The role of intra-articular hyaluronan (Sinovial®) in the treatment of osteoarthritis

Abstract

Osteoarthritis (OA) leads to significant pain and disability. For pain relief, a tailored approach using non-pharmacological and pharmacological therapies is recommended. If adequate symptom relief is not achieved with acetaminophen, other pharmacological options include non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, intra-articular corticosteroids and intra-articular hyaluronic acid (HA) viscosupplementation. Most of these therapies generally do not improve functional ability or quality of life or are associated with tolerability concerns. In OA patients, concentration and molecular weight (MW) of HA are reduced, diminishing elastoviscosity of the synovial fluid, joint lubrication and shock absorbancy, and possibly anti-inflammatory, analgesic and chondroprotective effects. In knee OA, viscosupplementation with 3-5 weekly intra-articular HA injections diminishes pain and improves disability, generally within 1 week and for up to 3-6 months and is well tolerated. HAs have comparable efficacy as NSAIDs, with less gastrointestinal adverse events, and compared with intra-articular corticosteroids, benefits last generally longer. High MW hylans provide comparable benefits versus HA, albeit with an increased risk of immunogenic adverse events. In mild-to-moderate hip OA, intra-articular injection of HA moderately improved pain and function, generally for up to 3 months with no serious adverse events. Efficacy in other joints is being evaluated. Viscosupplementation with intra-articular Sinovial(®) (other trade names: Yaral(®), Intragel(®)) injections (an HA of low-medium MW) relieves pain and improves function in OA of the knee, and other joints including the carpometacarpal joint of the thumb and the shoulder. HA viscosupplementation, including use of Sinovial(®), is a valuable treatment approach for OA patients, if other therapies are contraindicated or have failed.

Protective effect of Shenmai injection on knee articular cartilage of osteoarthritic rabbits and IL-1β-stimulated human chondrocytes

“…In September 2000, the American college of rheumatology guidelines for the treatment of knee osteoarthritis recommended that one therapeutic option to be considered is the use of intra-articular injections of hyaluronic acid in the knee joint to relieve osteoarthritic pain (10). This therapeutic strategy has since become popular in the non-operative management of patients with osteoarthritis (11)(12)(13)(14). However, recent reviews conclude that intra-articular injection of hyaluronic acid has only minimal benefits on patient outcomes, and so its clinical relevance and cost-utility should be reassessed (15,16).…”

Safety and Tolerability of Intra-Articular Hyaluronic Acid Injection (Sinovial®) in Experimental and Clinical Practice

“…As for Sinovial", even without sufficient data from randomized controlled trials demonstrating no risk of immunologic hazard, the biofennentation process and the technology used in the production of HA (both of which assure that the final product is highly purified and free from potentially allergenic animal proteins and pathogenic agents) leads us to believe that a lack of immunologic hazard can be assumed (37).…”

Polymer Based Therapies for the Treatment of Chronic Pain

“…Since OA onset is attributed to degradation of high molecular weight HA and its concentration in the synovial fluid, increase in HA concentration either by increasing the rate of the proteoglycan biosynthesis or by incorporating HA exogenously to the joint space would improve joint function and relieve OA associated chronic pain. Therefore, the effect of intraarticular administration of exogenous HA to restore rheological properties of the synovial fluid have been extensively studied [45]. In order to maintain desired viscoelastic property of synovial fluid, the exogenous HA needs to have high molecular weight.…”