Modern approaches to the treatment of joint pathology: the value of hyaluronic acid

Pathology of the musculoskeletal system and osteoarthritis, in particular, remain a frequent reason for seeking outpatient care. Among the various joints, the knee joint is considered the most affected - it accounts for up to 25% of all lesions of the musculoskeletal system, which is associated with its supporting function and frequent traumatic injury. The growing popularity of outdoor activities, the development of playing and extreme sports leads to an increase in the frequency of injuries of the knee joint, ligamentous apparatus, as well as intra-articular injuries. It is traumatization that is recognized as one of the leading causes of subsequent osteoarthritis. The article offers brief algorithms for the diagnosis and treatment of osteoarthritis for use at the outpatient stage of medical care. Attention is paid to the use of hyaluronic acid preparations, an analysis of the literature data is carried out, the prospects for the use of such therapy in a complex of therapeutic measures are assessed. Hyaluronic acid is a natural component of synovial fluid that serves as a lubricant for articular surfaces and provides a range of protective and regulatory effects. Hyaluronic acid introduced from the outside takes on the load, replenishing the missing functions of the synovial fluid, which allows us to consider such use as prosthetics of insufficient joint function. Hyaluronic acid preparations are a fast-acting local remedy to improve the function of the affected joint and relieve pain, which is important to keep patients active. These effects are due to the rheological features of hyaluronic acid, which not only improve lubricating properties and sliding in the affected joint, but also protect the articular cartilage from shock loads. The industrially obtained hyaluronic xylote has been successfully used in the treatment of osteoarthritis for more than 30 years.

1. Vertkin A. L. «Diagnosis at the door», or the changed mission of the therapist // Ambulatornyy priyem, 2016; 3 (6): 59-62.

2. Martel-Pelletier J., Barr A. J., Cicuttini F. M., et al. Osteoarthritis // Nat Rev Dis Primers. 2016; 2: 16072. DOI: 10.1038/nrdp.2016.72.

3. Bijlsma J. W., Berenbaum F., Lafeber F. P. Osteoarthritis: an update with relevance for clinical practice // Lancet. 2011; 377: 2115-2126.

4. Karateyev A. Ye., Lila A. M. Osteoarthritis: a modern clinical concept and some promising therapeutic approaches // Nauchno-prakticheskaya revmatologiya. 2018; 56 (1): 70-81.

5. Martynov A.I., Naumov A.V. i dr. Management of patients with osteoarthritis with comorbidity in general medical practice: expert opinion based on evidencebased medicine // Lechaschi Vrach. 2015; 4: 39-44.

6. Kotel'nikov G.P. Traumatology. National leadership [Electronic resource] / Pod red. G.P. Kotel'nikova, S.P. Mironova. M.: GEOTAR-Media, 2017. Р. 528.

7. Pitsyn I. A. Use of arthroscopy and the principle of feedback of specialists to assess the true effectiveness of ultrasound in the differential diagnosis of pathology of the intraarticular structures of the knee joint. Dis. … kand. med.nauk. Moskva, 2016. Р. 18.

8. Dell'Isola A., Steultjens M. Classification of patients with knee osteoarthritis in clinical phenotypes: Data from the osteoarthritis initiative // PLoS One. 2018; 13 (1): e0191045. DOI: 10.1371/journal.pone.0191045.

9. Lila A. M., Alekseyeva L. I., Telyshev K. A. Modern approaches to the phenotyping of osteoarthritis. Sovremennaya revmatologiya. 2019 ; 13 (2): 4-8. DOI: 10.14412/1996-7012-2019-2-4-8.

10. Alekseyeva L. I. Recommendations for the management of patients with osteoarthritis of the knee joints in real clinical practice // Lechaschi Vrach. 2015. № 1. P. 64-69.

11. Vertkin A. L., Shamuilova M. M., Sedyakina Yu. V., Knorring G. Yu., Nosova A. V. A patient with joint pain at an outpatient appointment // The Lechaschi Vrach Journal. 2020; 7: 28-35.

12. Alekseeva L. I., Taskina E. A., Kashevarova N. G. Osteoarthritis: epidemiology, classification, risk factors, and progression, clinical presentation, diagnosis, and treatment // Sovremennaya Revmatologiya (Modern Rheumatology Journal). 2019; 13 (2): 9-21. DOI: 10.14412/1996-7012-2019-2-9-21.

13. Strebkova E. A., Alekseeva L. I. Efficiency of intra-articular hyaluronic acid therapy in patients with osteoarthritis // Sovremennaya Revmatologiya (Modern Rheumatology Journal). 2019; 13 (2): 96-104. DOI: 10.14412/1996-7012-2019-2-96-104.

14. Vas' kova N.V., Lesnyak O.M. Hyaluronic acid preparations in the treatment of osteoarthritis of the knee joints // Rossiyskiy semeynyy vrach. 2014; 3: 29-34.

15. Varonko I. A. The role of hyaluronic acid preparations in the treatment of osteoarthritis // Medical news. 2018; 2 (281): 24-28. (In Russ.)

16. Balabanova R. M. The place of hyaluronic acid preparations in the treatment of osteoarthritis // Ratsional'naya farmakoterapiya // Sovremennaya revmatologiya. 2014. № 8 (3). S. 73-6. DOI:10.14412/1996-7012-2014-3-73-76.

17. Bowman S., Awad M. E., Hamrick M. W. et al. Recent advances in hyaluronic acid based therapy for osteoarthritis // Clin. Transl. Med. 2018; 1 (7): 6.

18. Stern R., Jedrzejas M. J. Hyaluronidases: their genomics, structures, and mechanisms of action // Chem. Rev. 2006; 3 (106): 818-839.

19. Yakimov L., Tekeev I., Kalinsky B. et al. Application of hyaluronic acid preparations for ankle fractures: long-term results // Vrach. 2018; 29 (10):30-32. (In Russ.)] DOI: 10.29296/25877305-2018-10-08.

20. Chubukov A. S., Tsitskishvili N. I. Impellent rehabilitation of ankle joint crises at the stationary stage // Bulletin of Tambov University. Series: Humanities. 2010; 3 (83): 199–202. (In Russ.)

21. Vaquerizo V., Plasencia M. A., Arribas I. et al. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: A randomized controlled trial // Arthroscopy. 2013; 29: 1635-1643.

22. Sun S. F., Hsu C. W., Lin H. S. et al: Comparison of single intra-articular injection of novel hyaluronan (HYA-JOINT Plus) with Synvisc-one for knee osteoarthritis: A randomized, controlled, double-blind trial of efficacy and safety // J Bone Joint Surg Am. 2017; 99: 462-471.

23. Castellacci E., Polieri T. Antalgic effect and clinical tolerability of hyaluronic acid in patients with degenerative diseases of knee cartilage: an outpatient treatment survey // Drugs Exp Clin Res. 2004; 30 (2): 67-73.

24. Moreland L. W. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action // Arthritis Res Ther. 2003; 5 (2): 54-67. Epub 2003 Jan 14.

25. Vitanzo P. C. Jr., Sennett B. J. Hyaluronans: is clinical effectiveness dependent on molecular weight? // Am J Orthop (Belle Mead NJ). 2006; 35 (9): 421-428.

26. Bellamy N., Campbell J., Robinson V. et al. Viscosupplementation for the treatment of osteoarthritis of the knee // Cochrane Database Syst Rev. 2006; (2): CD005321.

27. Bollyky P. L., Falk B. A., Wu R. P. et al. Intact extracellular matrix and the maintenance of immune tolerance: high molecular weight hyaluronan promotes persistence of induced CD4+CD25+ regulatory T cells // J Leukoc Biol. 2009; 86: 567-572.

28. Goueffic Y., Guilluy C., Guerin P. et al. Hyaluronan induces vascular smooth muscle cell migration through RHAMM mediated PI3K-dependent Rac activation // Cardiovasc Res. 2006; 72: 339-348.

29. Bansal J., Kedige S. D., Anand S. Hyaluronic acid: a promising mediator for periodontal regeneration // Indian J. Dent. Res. 2010; 4 (21): 575-578.

30. Petrella R. J., Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee // J. Rheumatol. 2006; 33: 951–956.

31. Pyatykh Ye. A. Comparative analysis of the effectiveness of hyaluronic acid, chondroitin sulfate and their combined use in the complex therapy of primary gonarthrosis. Avtoref. dis. ... kand. med.nauk., Ryazan', 2013. Р. 25.

32. Colen S., van den Bekerom M. P., Mulier M., Haverkamp D. Hyaluronic acid in the treatment of knee osteoarthritis: a systematic review and meta-analysis with emphasis on the efficacy of different products // Bio Drugs. 2012; 26 (4): 257-268.

33. Chevalier X., Jerosch J., Goupille P. et al: Single, intra-articular treatment with 6 mL Hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: A randomised, multicentre, double-blind, placebo-controlled tri-al // Ann Rheum Dis, 2010; 69: 113119.

34. Petrella R. J., Petrella M. A prospective, randomized, double-blind, placebocontrolled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee // J Rheumatol. 2006; 33: 951956.

35. Rutjes A. W., Juni P., da Costa B. R. et al. Viscosupplementation for osteoarthritis of the knee: A systematic review and meta-analysis // Ann Intern Med. 2012; 157: 180-191.

36. Sun S. F., Hsu C. W., Lin H. S., et al: Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: A randomized controlled trial // J Foot Ankle Res. 2014; 7 (1): 9.

37. Witteveen A. G., Giannini S., Guido G. Jerosch J., Lohrer H., Vannini F., Donati L., Schulz A., Scholl J., Sierevelt I.N., van Dijk C. N. A prospective multicentre, open study of the safety and e cacy of hylan G-F 20 in patients with symptomatic ankle (talo-crural) osteoarthritis // Foot Ankle Surg. 2008; 14 (3):145-152. DOI:10.1016/j.fas.2008.01.001.

38. Navarro-Sarabia F., Coronel P., Collantes E., et al. A 40-month multicentre, randomized placebo-controlled study to assess the efficacy and carryover effect of repeated intraarticular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project // Ann Rheum Dis. 2011; 70 (11):1957-1562. DOI: 10.1136/ard.2011.152017.

39. Bruyere O., Cooper C., Pelletier J. P., et al. An algorithm recommendation for the management of knee osteoarthritis in Europe andinternationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) // Semin Arthritis Rheum. 2014; 44 (3): 253-263. DOI: 10.1016/j.semarthrit.2014.05.014.

40. Altman R. D. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review // BMC Musculoskelet Disord. 2015; 16: 321. DOI: 10.1186/s12891-015-0775-z.

41. Hochberg M. C., Altman R. D., April K. T., et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee // Arthritis Care Res (Hoboken). 2012; 64 (4): 465-474.

42. McAlindon T. E., Bannuru R. R., Sullivan M. C., et al. OARSI guidelines for the non-surgical management of knee osteoarthritis // Osteoarthritis Cartilage. 2014; 22 (3): 363-388. DOI: 10.1016/j.joca.2014.01.003.

43. Nasonov E. L. et al. Russian clinical guidelines. Rheumatology. Moscow: GEOTAR-Media, 2017. 240 p.

44. Moreland L. W. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action // Arthritis Res Ther. 2003; 5 (2): 54-67.

45. Zagorodniy N. V., Prizov A. P., Kamenchuk Ya. A., Il'ina Ye. A. Rheological and viscoelastic properties of hyaluronic acid preparations // Opinion Leader. 2021; 2(43): 28-35.

46. Vitanzo P. C. Jr., Sennett B. J. Hyaluronans: is clinical effectiveness dependent on molecular weight? // Am J Orthop (Belle Mead NJ). 2006; 35 (9): 421-428.

47. Guo Y., Yang P., Liu L. Origin and Efficacy of Hyaluronan Injections in Knee Osteoarthritis: Randomized, Double-Blind Trial // Med Sci Monit. 2018; 24: 4728-4737. DOI: 10.12659/MSM.908797.

48. Shvaychak E. Dependence of the viscosity of an aqueous solution of hyaluronic acid on its microstructure. Part I // Rossiyskiy zhurnal biomekhaniki. 2003. Tom 7. № 3. P. 87-98.

49. Kavalerskiy G. M., Kavalerskiy M. G., Dugina Yu. L., Rukin Ya. A. Comparative characteristics of the rheological properties of intra-articular prostheses based on hyaluronic acid // Kafedra travmatologii i ortopedii. 2018; 1 (31): 18-22.

50. Asari A., Miyauchi S., Matsuzaka S., Ito I., Kominamia E. , Uchiyama Y. Molecular weightdependent effects of hyaluronate on the arthritic synovium // Arch Histol Cytol. 1998: 61: 125-135

51. Altman R. D., Bedi A., Karlsson J., et al. Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee // Am J Sports Med. 2016; 44 (8): 2158-2165. DOI: 10.1177/0363546515609599.

52. Ariyentso A., Somma E. Reduction of pain and restoration of joint mobility after injections of intra-articular gel Flexotron® solo 2.2% in the treatment of gonarthrosis. Results of a six-month study. https://medi.ru/info/26472/.