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2015 ; 16
(ä): 321
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The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee:
a systematic review
#MMPMID26503103
Altman RD
; Manjoo A
; Fierlinger A
; Niazi F
; Nicholls M
BMC Musculoskelet Disord
2015[Oct]; 16
(ä): 321
PMID26503103
show ga
BACKGROUND: Knee osteoarthritis (OA) is one of the leading causes of disability
within the adult population. Current treatment options for OA of the knee include
intra-articular (IA) hyaluronic acid (HA), a molecule found intrinsically within
the knee joint that provides viscoelastic properties to the synovial fluid. A
variety of mechanisms in which HA is thought to combat knee OA are reported in
the current basic literature. METHODS: We conducted a comprehensive literature
search to identify currently available primary non-clinical basic science
articles focussing on the mechanism of action of IA-HA treatment. Included
articles were assessed and categorized based on the mechanism of action described
within them. The key findings and conclusions from each included article were
obtained and analyzed in aggregate with studies of the same categorical
assignment. RESULTS: Chondroprotection was the most frequent mechanism reported
within the included articles, followed by proteoglycan and glycosaminoglycan
synthesis, anti-inflammatory, mechanical, subchondral, and analgesic actions.
HA-cluster of differentiation 44 (CD44) receptor binding was the most frequently
reported biological cause of the mechanisms presented. High molecular weight HA
was seen to be superior to lower molecular weight HA products. HA derived through
a biological fermentation process is also described as having favorable safety
outcomes over avian-derived HA products. CONCLUSIONS: The non-clinical basic
science literature provides evidence for numerous mechanisms in which HA acts on
joint structures and function. These actions provide support for the purported
clinical benefit of IA-HA in OA of the knee. Future research should not only
focus on the pain relief provided by IA-HA treatment, but the disease
modification properties that this treatment modality possesses as well.
|Analgesics/pharmacology/therapeutic use
[MESH]
|Anti-Inflammatory Agents/pharmacology/therapeutic use
[MESH]
|Bone and Bones/drug effects
[MESH]
|Chondrocytes/*drug effects
[MESH]
|Glycosaminoglycans/biosynthesis
[MESH]
|Humans
[MESH]
|Hyaluronic Acid/pharmacology/*therapeutic use
[MESH]