Local injection therapy: the use of hyaluronic acid in osteoarthritis and other joint diseases

Abstract

The article deals with local injection therapy (LIT) in arthrological practice, the purpose of which is the introduction of a drug into the joint cavity or periarticularly, removal of excess synovial fluid from the joint cavity with subsequent analysis of its composition for differential diagnosis and decision-making on treatment tactics. The most commonly used in LIT are glucocorticoids, hyaluronic acid (GlK), autologous platelet-rich plasma. The method of introducing GLA into the joint cavity is considered by experts as a promising method for the treatment of osteoarthritis, the most common chronic joint disease. GlK-based preparations differ in concentration, molecular weight and production method. The article presents the results of studies using high- or low-molecular drugs GlK in the treatment of patients with osteoarthritis of the knee, hip and small joints. Attention is drawn to the fact that LIT with GlK preparations is used in the treatment of other diseases of the musculoskeletal system. Data are presented, including those of Russian authors, on the effectiveness of GlK in OA of the shoulder joints, in the syndrome of compression of the shoulder rotators. Thus, the restoration of range of motion and a significant reduction in pain in the shoulder area was achieved against the background of the use of 3 to 5 injections of the GlK preparation produced in the Russian Federation by bacterial fermentation. The unique production technology of the GlK preparation makes it possible to reduce the risk of bacterial endotoxins, completely purify the solution from hyaluronidase, increase homogeneity, and preserve the molecular weight. On the basis of the obtained evidence of efficacy and safety, HLA preparations are included by various medical associations and professional communities in Russian and international clinical guidelines for the treatment of OA.