Update: October 2018
Hyaluronic acid, hyaluronate (hereinafter – GK) is a unique
chemical compound actively used in medicine for the treatment
a number of diseases and cosmetology for the correction of appearance. Open at
1930 By Karl Meier. In the US, the FDA approved FDA – special
food control and
Has the widest range of application – treatment of osteoarthritis,
cancer therapy, eye surgery, tissue engineering,
cosmetology. Вещество может вводиться в капсулу jointов,
sc, applied topically and taken orally.
Действительно ли препараты гиалуроновой кислоты для jointов
are “liquid endoprostheses” and are able to restore cartilage
sheath of bone heads that form a joint? Undeniable
there is only one thing – hyaluronate is produced by the body
human, is present in many tissues and body fluids
(about 15 grams. in a person weighing 70 kg) and performs vital
Роль ГК в jointах
Endogenous GK is produced by fibroblast cells. it
natural polysaccharide from the glycosaminoglycans family,
consisting of two sugars: glucuronic acid and
N-acetyl-glucosamine. Present in cartilage and synovial tissue.
liquids, may include 25,000 linear disaccharide monomers,
average molecular weight is 2000 kDa.
ГК ответственна за упругость синовиальной жидкости в jointах.
The higher the elasticity of the fluid, the greater the molecular weight
hyaluronates. The hyaluronate solution is a viscous fluid when
external forces act at low speeds, and elastic body
when exposed to increased forces or high speeds. Turns out
что при медленных движениях в jointе гиалуронаты выступают
lubricant, and with fast movements – shock absorber.
- With age, the total acid content in the body increases,
but at the same time its molecular weight decreases, respectively
suffer and functions assigned to this connection.
- It has been proven that the size of HA molecules decreases with inflammatory
процессах в jointе (острых и хронических).
- In patients with osteoarthritis, the concentration of HA in the synovial
fluids are lower than in healthy people.
The mechanism of action of hyaluronates in synovial fluid and
применение для лечения jointов
Экзогенная гиалуроновая кислота для jointов применяется
for a long time and has the second name – the synovial prosthesis
fluid. Hyaluronates are “substituents” of the synovial
жидкости, позволяют купировать jointной и околоjointной болевой
syndrome and show high efficiency in complex treatment
Being the main element of the synovial fluid, acid
responsible for its viscosity, provides a lubricating effect and absorbs
shock pulses. Также входит в состав jointного хряща, а точнее
– in the composition of the shell of chondroitsitov. In the interaction of molecules
acids with aggrecan monomers that occurs in the presence of
protein, in the cartilage tissue formed large, absorbing water
negatively charged aggregates. These compounds are responsible for
cartilage elasticity, i.e. its resistance to external influences.
Maintain optimal levels of HA in synovial fluid
prevents the loss of proteoglycans by the matrix and stops
инвазию активированных макрофагов в jointную полость.
Hyaluronates inhibit the phagocytic function of cells and inhibit
release of inflammatory mediators, suppress dehydration of cartilage and
stimulate the synthesis of new cells.
Scientific research and facts
пациенту с остеоартрозом предлагаются инъекции для jointов с
using hyaluronate preparations, and many agree. Price
on drugs is high, but they are assigned a short course that together
with predictable positive effects tip the scales toward their
choice. What really?
All patients with osteoarthritis in synovial fluid is reduced
средний молекулярный вес и концентрация hyaluronates. it послужило
обоснованием для применения уколов в joint при артрозе, но возник
the question of which molecular weight drugs will be
As a result of clinical trials that were conducted on
animals with osteoarthritis, managed to establish that that hyaluronates
with an average molecular weight (2000-2500 kDa) are more
effective than high-molecular drugs, because it is easier for them
penetrate damaged tissue. In parallel held
comparative studies have confirmed that increasing
the molecular weight or viscosity of hyaluronate does not increase
The duration of action of drugs does not correspond to their main
механической ролью в jointе, поскольку положительный эффект
сохраняется на несколько месяцев after курса уколов, тогда как
период выведения гиалуроновой кислоты из капсулы jointа составляет
from 2 hours to 10 days. Observed difference between period
нахождения препарата в jointной сумке и продолжительностью
clinical effect may be due to enhanced penetration
weight hyaluronates in the extracellular matrix
synovial tissue, and possibly in cartilage. In experimental
animal studies have obtained evidence that
medium molecular weight hyaluronates more efficiently penetrate into
articular tissue, with pathological changes
synovial tissues provide increased accessibility to molecules
But these issues are still being discussed. Today generally recognized
worldwide is the point of view that hyaluronates with molecular
a mass equivalent to normal, which is observed in healthy
people in the synovial fluid (which is about 2000 kDa) provide
optimal elastic properties of the intraarticular fluid and good
mechanical protection of articular cartilage. But according to reviews, good
drugs with low and high
Hyaluronic acid preparations for the treatment of joints
At the moment there is an impressive list
hyaluronate drugs that differ in
production technology, molecular weight indicators,
additional components, the manufacturing country and of course
price, which in any case is high.
Medications are available for joints in ampoules or immediately in
sterile syringes for direct injection into the joint.
Injections are carried out only by a doctor in a hospital setting.
Department of Rheumatology, under the control of ultrasound – in all other
options very high risk of infection in the cavity
The most effective of these are considered high hyaluronates.
purification rates with optimum molecular weight and no impurities
Preparations are made using two main technologies:
from animal tissues (crests of mature cocks, chickens, umbilical cords
animals) and the method of bacterial fermentation: a number of strains
Streptococcus and Pasteurella under cultivation form
GK-containing shell. Bacterial preparations constitute the main
part of the market, but most of them are synthesized by bacteria,
pathogenic for humans, therefore in terms of toxicology
preferably hyaluronic acid injections synthesized from
animal tissue, but only highly purified.
The main allergens in the composition of the drugs are impurities
proteins. The degree of immunogenicity of protein fractions may be higher in
preparations obtained by the method of bacterial fermentation, despite
however, their concentration in the preparation itself may be lower. it
associated with the pathogenicity of bacteria involved in the reaction
bacterial fermentation, for humans. In addition to proteins, allergens
may be impurities of DNA and RNA of bacteria.
The effectiveness of intra-articular therapy of GC is proven in
osteoarthritis of the shoulder, knee, clavicular-acromial,
ankle, hip, temporomandibular joints, and
also small joints of the hand and wrist. As for the gel for
joints with HA and oral medications and dietary supplements, their clinical
effectiveness is questioned. Oral administration of GK
distributed throughout the body, and when applied locally, the degree
The substance’s absorption by the tissues is small, and all the acid that
entered the body remains in the skin.
Comparative characteristics of drugs intended for
The range of these drugs is constantly expanding: available
new medicines, many of them are registered on
the territory of the Russian Federation and occupy their niche in the pharmaceutical market. Submitted
data are indicative, and patients should first
turn to rely on the recommendations of the attending physician.
|The name of the group of drugs||Trade names of drugs||Characteristic|
|Low molecular weight drugs||Suplazin, Gialgin Phidia, Fermatron||Well tolerated and distinguished by the rapid splitting of the introduced
GC in the joint, but short duration of positive
actions. Used for extra-articular injections with tendonitis,
tenosynovites, bursitis. 3-5 injections per course is enough.
|Medium Molecular Weight||Intragel, Ortolur, Viskosil, Girouan Plus, Hiastat, Rusvisk,
Hyaloal Artro, ViscoPlus, Sinokrom Forte
|The largest group of drugs that are products
bacterial fermentation. Well tolerated in most
cases and are introduced 3-5 times during the course. Some may
administered immediately after arthroscopic intervention in order to
normalization of metabolism.
|High molecular weight drugs||Synvisc||Have the longest analgesic effect, which
can be explained by a long period of excretion of GK from the joint.
|Drugs with the presence of cross-molecules||Dyuralan Es Jay||
Have a pronounced analgesic effect and significantly
Only one injection may be required.
|Preparations with active concomitant components.||Ostenil Plus||In addition to the main, have pronounced additional effects
for example, anti-inflammatory, dehydrating.
Hyaluronic acid in the knee joint
Положительный клинический эффект внутриjointного лечения ГК при
gonarthrosis is proven in controlled studies. After 6 months
уколов при артрозе коленного jointа пациенты отмечали уменьшение
pains. The clinical efficacy of CG injections correlated with the severity
структурных нарушений при остеоартрозе коленных jointов: самая
was high in patients with the least disease severity, low
— при наличии jointного выпота.
Оценка артроскопической картины коленного jointа до лечения и
after 1 year of therapy allowed to confirm the low degree
структурных повреждений в хрящевой ткани jointа по сравнению с
patients who did not receive GK. Also in treated patients
marked reduction in the need for nonsteroidal anti-inflammatory
and corticosteroid drugs that have much more
serious side effects, rather than hyaluronates, improved quality
Side effects and deficiencies of drugs
According to the results of many years of observation, side effects
rarely occur. The following local reactions may occur (in
- feeling warm;
- itching and burning;
- redness of the skin.
Patients may notice rapid pain in
nearby muscles. To side effects quickly pass,
иногда достаточно приложить к jointу холодный компресс.
Extremely rarely in patients (only a few cases are described)
severe acute inflammatory reaction or pseudosepsis develops
at the injection site.
If, however, after the introduction of the injection developed common phenomena
hypersensitivity (swelling of the mucous membranes of the mouth and larynx, urticaria,
paresthesia), you should immediately consult a doctor and cancel
drug, since it is possible the development of an anaphylactic reaction.
Although over the entire period of use of drugs of this group, systemic
no side effects were observed in the patients.
При введении препаратов в коленный joint отмечено, что при
переднем доступе в joint частота побочных реакций выше, чем при
prick side access.
Unfortunately, not all patients have a clinical
improvement, and in some cases, possible exacerbation of symptoms.
It turns out that expensive drugs can bring harm.
The effectiveness of treatment depends on the individual reaction of the body,
stages of the disease (at terminal stages of feasibility in
there is no such treatment), as well as the qualifications of a medical professional
conducting the injection.
Hyaluronic acid preparations have a number of strict
contraindications that can not be ignored:
- hypersensitivity to acting or additional
components of drugs;
- острый воспалительный процесс внутри jointа;
- children up to 18 years;
- breastfeeding period;
- skin integrity or dermatological diseases
- acute period of infectious diseases;
Выводы: Препараты ГК при внутриjointном
have anti-inflammatory, analgesic and
structural modifying effect with a duration of up to 8-12 months. after
injection rates, allow to delay the terms of arthroplasty and
to help patients in whom this surgical method is contraindicated
лечения (сахарный диабет, ранний восстановительный период after
stroke and heart attack, etc.). Play an important role in complex treatment
According to the observations of experts, hyaluronates and corticosteroids
оказывают примерно равную эффективность через 1 месяц after
инъекции, но через 5-13 недель after введения препараты ГК
show significantly greater effect.
Автор: врач-гигиенист, эпидемиолог