Objective: To determine the influence of a new intraarticular hyaluronic acid based hydrogel (Hymovis®) injections on the amount of analgesics consumption in patients diagnosed with primary knee OA.
Methods: A prospective, single-center study that included 35 patients, aged 45-80 years was conducted in our orthopaedics department. Patients received two intra-articular injections of hyaluronic acid (24 mg/3 ml; 500–730 kDa; Hymovis®) at one week apart. Follow-up was scheduled at 2 and 6 months after the injections. Assessment tools included Visual Analogue Scale (VAS) and an in-house designed questionnaire regarding analgesic consumption (quantity, period and product) during the follow-up.
Results: Compared to baseline, a significant amelioration in visual analogue scale was observed at six months’ follow-up (74.2mm ± 11.7 vs. 57.3mm ± 12.1; p <.0001). 28% (n=10) of the patients reduced their total analgesic consumption at two months after the injections. At final follow-up, the analgesic intake was reduced by more than 50% in almost every case.
Conclusions: Intraarticular administered injections with a novel hyaluronan-based hydrogel (Hymovis®) may reduce the amount of analgesic consumption and self-reported pain intensity in patients with knee OA.
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1. Jevsevar DS - Treatment of osteoarthritis of the knee: evidence-based guideline 2nd edition. J Am Acad Orthop Surg 21(9):571–576
2. Balazs E - Viscosupplementation for osteoarthritis. from initial discovery to current status and results Surg. Technol. Int. 12 (2004) 278–289.
3. Balazs E Denlinger J - Viscosupplementation – a new concept in the treatment of osteoarthritis J. Rheumatol. 20 (1993) 3–9.
4. Qvist P Bay-Jensen A Christiansen C et al. - The disease modifying osteoarthritis drug (DMOAD): is it in the horizon? Pharmacol Res. 58 (2008) 1–7.
5. Strauss E Hart J Miller M et al. - Hyaluronic acid viscosupplementation and osteoarthritis: current uses and future directions Am. J. Sports Med. 37 (2009) 1636–1644.
6. Moreland L Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action Arthritis Res. Ther. 5 (2003) 54–67.
7. Vincent HK Montero C Conrad BP et al. - “Functional Pain” Functional Outcomes and Quality of Life After Hyaluronic Acid Intra-articular Injection for Knee Osteoarthritis. PM R. 2013 Apr;5(4):310-8
8. Altman RD Manjoo A Fierlinger A et al. - The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015; 16: 321
9. Smith MM Russell AK Schiavinato A et al. - A hexadecylamide derivative of hyaluronan (HYMOVIS®) has superior beneficial effects on human osteoarthritic chondrocytes and synoviocytes than unmodified hyaluronan. Journal of Inflammation (London England). 2013;10:26.
10. Shimizu C. Kubo T Hirasawa Y et al. - Histomorphometric and biochemical effect of various hyaluronans on early osteoarthritis. J Rheumatol. 1998 Sep;25(9):1813-9.
11. Newberry SJ Fitzgerald JD Maglione MA et al. - Systematic Review for Effectiveness of Hyaluronic Acid in the Treatment of Severe Degenerative Joint Disease (DJD) of the Knee [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Jul.
12. Bagga H Burkhardt D Sambrook P et al. - Longterm effects of intraarticular hyaluronan on synovial fluid in osteoarthritis of the knee. J Rheumatol. 2006;33(5):946-50
13. Skwara A Peterlein CD Tibesku CO et al. - Changes of gait patterns and muscle activity after intraarticular treatment of patients with osteoarthritis of the knee: a prospective randomised doubleblind study. Knee. 2009 Dec;16(6):466-72.
14. Wang F He X - Intra-articular hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis: A meta-analysis. Exp Ther Med. 2015 Feb; 9(2): 493–500.
15. Creamer P - Intra-articular corticosteroid treatment in osteoarthritis. Curr Opin Rheumatol. 1999 Sep;11(5):417-21.
16. McAlindon TE - OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014 Mar;22(3):363-88
17. Carter GT Duong V Ho S et al. - Side effects of commonly prescribed analgesic medications. Phys Med Rehabil Clin N Am. 2014 May;25(2):457-70.
18. Nuesch E Rutjes AW Husni E Welch V Juni P. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2009;(4):CD003115.
19. Rosemann T Laux G Szecsenyi J. Osteoarthritis: quality of life comorbidities medication and health service utilization assessed in a large sample of primary care patients. J Orthop Surg Res. 2007 Jun 30;2:12.
20. Michael JW Schlüter-Brust KU Eysel P. The epidemiology etiology diagnosis and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010 Mar;107(9):152-62.
21. Scott J - Vertical or horizontal visual analogue scales. Ann Rheum Dis. 1979; 38:560. 4. McCormack HM Horne DJL Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988; 18:1007–19.
22. Jensen MP - The measurement of clinical pain intensity: a comparison of six methods. Pain 1986; 27: 117–26.
23. Burckhardt CS - Adult measures of pain: The McGill Pain Questionnaire (MPQ) Rheumatoid Arthritis Pain Scale (RAPS) Short-Form McGill Pain Questionnaire (SF-MPQ) Verbal Descriptive Scale (VDS) Visual Analog Scale (VAS) and West Haven-Yale Multidisciplinary Pain Inventory (WHYMPI). Arthritis Rheum 2003; 49: S96–104.
24. Romanian National Institute of Statistics - “Population by ethnicity 2011”
25. Smith MM Russell AK Schiavinato A et al. - A hexadecylamide derivative of hyaluronan (HYMOVIS®) has superior beneficial effects on human osteoarthritic chondrocytes and synoviocytes than unmodified hyaluronan. J Inflamm (Lond). 2013 Jul 27;10:26.
26. Finelli I Chiessi E Galesso D et al. - A new viscosupplement based on partially hydrophobic hyaluronic acid: a comparative study. Biorheology. 2011;48(5):263-75.
27. Benazzo F Perticarini L Padolino A et al. - A multi-centre open label long-term follow-up study to evaluate the benefits of a new viscoelastic hydrogel (Hymovis®) in the treatment of knee osteoarthritis. Eur Rev Med Pharmacol Sci. 2016 Mar;20(5):959-68.
28. Conrozier T Eymard F Afif N et al. - Safety and efficacy of intraarticular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis: Results of a double-blind controlled multicenter randomized trial. Knee. 2016 Oct;23(5):842-8.
29. Askari A Gholami T NaghiZadeh MM et al. - Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail.
30. Ray TR - Using viscosupplementation to treat knee osteoarthritis. Phys Sportsmed. 2013 Nov;41(4):16-24.
31. Food and Drug Administration. Clinical Development Programs for Drugs Devices and Biological Products Intended for the Treatment of Osteoarthritis. Draft Guidance. Washington DC: FDA; July 1999.