Osteoarthdtis (OA) is a common, chronic, and painful disorder characterized by cartilage loss. It is the most common among all rheumatic disorders and is a major cause of disability. OA can be managed with a variety of pharmacological therapies, including acetaminophen, traditional nonsteroidal antiinflammatory drugs, cyclooxygenase2 inhibitors, intraarticular steroids, viscosupplements, glucosamine, chondroitin sulfate, and capsaicin. In this review, I describe the clinical efficacy and side effects of these pharmaceuticals and review diseasemodifying osteoarthritis drugs (DMOAD), such as glucosamine, diacerein, and avocado/soybean unsaponifiables, of which the clinical efficacy still remains to be determined.
Acetaminophen ; Capsaicin ; Cartilage ; Chondroitin Sulfates ; Glucosamine ; Osteoarthritis* ; Steroids ; Viscosupplements

The viscoelastic properties of four novel, low molecular weight hyaluronic acid derivatives were investigated and compared to the parent hyaluronic acid compound. Briefly, all derivatives were synthesized by first deacetylating the parent hyaluronic acid. One sample was left as such, while two others were reacytelated. The final compound, of particular interest for its anti-inflammatory properties, was butyrylated. The compounds were dissolved in phosphate buffer solution (PBS) and studied at a concentration of 5 mg/mL. Shear thinning behaviour was observed for all compounds, however, derivative samples had a lower viscosity than the parent compound at high shear rates. Viscoelastic properties were also observed to decrease as a result of the derivative preparation method. It is believed that these changes are primarily caused by a decrease in hyaluronic acid molecular weight. By increasing the concentration of the anti-inflammatory compound, it may be possible to modulate the viscoelastic properties to more closely resemble those of commercial viscosupplements. As a result, an anti-inflammatory derivative of hyaluronic acid may potentially improve upon existing viscosupplements used to treat patients who are susceptible to flare up.
Humans ; Hyaluronic Acid* ; Methods ; Molecular Weight ; Osteoarthritis ; Parents ; Viscosity ; Viscosupplements

BACKGROUND: The aim of this study is to test if adjuvant hydrotherapy with viscosupplement is beneficial on management of pain, stiffness, function, and mental relaxation in knee osteoarthritis (OA). METHODS: Nineteen patients with OA were randomly assigned to hydrotherapy or control groups. All patients received viscosupplement injections once a week for 3 weeks. Hydrotherapy group (n=9) had a spa containing green tea, 3 days a week for 2 weeks. The control group (n=10) received only injections. All patients were assessed at baseline and after the third injection. All were assessed for pain (visual analog scale, VAS), pain severity, and functional status (Western Ontario and McMaster Universities osteoarthritis index, WOMAC), emotional status, quality of life (Euro quality of life health-related quality of life inventory five dimension, EQ-5D), and relative spectral power of alpha waves in electroencephalography (EEG). RESULTS: Both groups reported a statistically significant reduction of pain at the end of treatment and detailed assessment of pain, and function in WOMAC and the relative power of alpha in electroencephalogram showed statistical significant difference only in the hydrotherapy group. However, there were no significant intergroup differences, except for VAS score. CONCLUSION: Adjuvant 2-week hydrotherapy to viscosupplement might have a modest role in the management of pain and functional disability and the mental relaxation in patients with knee OA. Larger, randomized controlled trials with intervention of long term period to determine efficacy in treating knee OA are warranted.
Electroencephalography ; Humans ; Hydrotherapy* ; Knee ; Ontario ; Osteoarthritis ; Osteoarthritis, Knee* ; Quality of Life ; Relaxation* ; Tea ; Viscosupplements

Osteoarthritis is a common but often difficult problem to manage. Nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medications), is often ineffective or leaves residual symptoms. Viscosupplementation is a newly available option for patients with symptomatic knee osteoarthritis that involves a series of intra-articular injections of hyaluronic acid. The exact mechanism of action is unclear, although increasing the viscoelasticity of the synovial fluid appears to play a role. The exact indications for viscosupplementation are still evolving, but it currently can be considered for use in patients who have significant residual symptoms despite traditional nonpharmacologic and pharmacologic treatments. In addition, patients who are intolerant of traditional treatments (e.g., gastrointestinal problems related to anti-inflammatory medications) can be considered for these injections.
Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Hyaluronic Acid* ; Injections, Intra-Articular ; Life Style ; Osteoarthritis ; Osteoarthritis, Knee ; Synovial Fluid ; Viscosupplementation ; Viscosupplements

No abstract available.
Adult ; Female ; Glaucoma, Angle-Closure/*surgery ; Humans ; Intraocular Pressure/physiology ; *Iridectomy ; Iris/*surgery ; Laser Therapy/*methods ; Lens, Crystalline/*physiology ; Middle Aged ; Suture Techniques ; Tonometry, Ocular ; Viscosupplements/administration & dosage

PURPOSE: Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis. MATERIALS AND METHODS: A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results. RESULTS: Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint. CONCLUSIONS: This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.
Arthroplasty ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Injections, Intra-Articular ; Knee ; Molecular Weight ; Osteoarthritis ; Osteoarthritis, Knee ; Patient Selection ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Viscosupplementation ; Viscosupplements

PURPOSE: The purpose of this study was to study the protective effect and influence of sodium hyaluronate (Na-HA) on mRNA expression of peroxisome proliferators-activated receptor gamma (PPAR-gamma) in cartilage of rabbit osteoarthritis (OA) model. MATERIALS AND METHODS: Forty eight white rabbits were randomly divided into A, B, and C groups. Group A was normal control group, B and C groups underwent unilateral anterior cruciate ligament transection (ACLT). The rabbits in group B were injected normal saline after ACLT; and Group C received intraarticular1% sodium hyaluronate (HA) injection 5 weeks after surgery, 0.3 mL once a week. At 11th week after surgery, all the rabbits were sacrificed. The cartilage changes on the medial femoral condyles were graded separately. Cartilage sections were stained with safranin-O and HE, and messenger RNA (mRNA) expression of PPAR-gamma was detected by using real time polymerase chain reaction (Real Time-PCR). RESULTS: Cartilage degeneration in group B was significantly more severe than in A and C injection group. The grey value of Safranin-O of B group was higher than A and C groups. Expression of PPAR-gamma mRNA in group B was higher than group A and C. CONCLUSION: This study shows that Na-HA has a protective effect on articular cartilage degeneration, and the inhibitory effect on the PPAR-gamma mRNA expression may be one of therapeutic mechanism of Na-HA.
Animals ; Cartilage/*drug effects/*metabolism ; Gene Expression/drug effects/genetics ; Hyaluronic Acid/*pharmacology/therapeutic use ; Microscopy ; Osteoarthritis/*drug therapy/metabolism ; PPAR gamma/*genetics ; RNA, Messenger/*genetics ; Rabbits ; Random Allocation ; Reverse Transcriptase Polymerase Chain Reaction ; Viscosupplements/*pharmacology/therapeutic use

OBJECTIVETo assess the efficacy of injection of sodium hyaluronate in the treatment of patients with disc perforation by using cone- beam computed tomography (CBCT) and temporomandibular joint (TMJ) function.

METHODSTwenty- eight patients (38 joints) with disc perforation observed through arthrography who received injection of sodium hyaluronate and other 20 patients (29 joints) who received disc repair were included in this study. Pain (visual analog scale, scores 0 to 100), maximal mouth opening, modified Helkimo's clinical dysfunction index and TMJ examinations with CBCT were obtained before and 3, 9 months after treatment.

RESULTSA statistically significant increase (P < 0.05) in TMJ clinical outcome was observed at each follow-up. The maximal mouth opening (MMO) increased 5.89 mm and 7.64 mm at 3 and 9 months follow-up in the hyaluronic acid (HA) group, and the MMO increased 2.75 mm and 6.10 mm at 3 and 9 months follow-up in the operation group. Osseous remodeling occurred in 66% (25 of 38 joints) of patients after HA injection and 55% (16 of 29 joints) of patients appeared bone remodeling after disc repair.

CONCLUSIONSBoth injection of hyaluronic acid and disc repair are effective for treatment of temporomandibular joint disc perforation.

Facial Pain ; Humans ; Hyaluronic Acid ; administration & dosage ; Injections, Intra-Articular ; Joint Dislocations ; Pain Measurement ; Range of Motion, Articular ; Temporomandibular Joint Disc ; injuries ; Temporomandibular Joint Disorders ; drug therapy ; Viscosupplements ; administration & dosage

PURPOSE: To evaluate the clinical outcome of viscoelastics (VE, sodium hyaluronate)-augmented trabeculectomy (VAT, 66 eyes) and conventional trabeculectomy (CT, 57 eyes) for glaucomatous eyes. METHODS: In the VAT group, half of the anterior chamber space was filled with VE via the paracentesis site at the end of CT and a balanced salt solution was injected into the anterior chamber. This procedure induced migration of VE from the anterior chamber into the bleb space; thus the bleb was elevated with underlying VE. Follow-up examinations were performed until 1 year after surgery. Success was defined as the attainment of an intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of success without antiglaucoma medication, it was regarded as a complete success. RESULTS: The mean postoperative IOP was significantly lower in the VAT group at postoperative 1 day, 1 week, and 1 month. The complete success rate was significantly higher in the VAT group (89%) than in the CT group (75%), though the qualified success rate was not different between the two groups. The number of IOP-lowering medications at postoperative 1 year was significantly higher in the CT group (1.30 ± 1.08 vs. 0.73 ± 0.98, p = 0.003). Among postoperative procedures, laser suture lysis was required less frequently in the VAT group (p < 0.001). CONCLUSIONS: Placing VE within the bleb at the end of surgery may result in better IOP control and less need for IOP-lowering medication without any additional materials, cost, or time.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Glaucoma/*surgery ; Humans ; Hyaluronic Acid/*therapeutic use ; Intraocular Pressure/physiology ; Male ; Middle Aged ; Tonometry, Ocular ; Trabeculectomy/*methods ; Viscosupplements/*therapeutic use

INTRODUCTIONMost current cell-based cartilage repair techniques require some form of scaffolds and 2 separate surgical procedures. We propose a novel, scaffold-less technique of cartilage repair in the human knee that combines arthroscopic microfracture and outpatient intra-articular injections of autologous bone marrow-derived mesenchymal stem cells (MSCs) and hyaluronic acid (HA).

MATERIALS AND METHODSSeventy matched (age, sex, lesion size) knees with symptomatic cartilage defects underwent cartilage repair with the proposed technique (n = 35) or an open technique (n = 35) in which the MSCs were implanted beneath a sutured periosteal patch over the defect. Prospective evaluation of both groups were performed using the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package, which included questions from the Short-Form (SF-36) Health Survey, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm knee scale, and Tegner activity level scale. Postoperative magnetic resonance imaging (MRI) evaluation was also performed at 1 year for most patients.

RESULTSThere were no clinically significant adverse events reported through the course of our study. At the fi nal follow-up (mean = 24.5 months), there was significant improvement in mean IKDC, Lysholm, SF-36 physical component score and visual analogue pain scores in both treatment groups.

CONCLUSIONIn the short term, the results of this novel technique are comparable to the open procedure with the added advantages of being minimally invasive and requiring only a single operation under general anaesthesia. Its safety has been validated and its efficacy is currently being evaluated in an ongoing randomised controlled trial.

Adult ; Arthroscopy ; methods ; Cartilage, Articular ; injuries ; Combined Modality Therapy ; methods ; Female ; Humans ; Hyaluronic Acid ; therapeutic use ; Knee Injuries ; therapy ; Magnetic Resonance Imaging ; Male ; Mesenchymal Stem Cell Transplantation ; methods ; Outcome Assessment (Health Care) ; Patient Safety ; Prospective Studies ; Singapore ; Viscosupplements ; therapeutic use