RESEARCH - Longterm effects of intraarticular hyaluronan on synovial fluid in OA of the knee

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J Rheumatol. 2006 May;33(5):946-50.

Longterm effects of intraarticular hyaluronan on synovial fluid in

osteoarthritis of the knee.

University of Sydney Institute of Bone and Joint Research, Royal North Shore

Hospital, St. Leonards, NSW, Australia.

OBJECTIVE: Intraarticular (IA) hylan injections constitute second-line

therapy for osteoarthritis (OA) of the knee, but human studies suggesting a

possible mechanism of action are lacking. We examined the effect of IA Hylan

GF-20 injections on synovial fluid (SF) hyaluronan (HA) concentration,

viscosity, and elasticity over a 6-month period in patients with mild to

moderate OA of the knees. METHODS: Patients with symptomatic knee OA

(Osteoarthritis Research Society International grade 1-2) had SF aspirated

from the study knee pre- and 3 and 6 months post-Hylan injection. Primary

endpoints included SF HA concentration, viscosity, and elasticity. SF HA

concentration was determined using uronic acid assay, and rheology measured

using a micro-Fourier rheometer. RESULTS: Sequential SF samples were

available from 32 of 60 subjects injected at baseline (15 men, 17 women;

mean age 65 yrs) at 3 months post-injection. The mean HA concentration had

increased by 13% (p<0.0008), and the complex shear modulus had increased by

16% (p<0.03). Sufficient SF was also available from 19 of these subjects at

6 months post-injection when mean HA concentration was 2.24+/-0.62 mg/ml

compared to their baseline mean of 2.02+/-0.52 mg/ml, an increase of 10%

(p<0.053).

CONCLUSION: This open-label study showed a statistically significant change

from baseline in both SF HA concentration and complex shear modulus at 3

months following IA Hylan GF-20 injection among subjects with mild to

moderate knee OA. These results suggest that one possible mechanism of

action of viscosupplementation is to promote endogenous HA production.

Longer-term studies are required to identify whether these changes in SF

measures are important for modification of disease progression in knee OA.

PMID: 16652425

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16652425

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