Bagga Hanish, Burkhardt Daniel, Sambrook Philip, March Lyn
University of Sydney Institute of Bone and Joint Research, Royal North Shore Hospital, St. Leonards, NSW, Australia.
J Rheumatol. 2006 May;33(5):946-50.
Intraarticular (IA) hylan injections constitute second-line therapy for osteoarthritis (OA) of the knee, but human studies suggesting a possible mechanism of action are lacking. We examined the effect of IA Hylan GF-20 injections on synovial fluid (SF) hyaluronan (HA) concentration, viscosity, and elasticity over a 6-month period in patients with mild to moderate OA of the knees.
Patients with symptomatic knee OA (Osteoarthritis Research Society International grade 1-2) had SF aspirated from the study knee pre- and 3 and 6 months post-Hylan injection. Primary endpoints included SF HA concentration, viscosity, and elasticity. SF HA concentration was determined using uronic acid assay, and rheology measured using a micro-Fourier rheometer.
Sequential SF samples were available from 32 of 60 subjects injected at baseline (15 men, 17 women; mean age 65 yrs) at 3 months post-injection. The mean HA concentration had increased by 13% (p<0.0008), and the complex shear modulus had increased by 16% (p<0.03). Sufficient SF was also available from 19 of these subjects at 6 months post-injection when mean HA concentration was 2.24+/-0.62 mg/ml compared to their baseline mean of 2.02+/-0.52 mg/ml, an increase of 10% (p<0.053).
This open-label study showed a statistically significant change from baseline in both SF HA concentration and complex shear modulus at 3 months following IA Hylan GF-20 injection among subjects with mild to moderate knee OA. These results suggest that one possible mechanism of action of viscosupplementation is to promote endogenous HA production. Longer-term studies are required to identify whether these changes in SF measures are important for modification of disease progression in knee OA.
关节内（IA）注射透明质烷是膝关节骨关节炎（OA）的二线治疗方法，但缺乏提示其可能作用机制的人体研究。我们研究了IA注射透明质烷GF-20对轻至中度膝关节OA患者滑液（SF）透明质酸（HA）浓度、粘度和弹性在6个月期间的影响。
有症状的膝关节OA患者（国际骨关节炎研究学会1-2级）在注射透明质烷前以及注射后3个月和6个月从研究膝关节抽取滑液。主要终点包括SF HA浓度、粘度和弹性。使用糖醛酸测定法测定SF HA浓度，并使用微型傅里叶流变仪测量流变学。
在基线时注射的60名受试者中，有32名（15名男性，17名女性；平均年龄65岁）在注射后3个月有连续的SF样本。平均HA浓度增加了13%（p<0.0008），复合剪切模量增加了16%（p<0.03）。在这些受试者中，有19名在注射后6个月也有足够的SF，此时平均HA浓度为2.24±0.62mg/ml，而基线平均值为2.02±0.52mg/ml，增加了10%（p<0.053）。
这项开放标签研究表明，在轻至中度膝关节OA患者中，IA注射透明质烷GF-20后3个月，SF HA浓度和复合剪切模量与基线相比有统计学上的显著变化。这些结果表明，粘弹性补充疗法的一种可能作用机制是促进内源性HA的产生。需要进行长期研究以确定SF指标的这些变化对于改变膝关节OA疾病进展是否重要。
