Criteria for choosing a hyaluronic acid preparation for intra-articular administration in patients of different ages with osteoarthritis of the knee joint

To date, the search for optimal approaches to the conservative treatment of patients with osteoarthritis (OA) is an urgent problem. This is due to the prevalence, multifactorial of the disease, as well as an increase in the incidence of OA among young patients. In the early stages of the disease, as well as in the treatment of young patients, doctors prefer to choose the non-surgical treatment. In OA, the most vulnerable structure of the joint is hyaline cartilage. In degenerative-dystrophic diseases, it becomes thinner, and the synovial fluid in OA tends to lose its elastic properties. To reduce the load on the articular cartilage, (prostheses) of synovial fluid – hyaluronic acid (HA) are actively used. HA is a natural component of synovial fluid, it serves as a lubricant for articular surfaces and provides a number of protective and regulatory effects. The HA injected from the outside takes on the load, compensating for the lost properties of the joint's own synovial fluid. So GC drugs are able to quickly relieve pain and return activity to the patient. During treatment, the choice of the HA drug should depend on the phenotype, age, stage of the disease, concomitant somatic pathology, daily physical activity and individual needs of the patient. The doctor selects a HA drug of different molecular weight, structure and concentration. As a consequence, the number of injections per course of treatment may also vary. It is necessary to evaluate in more detail the criteria for selecting the GC drug to improve the quality of treatment and results in the long term. The analysis of the literature data devoted to the selection of GC drugs presented on the domestic market, depending on the stage of the disease and the age of the patient.

1. Rheumatology: national guidelines / Pod red. Ye. L. Nasonova, V. A. Nasonovoy. M.: GEOTAR-Media, 2008. P. 573-588.

2. Katz, Jeffrey N., Kaetlyn R. Arant, and Richard F. Loeser. Diagnosis and Treatment of Hip and Knee Osteoarthritis // JAMA. 202; 325 (6): 568-578. DOI: 10.1001/jama.2020.22171.

3. Martusevich N. A. Osteoarthritis. Issues of epidemiology, etiopathogenesis, clinic, diagnosis and treatment: Guidelines. Mn. BGMU, 2003. Р. 28.

4. Huskisson E. C. Nimesulide, a balanced drug for the treatment of osteoarthritis // Clin Exp Rheumatol. 2001; 19 (1 Suppl 22): S21-25. PMID: 11296545.

5. Hunter D., Schofield D., Callander E. The individual and socioeconomic impact of osteoarthritis // Nat Rev Rheumatol. 2014; 10: 437-441. https://doi.org/10.1038/nrrheum.2014.44.

6. Hunter D. J., Bierma-Zeinstra S. Osteoarthritis // Lancet. 2019; 393 (10182): 1745-1759. DOI: 10.1016/S0140-6736(19)30417-9. PMID: 31034380.

7. Hussain S., Neilly D., Baliga S., Patil S., Meek R. Knee osteoarthritis: a review of management options // Scottish Medical Journal. 2016; 61 (1): 7-16. DOI: 10.1177/0036933015619588.

8. Fakhari A., Berkland C. Applications and emerging trends of hyaluronic acid in tissue engineering, as a dermal filler and in osteoarthritis treatment // Acta Biomater. 2013; 9 (7): 7081-7092. DOI: 10.1016/j.actbio.2013.03.005. Epub 2013 Mar 15. PMID: 23507088; PMCID: PMC3669638.

9. Shamuilova M. M., Sedyakina Yu. V., Knorring G. Yu. Modern approaches to the treatment of joint pathology: the role of hyaluronic acid // The Lechaschi Vrach Journal 2021; 11 (24): 67-72. DOI: 10.51793/OS.2021.24.11.011.

10. Maheu E., Rannou F., Reginster J. Y. Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys // Semin Arthritis Rheum. 2016; 45 (4 Suppl): S28-33. DOI: 10.1016/j.semarthrit.2015.11.008. Epub 2015 Dec 2. PMID: 26806183.

11. 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. PMID: 29983409; PMCID: PMC6069440.

12. Alekseyeva L. I., Kashevarova N. G. Efficiency of intra-articular injections of high molecular weight hyaluronic acid in osteoarthritis of the knee and hip joints // The Lechaschi Vrach Journal. 2021; 7 (24): 39-44. DOI: 10.51793/OS.2021.24.7.008.

13. Belyayeva Ye. A., Fatenko A. S., Avdeyeva O. S., Belyayeva S. V. Comparative efficacy of intra-articular administration of hyaluronic acid preparations with different physicochemical properties in osteoarthritis of the knee joint // Sovremennaya revmatologiya. 2021; 15 (6): 48-54. https://doi.org/10.14412/1996-7012-2021-6-48-54.

14. 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.

15. Strebkova Ye. A., Alekseyeva L. I. Efficiency of intra-articular therapy with hyaluronic acid preparations in patients with osteoarthritis // Sovremennaya revmatologiya. 2019; 13 (2): 96-104.

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

17. 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.

18. 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.

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

20. Belen' kiy A. G., Denisov L. N., Panasyuk Ye. Yu., Ionichenok N. G., Shmidt Ye. I, Lila A. M., Arkhangel'skaya G. S., Ivanova O. N., Zlobina T. I., Plaksina N. V. Goryachev D. V. Treatment of rheumatic diseases. Hyaluronic acid preparation «Ostenil®» for the treatment of gonarthrosis. Results of a multicenter, randomized, masked one-year study // Nauchno-prakticheskaya 2005; 6: 49.