COVID-19 switch to Hyaluronic acid?

the alternative to corticosteroids

 

Three presentations that give you a clear picture of what why and when Hyaluronic acid

 

what is HA?

 

A naturally occurring glycosaminoglycan found in the synovial fluid.
A physiological lubricant that stimulates endogenous HA synthesis.
 

 

 

 

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COVID-19

 

UK position statements on Corticosteroids and their potential side effects.

Who is delivering Hyaluronic acid  in the NHS. 

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efficacy of HA

 

Here is the published evidence

Joint and peritendinous

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Book a home visit for your HA injection

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OSTENIL® injections help to prolong the professional careers of Premier League and England Football Players 

Hyaluronic acid Pros

  • No risk of COVID-19 immunosuppression
  • No more worry about tendon rupture after injection
  • No post injection steroid flare
  • No risk of post injection COVID-19 or Flu vaccine failure
  • No accelerated joint degradation
  • 6 months benefit to joints
  • Does not degrade joint capsule, giving the surgeon healthier tissues to work with

Hyaluronic acid Cons

  • Research is emerging
  • Gradual pain relief
  • Cost per unit is higher in short term

Research published since NICE 2014 Osteoarthritis guideance

  • Strand V, McIntyre LF, Beach WR et al. (2015) Journal of pain research 8:217-228.

    Safety and efficacy of US-approved viscosupplements for knee osteoarthritis: A systematic review and meta-analysis of randomized, saline-controlled trials.

    <p><span style="color: #ff6600;">Conclusion: Intra-articular injection of US-approved viscosupplements is safe and efficacious through 26 weeks in</span><br /><span style="color: #ff6600;">patients with symptomatic knee OA.</span></p>

  • Bannuru RR, Vaysbrot EE, Sullivan MC et al. (2014) Seminars in Arthritis and Rheumatism 43:593-599.

    Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: A systematic review and meta-analysis.

    <p><span style="color: #ff6600;">Conclusion: This meta-analysis suggests that IAHA is not significantly different from continuous oral NSAIDs at 4 and 12 weeks. Our study detected no safety concerns; however, the included trials had only a short follow-up duration. Given the favorable safety profile of IAHA over NSAIDs, this result suggests that IAHA might be a viable alternative to NSAIDs for knee OA, especially for older patients at greater risk for systemic adverse events.</span></p>

  • Bannuru RR, Osani M, Vaysbrot EE et al. (2016) Osteoarthritis and Cartilage 24:2022-2041.

    Comparative safety profile of hyaluronic acid products for knee osteoarthritis: a systematic review and network meta-analysis

    <p><span style="color: #ff6600;">Conclusion: Given the very low incidence of any particular AEs, we conclude that HA products are relatively well<br />tolerated. These products have a similar safety profile compared to each other. This information along with the<br />comparative effectiveness profile and relative cost would be helpful for clinicians in delivering individualized patient<br />care.</span></p>

  • Housman L, Arden N, Schnitzer TJ et al. (2014 Knee Surgery, Sports Traumatology, Arthroscopy 22:1684-1692.)

    Intra-articular hylastan versus steroid for knee osteoarthritis.

    <p><span style="color: #ff6600;">Conclusion: no significant difference between hyaluronic acid and corticosteroids.</span></p>

  • Zhang Q and Zhang T. (2016) American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 95:366-371.

    Effect on Pain and Symptoms of Aspiration Before Hyaluronan Injection for Knee Osteoarthritis: A Prospective, Randomized, Single-blind Study

    <p><span style="color: #ff6600;">Conclusion: significantly greater effect on pain and function when synovial fluid was aspirated before administering<br />hyaluronic acid compared with no aspiration.</span></p>

  • Ishijima M, Nakamura T, Shimizu K et al. (2014) Arthritis Research and Therapy 16:no.

    Intra-articular hyaluronic acid injection versus oral non-steroidal antiinflammatory drug for the treatment of knee osteoarthritis: A multi-center, randomized, open-label, non-inferiority trial

    <p><span style="color: #ff6600;">Conclusion: HA non-inferior to NSAIDs for change in Japanese Knee Osteoarthritis Measure after 5 weeks.</span></p>

  • Kuang MJ, Zhao J, Sun L et al. (2017) International Journal of Surgery 39:95- 103.

    Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis.

    <p><span style="color: #ff6600;">Conclusion: IACS more effective on pain relief than IAHA in short term (up to 1 month) however HA more effective in long</span><br /><span style="color: #ff6600;">term (up to 6 months) for pain and function.</span></p>

  • Wang F and He X. (2015) Experimental and Therapeutic Medicine 9:493-500.

    Intra-articular hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis: A meta-analysis.

    <p><span style="color: #ff6600;">Conclusion: after one month IACS and IAHA exhibited equal efficacy however in long term HA was found to have an<br />enhanced effect. No statistically significant difference was observed in the adverse events.</span></p>

  • Therrien R, Richardson JB, Andersson M et al. (2014) Osteoarthritis and Cartilage 22:17-25.

    NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: A prospective, multi-centre, randomized, non- inferiority trial.

    <p><span style="color: #ff6600;">Conclusion: single-injection NASHA was well tolerated and non-inferior to MPA at 12 weeks. The benefit of NASHA was </span><span style="color: #ff6600;">maintained to 26 weeks while that of MPA declined.</span></p>

  • Davalillo CAT, Vasavilbaso CT, Alvarez JMN et al. (2015) Open Access Rheumatology: Research and Reviews 7:9-18.

    Clinical efficacy of intra-articular injections in knee osteoarthritis: A prospective randomized study comparing hyaluronic acid and betamethasone.

    <p><span style="color: #ff6600;">Conclusion: BM showed higher short-term effectiveness, while HA showed better long-term effectiveness, maintaining<br />clinical efficacy in a large number of patients 1 year after administration.</span></p>

  • Erturk C, Altay MA, Altay N et al. (2016)Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 24:3653-3660.

    Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?

    <p><span style="color: #ff6600;">Conclusion: HA plus CS plus lidocaine significantly improved pain compared with HA alone after 3 weeks in knee OA.</span><br /><span style="color: #ff6600;">From week 6 no significant differences were seen between groups.</span></p>

  • Tammachote N, Kanitnate S, Yakumpor T et al. (2016)Journal of Bone and Joint Surgery - American Volume 98:885-892.

    Intra-articular, single-shot hylan G-F 20 hyaluronic acid injection compared with corticosteroid in knee osteoarthritis:a double-blind, randomized controlled trial.

    <p><span style="color: #ff6600;">Conclusion: Triamcinolone acetonide provided similar improvement in knee pain, function, and range of motion</span><br /><span style="color: #ff6600;">compared with hylan G-F 20 at the 6-month follow-up, with better pain control in the first week and better knee</span><br /><span style="color: #ff6600;">functional improvement in the second week.</span></p>

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    Hyaluronic acid Pros

    • No risk of COVID-19 immunosuppression
    • No more worry about tendon rupture after injection
    • No post injection steroid flare
    • No risk of post injection COVID-19 or Flu vaccine failure
    • No accelerated joint degradation
    • 6 months benefit to joints
    • Does not degrade joint capsule, giving the surgeon healthier tissues to work with

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