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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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.

Conclusion: Intra-articular injection of US-approved viscosupplements is safe and efficacious through 26 weeks in
patients with symptomatic knee OA.
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.

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.
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

Conclusion: Given the very low incidence of any particular AEs, we conclude that HA products are relatively well
tolerated. These products have a similar safety profile compared to each other. This information along with the
comparative effectiveness profile and relative cost would be helpful for clinicians in delivering individualized patient
care.
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.

Conclusion: no significant difference between hyaluronic acid and corticosteroids.
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

Conclusion: significantly greater effect on pain and function when synovial fluid was aspirated before administering
hyaluronic acid compared with no aspiration.
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

Conclusion: HA non-inferior to NSAIDs for change in Japanese Knee Osteoarthritis Measure after 5 weeks.
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.

Conclusion: IACS more effective on pain relief than IAHA in short term (up to 1 month) however HA more effective in long
term (up to 6 months) for pain and function.
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.

Conclusion: after one month IACS and IAHA exhibited equal efficacy however in long term HA was found to have an
enhanced effect. No statistically significant difference was observed in the adverse events.
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.

Conclusion: single-injection NASHA was well tolerated and non-inferior to MPA at 12 weeks. The benefit of NASHA was maintained to 26 weeks while that of MPA declined.
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.

Conclusion: BM showed higher short-term effectiveness, while HA showed better long-term effectiveness, maintaining
clinical efficacy in a large number of patients 1 year after administration.
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?

Conclusion: HA plus CS plus lidocaine significantly improved pain compared with HA alone after 3 weeks in knee OA.
From week 6 no significant differences were seen between groups.
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.

Conclusion: Triamcinolone acetonide provided similar improvement in knee pain, function, and range of motion
compared with hylan G-F 20 at the 6-month follow-up, with better pain control in the first week and better knee
functional improvement in the second week.

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Please contact info@trbchemedica.co.uk

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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

COVID-19 switch to Hyaluronic acid?

the alternative to corticosteroids

what is HA?

COVID-19

efficacy of HA

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

Hyaluronic acid Pros

Hyaluronic acid Cons

Research published since NICE 2014 Osteoarthritis guideance

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

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

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

Intra-articular hylastan versus steroid for knee osteoarthritis.

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

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

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

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

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

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

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

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

for Ostenil information

Quote “MSK practitioner.com”

Hyaluronic acid Pros

Our purpose

AFFILIATE

DISCLAIMER

Useful links

COVID-19 switch to Hyaluronic acid?

the alternative to corticosteroids

what is HA?

COVID-19

efficacy of HA

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

Hyaluronic acid Pros

Hyaluronic acid Cons

Research published since NICE 2014 Osteoarthritis guideance

for Ostenil information

Quote “MSK practitioner.com”

Hyaluronic acid Pros

Our purpose

AFFILIATE

DISCLAIMER

Useful links

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