Intra-articular hyaluronic acids for osteoarthritis of the knee
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REVIEW ARTICLE
Intra‑articular hyaluronic acids for osteoarthritis of the knee Micheline Andel Goldwire1 · Leticia A. Shea1
© Springer Nature Switzerland AG 2020
Abstract Hyaluronic acids (HAs) are one modality in the arsenal for the treatment of osteoarthritis (OA) of the knee. Non-pharmacologic strategies, such as exercise therapy and weight loss, improve functional capacity and provide pain relief. When patients require adjunct pharmacologic therapy, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, intra-articular (IA) corticosteroids, duloxetine, HA, topical capsaicin, and, when necessary, opioid medications may be used. Current guidelines recommend caution with use of many of these therapies because of safety concerns, especially in patients with comorbidities. HAs provide pain relief for patients with mild-to-moderate knee OA without adversely affecting patients with comorbidities. With 15 HA preparations available, these agents vary according to origin of derivation, molecular weight, number of injections per series, and duration of effect. This article discusses the various HA preparations.
Introduction and background Osteoarthritis (OA) is a chronic degenerative joint disease characterized by inflammation, pain, and immobility [1]. Genetics, increasing age, and obesity increase the risk of developing OA [1]. Traumatic injury to the knee increases the risk of OA fourfold and provides additional bone or cartridge damage, making the joint susceptible to further insult [1]. Once cartilage breakdown progresses to bone remodeling, patients often experience pain with movement, stiffness, and swelling, which can lead to decreased participation in daily physical activities, such as dressing, toileting, etc. Non-pharmacologic strategies, such as exercise therapy and weight loss, improve functional capacity, provide pain relief, and remain the gold standard of care, regardless of the staging. There is a distinct delineation between medications deemed to have the highest evidence in efficacy and medications that are safe for use in high-risk patient populations. A large majority of patients with knee OA also experience comorbid conditions such as hypertension, cardiovascular disease, diabetes, dyslipidemia, and metabolic syndrome [2]. These patients are at risk for more significant adverse effects from common OA therapies, such as increased risks of renal injury, dysglycemia, and increased cardiometabolic * Micheline Andel Goldwire [email protected] 1
Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, CO 80221, USA
risk [2]. This precludes a large majority of patients with knee OA from attaining safe therapy (see Table 1). Additionally, patients with OA are more likely to develop comorbidities than the general population [3]. First-line medication therapy for the management of knee OA includes non-steroidal anti-inflammatory drugs (NSAIDs), and possibly intra-articular (IA) corticosteroids, although IA corticosteroids are not considered first line in the American A
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