Products
Hyaluronic acid is commercially available as a solution for intraarticular use (e.g., Durolane, Hyalur, Ostenil, Sinovial, Synvisc). The preparations are approved in many countries as medical devices and not as drugs.
Ingredients
These are viscoelastic, sterile, pyrogen-free, and isotonic solutions containing the sodium salt of hyaluronic acid (sodium hyaluronate) and excipients. Sodium hyaluronate is a glycosaminoglycan consisting of disaccharide units of -glucuronic acid and -acetyl–glucosamine. Hyaluronic acid can be obtained from rooster combs. Synthetic, cross-linked derivatives such as Hylan G-F 20 (Synvisc) with higher molecular weight and viscoelasticity are also used.
Effects
Hyaluronic acid (ATC M09AX01) has a lubricating, shock-absorbing, and nourishing effect as a supplement or substitute for natural synovial fluid. This is thought to reduce pain and improve mobility. The effect is delayed and may last more than 6 months. The preparations also have pharmacological properties and are anti-inflammatory. Whether the treatment is actually clinically effective is controversial in the scientific literature. Various authors have come to opposite conclusions.
Indications
For symptomatic treatment of mild to moderate osteoarthritis with symptoms such as pain and limited mobility. The drug is used on the knee joint, hip, and other joints and is also used after diagnostic and surgical procedures and trauma.
Dosage
According to the SmPC. The drug is injected (intraarticular) into the joint space of the diseased joint between 3 to 5 times at weekly intervals. Repeat treatment cycles are possible if needed.
Contraindications
Hyaluronic acid is contraindicated in cases of hypersensitivity to the ingredients, venous or lymphatic congestion in the affected limb, infected or severely inflamed joints, skin diseases, or infections in the injection area. If the product is derived from rooster combs, it should not be used in cases of hypersensitivity to hen’s egg protein. For complete precautions, see the drug label.
Interactions
Drug-drug interactions have not been reported to date.
Adverse effects
Possible adverse effects include local reactions such as pain, warm sensation, redness, swelling, and joint effusion. It is recommended that an ice pack be applied for 5-10 minutes to reduce these symptoms. Hypersensitivity reactions are rarely possible.
