 and 8, n = 10) or long-term (days 1, 8, 15 and 22, n = 10) intra-articular treatment with microbially manufactured, high-molecular-weight HA (molecular weight, 1.7 × 106 Da; 0.5 mg/dose). In both tests, 10 buffer-treated AIA rats served as arthritic controls and six healthy animals served as normal controls. Arthritis was monitored by weekly assessment of joint swelling and histological evaluation in the short-term test (day 8) and in the long-term test (day 29). Safranin O staining was employed to detect proteoglycan loss from the epiphyseal growth plate and the articular cartilage of the arthritic knee joint. Serum levels of IL-6, tumour necrosis factor alpha and glycosaminoglycans were measured by ELISA/kit systems (days 8 and 29). HA treatment did not significantly influence AIA in the short-term test (days 1 and 8) but did suppress early chronic AIA (day 15, P < 0.05); however, HA treatment tended to aggravate chronic AIA in the long-term test (day 29). HA completely prevented proteoglycan loss from the epiphyseal growth plate and articular cartilage on day 8, but induced proteoglycan loss from the epiphyseal growth plate on day 29. Similarly, HA inhibited the histological signs of acute inflammation and cartilage damage in the short-term test, but augmented acute and chronic inflammation as well as cartilage damage in the long-term test. Serum levels of IL-6, tumour necrosis factor alpha, and glycosaminoglycans were not influenced by HA. Local therapeutic effects of HA in AIA are clearly biphasic, with inhibition of inflammation and cartilage damage in the early chronic phase but with promotion of joint swelling, inflammation and cartilage damage in the late chronic phase.

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Section: Discussioncontrasting

confidence: 58%

Intra-articular injections of high-molecular-weight hyaluronic acid have biphasic effects on joint inflammation and destruction in rat antigen-induced arthritis

et al. 2005

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“…However, local adverse reactions (hot, painful, swollen joint) were reported, typically occurring 24-72 hours, and mostly after injection of HMW HA (Hylan) in the knee [30-33]. Ten to thirty per cent of hip OA patients treated with intra-articular injections of HA reported adverse effects, which is slightly higher than in OA of the knee [13].…”

Section: Methodsmentioning

confidence: 99%

Comparison of intra-articular injections of Hyaluronic Acid and Corticosteroid in the treatment of Osteoarthritis of the hip in comparison with intra-articular injections of Bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

Colen

Bekerom

Bellemans

et al. 2010

BMC Musculoskelet Disord

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BackgroundAlthough intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this subject is still very much under debate.Methods/DesignRandomized, controlled trial with a three-armed, parallel-group design. Approximately 315 patients complying with the inclusion and exclusion criteria will be randomized into one of the following treatment groups: infiltration of the hip joint with hyaluronic acid, with a corticosteroid or with 0.125% bupivacaine.The following outcome measure instruments will be assessed at baseline, i.e. before the intra-articular injection of one of the study products, and then again at six weeks, 3 and 6 months after the initial injection: Pain (100 mm VAS), Harris Hip Score and HOOS, patient assessment of their clinical status (worse, stable or better then at the time of enrollment) and intake of pain rescue medication (number per week). In addition patients will be asked if they have complications/adverse events. The six-month follow-up period for all patients will begin on the date the first injection is administered.DiscussionThis randomized, controlled, three-arm study will hopefully provide robust information on two of the intra-articular treatments used in hip osteoarthritis, in comparison to bupivacaine.Trial registrationNCT01079455

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“…In 2001, Martens reported a patient who developed severe symmetric pseudoseptic arthritis (the synovial fluid was negative for bacteria and CPPD) in bilateral knees following the first injection of Hylan G-F 20 in the second course of treatment [11]. Rees et al reported a patient who received repeated OrthoVisc injection developed fever and inflammation (elevated CRP and ESR), leukocytosis and eosinophilia in the absence of septic or gout/pseudogout arthritis, although the patient did have large intra-articular effusion [12].…”

Section: Ma Etmentioning

confidence: 99%

“…This study suggested that the immunogenic properties of different hyaluronate products differ from each other and the development of humoral response to HA required repeated immunization (sensitization), which explained the cases previously reported by Martens with SAIR [11]. The anti-chicken protein antibodies could be elicited by the more immunogenic degraded small fragment HA [14].…”

Section: Ma Etmentioning

confidence: 99%

Acute Ischemic Stroke Associated With OrthoVisc (Hyaluronic Acid) Injection

Ma¹,

Shanmugham²

2017

J Med Cases

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Hyaluronic acid (HA) is one of the main components of normal synovial fluid, acting as a shock absorber and a lubricant in the joints. When injected intra-articularly, the viscosupplementation of HA may potentially restore the biomechanical and biochemical functions of normal synovial fluid and may reduce the pain caused by osteoarthritis through anti-inflammatory, anabolic, analgesic, and chondroprotective mechanisms. HA has been approved by FDA as a medical device and has been used in patients with advanced osteoarthritis. Though it is usually safe and well tolerated, some local and systemic reactions can occur in rare cases. Here we report a 53-year-old man with severe osteoarthritis, who developed acute left cerebellar infarct after the injection of HA (OrthoVisc) preceded by symptoms of allergic reaction. Review of literature showed this is to date the first case of possible link between HA and ischemic stroke.

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Bilateral symmetric inflammatory reaction to hylan G-F 20 injection

Cited by 53 publications

References 7 publications

Intra-articular injections of high-molecular-weight hyaluronic acid have biphasic effects on joint inflammation and destruction in rat antigen-induced arthritis

Intra-articular injections of high-molecular-weight hyaluronic acid have biphasic effects on joint inflammation and destruction in rat antigen-induced arthritis

Comparison of intra-articular injections of Hyaluronic Acid and Corticosteroid in the treatment of Osteoarthritis of the hip in comparison with intra-articular injections of Bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

Acute Ischemic Stroke Associated With OrthoVisc (Hyaluronic Acid) Injection

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