Intra-articular hyaluronan

Intra-articular hyaluronan (lA-HA) injections are widely used to treat osteoarthritis (OA). This procedure is often referred to as viscosupplementation (22) because it involves the replacement of pathologic synovial fluid with viscoelastic hyaluro-nan-based solutions or gels. In the United States, lA-HA is specifically labeled as an intra-articular analgesic and is indicated to treat pain associated with knee OA when conservative measures and simple analgesics fail (e.g., acetaminophen). In other parts of the world, lA-HA is also approved for treatment of joints other than the knee and in some countries for arthritic conditions other than OA. The molecular basis for this application of hyaluronan, and the history of its development, has been recently reviewed (23). In this chapter, we will update the clinical evidence and describe the different types of hyaluronan formulations available in the United States. 

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The difference in avg MW of the different products greatly influences then-rheological properties, namely their viscosity, elasticity, and pseudoplasticity. Synvisc was designed to imitate the rheology of the hyaluronan in healthy human synovial fluid, and adding hylan B gel to it increases the intra-articular residence time of the product. 

With knee osteoarthritis (OA) patients increasing to a staggering 19 million in 2010, treatment by viscosupplementation has become popular. Visco-supplementation refers to the concept of synovial fluid replacement with intra-articular injections of hyaluronan mainly for the relief of pain associated with OA [47,48]. Intra-articular injections of hyaluronan ameliorate pain and function, generally for up to 3 months with no serious adverse events. In the... 

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