Hyaluronic acid in rheumatic disorders of the periarticular soft tissues: a brief descriptive review

Abstract

Periarticular soft tissue disorders (PSTD) are typical manifestation of immunoinflammatory rheumatic diseases, primarily spondyloarthritis. However, in real clinical practice, physicians involved in the management of patients with musculoskeletal diseases often have to deal with "non-systemic" PSTD resulting from trauma, physical exertion, or degenerative processes associated with endocrine, metabolic, and cardiovascular diseases. PSTD causes acute and chronic pain, significant impairment of function and deterioration in the quality of life. The treatment of this pathology is complex and includes non-drug methods, painkillers and local injection therapy. Hyaluronic acid (HA) drugs occupy an important place in this treatment. Their use is pathogenetically justified, because when the tendon and enthesis are involved, the internal environment (intercellular matrix) change, and its basis is natural hyaluronate, which provides the viscoelastic properties of biological structures, as well as regulates metabolism, proliferative and immune processes. A relatively low molecular weight HA drug (530–730 kDa) has favorable rheological parameters, anti-inflammatory and anabolic potential, which makes it the drug of choice for local injection therapy of PSTD. This review briefly presents data on the pathogenesis of PSTD and the advisability of HA drugs use for its therapy, as well as the evidence base for the use of HA (530–730 kDa) in various types of ligamentous apparatus lesions.