Intra-articular hyaluronic acid: dependence of the effect on molecular weight

The article discusses the patient management with knee osteoarthritis according to the ESCEO 2019 algorithm. The focus is on the second stage in the persistence of osteoarthritis signs. The article pays attention to the means based on hyaluronic acid for intra-articular injection. It also provides the study analysis that proved the anti-inflammatory mechanism of action of hyaluronic acid-based drugs during intraarticular administration, as well as the study results in which histology data indicated that hyaluronic acid prevents cartilage degradation and can promote its regeneration. These researches show that repeated injections of hyaluronic acid are not only effective, but also safe. In the literature, there is evidence that during treatment, the time to endoprosthesis increases, as well as the need for taking NSAIDs and opioids decreases. The article discusses the molecular weight of hyaluronic acid, providing research data confirming the greatest efficacy of hyaluronic acid with medium and high molecular weight. KEYWORDS: osteoarthritis, knee joints, hyaluronic acid, intraarticular injection. FOR CITATION: Filatova Yu.S., Gawert V.R. Intra-articular hyaluronic acid: dependence of the effect on molecular weight. Russian Medical Inquiry. 2021;5(3):156–161. DOI: 10.32364/2587-6821-2021-5-3-156-161.

Intraarticular Administration Effect of Hydrogen Sulfide on an In Vivo Rat Model of Osteoarthritis

Osteoarthritis (OA) is the most common articular chronic disease. However, its current treatment is limited and mostly symptomatic. Hydrogen sulfide (H2S) is an endogenous gas with recognized physiological activities. The purpose here was to evaluate the effects of the intraarticular administration of a slow-releasing H2S compound (GYY-4137) on an OA experimental model. OA was induced in Wistar rats by the transection of medial collateral ligament and the removal of the medial meniscus of the left joint. The animals were randomized into three groups: non-treated and intraarticularly injected with saline or GYY-4137. Joint destabilization induced articular thickening (≈5% increment), the loss of joint mobility and flexion (≈12-degree angle), and increased levels of pain (≈1.5 points on a scale of 0 to 3). Animals treated with GYY-4137 presented improved motor function of the joint, as well as lower pain levels (≈75% recovery). We also observed that cartilage deterioration was attenuated in the GYY-4137 group (≈30% compared with the saline group). Likewise, these animals showed a reduced presence of pro-inflammatory mediators (cyclooxygenase-2, inducible nitric oxide synthase, and metalloproteinase-13) and lower oxidative damage in the cartilage. The increment of the nuclear factor-erythroid 2-related factor 2 (Nrf-2) levels and Nrf-2-regulated gene expression (≈30%) in the GYY-4137 group seem to be underlying its chondroprotective effects. Our results suggest the beneficial impact of the intraarticular administration of H2S on experimental OA, showing a reduced cartilage destruction and oxidative damage, and supporting the use of slow H2S-producing molecules as a complementary treatment in OA.

Agrin induces long-term osteochondral regeneration by supporting repair morphogenesis

Cartilage loss leads to osteoarthritis, the most common cause of disability for which there is no cure. Cartilage regeneration, therefore, is a priority in medicine. We report that agrin is a potent chondrogenic factor and that a single intraarticular administration of agrin induced long-lasting regeneration of critical-size osteochondral defects in mice, with restoration of tissue architecture and bone-cartilage interface. Agrin attracted joint resident progenitor cells to the site of injury and, through simultaneous activation of CREB and suppression of canonical WNT signaling downstream of β-catenin, induced expression of the chondrogenic stem cell marker GDF5 and differentiation into stable articular chondrocytes, forming stable articular cartilage. In sheep, an agrin-containing collagen gel resulted in long-lasting regeneration of bone and cartilage, which promoted increased ambulatory activity. Our findings support the therapeutic use of agrin for joint surface regeneration.

Spondyloarthrosis: pathogenesis, clinic, diagnosis and treatment (literature review and own experience)

8590% of the elderly people are diagnosed with spondyloarthrosis There are various synonyms for this disease in the literature: facet syndrome, facet pain syndrome, arthrosis of the intervertebral joints, zygapophysial joint arthrosis and spondyloarthropathy. The article analyzes the pathogenesis, clinical picture and methods of diagnosis of this disease. Modern types of conservative and surgical treatment are presented. The advantages and disadvantages of the surgical methods for the facet syndrome treatment are analyzed: instrumental denervation (radio frequency, laser, etc.), chemical denervaion and intraarticular administration of drugs. The results of our own clinical work are presented. The facet joint denervation appears to be a productive minimally invasive method of treatment of the reflex forms of spondyloarthrosis. In the early and long-term postoperative period, it leads to a persistent decrease in the intensity of pain and improvement of the quality of life with a low risk of perioperative complications.

A method of treatment of knee hemosynovitis after arthroscopic meniscal resection

Aim. Optimization of the treatment of patients with knee hemosynovitis after arthroscopic meniscal resection in early postoperative period. Methods. The results of treatment of 79 patients aged 18 to 60 years, who underwent arthroscopic meniscal resection complicated by knee hemosynovitis, were analyzed. Out of them, 38 patients underwent the treatment according to authors’ method (group 1) which included joint drainage with +5 °С isotonic solution of Sodium hydrocarbonate until the solution ran clear, and intraarticular administration of a cocktail of 5% Ascorbic acid solution for injections, 5% Sodium dimercaptopropansulfonate (unithiol) and 0.5% procaine (novocaine) in a ratio 1:1:1. 41 patients (group 2) received traditional treatment - only tapping and intraarticular administration of 3 ml of 0.5% procaine (novocaine). To assess the efficacy of treatment, severity of edema and pain syndrome, results of MRI on days 3 and 7 after arthroscopy, hydrogen ion concentration, relative density, lipid hydroperoxide level, total SH-groups, cytosis and synovial cytogram of hemosynovial fluid were measured, as well as the number of punctures, hospital stay and survey results of 45 patients. Results. Surgical intervention was found to lead to inflammation, decreased hydrogen ion concentration, increased lipid peroxidation and decreased thiol antioxidants concentration. The severity of these changes correlates with severity of clinical manifistations. In the early postoperative period inflammatory processes develop in the knee, which clinically manifest as hemosynovitis, occurrence of which after arthroscopic meniscal resection is 16%. Conclusion. The developed method of the treatment of postoperative hemosynovitis leads to faster decrease of severity of lipid peroxidation, pain syndrome and inflammatory reaction as opposed to traditional treatment.