The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review

Abstract

BackgroundKnee osteoarthritis (OA) is one of the leading causes of disability within the adult population. Current treatment options for OA of the knee include intra-articular (IA) hyaluronic acid (HA), a molecule found intrinsically within the knee joint that provides viscoelastic properties to the synovial fluid. A variety of mechanisms in which HA is thought to combat knee OA are reported in the current basic literature.MethodsWe conducted a comprehensive literature search to identify currently available primary non-clinical basic science articles focussing on the mechanism of action of IA-HA treatment. Included articles were assessed and categorized based on the mechanism of action described within them. The key findings and conclusions from each included article were obtained and analyzed in aggregate with studies of the same categorical assignment.ResultsChondroprotection was the most frequent mechanism reported within the included articles, followed by proteoglycan and glycosaminoglycan synthesis, anti-inflammatory, mechanical, subchondral, and analgesic actions. HA-cluster of differentiation 44 (CD44) receptor binding was the most frequently reported biological cause of the mechanisms presented. High molecular weight HA was seen to be superior to lower molecular weight HA products. HA derived through a biological fermentation process is also described as having favorable safety outcomes over avian-derived HA products.ConclusionsThe non-clinical basic science literature provides evidence for numerous mechanisms in which HA acts on joint structures and function. These actions provide support for the purported clinical benefit of IA-HA in OA of the knee. Future research should not only focus on the pain relief provided by IA-HA treatment, but the disease modification properties that this treatment modality possesses as well.

Terapias intervencionistas para manejo de dolor en Osteoartrosis de rodilla sintomática

“…El AH es una molécula que se encuentra intrínsecamente en la articulación de la rodilla, dándole propiedades viscoelásticas al líquido sinovial (14). A medida que la artrosis progresa, la concentración natural de AH disminuye, reduciendo las propiedades mecánicas/viscoelásticas propias del líquido sinovial (14).…”

“…A medida que la artrosis progresa, la concentración natural de AH disminuye, reduciendo las propiedades mecánicas/viscoelásticas propias del líquido sinovial (14).…”

Optoelectronic measurement of interfacial surface

“…However, medical studies (Ghosh, 2002) shown positive effect of viscosupplementation even 6 months after injection whilst exogenous hyaluronic acid can be detected in synovial fluid just few weeks after injection. This points out on another effects of hyaluronic acid like synthesis of endogenous hyaluronic acid or anti-inflammatory effect (Altman, 2015). However, the dominant effect of viscosupplementation and physiological phenomenon responsible for these results was not clarified yet.…”

<i>N</i>-acetyl glucosamine and proteoglycan containing supplement improves the locomotor functions of subjects with knee pain

“…Since, with age, the body starts to decrease the production of glycosaminoglycans from glucose (7), oral intake of GlcNac may increase synthesis of cartilage glycosaminoglycans and improve the symptoms of the knee joint (8). Because glucosamine consists of glycosaminoglycan after being converted into GlcNac in the cells of the target tissue, GlcNac is considered to be more effective in small amounts than glucosamine for improving knee functions.…”