Peck Jacquelin, Slovek Annabel, Miro Paulo, Vij Neeraj, Traube Blake, Lee Christopher, Berger Amnon A, Kassem Hisham, Kaye Alan D, Sherman William F, Abd-Elsayed Alaa
Mount Sinai Medical Center, Miami Beach, FL.
Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix.
Orthop Rev (Pavia). 2021 Jul 10;13(2):25549. doi: 10.52965/001c.25549. eCollection 2021.
The purpose of this systematic review is to discuss emerging evidence in the field of viscosupplementation for chronic knee pain secondary to Osteoarthritis (OA). This review focuses on types of viscosupplementation that are clinically available currently, evidence to support their use, contraindications, and adverse events.
OA, also known as degenerative joint disease, is the most common form of arthritis in the United States, affecting 54.4 million, or 22.7% of the adult population. The knee is the most common joint affected in OA, with up to 41% involvement, 30% in the hands, and 19% in the hips. The pathophysiology of OA is complex, with contributing factors including mechanical stress to the joint, as well as many person-specific factors such as genetic susceptibility, ethnicity, nutrition, and sex. Treatment modalities include weight control, exercise, non-steroidal and steroidal anti-inflammatory drugs, opioids, intra-articular platelet-rich plasma, placebo, corticosteroid injection, intra-articular viscosupplementation, and surgery. Viscosupplementation consists of injection of hyaluronic acid (HA) into affected joints, intending to restore the physiologic viscoelasticity in the synovial fluid (SF) in the absence of inflammation. HA has also been shown to downregulate pro-inflammatory factors, such as PGE2 and NFkB, and proteases and proteinases known to break down the joint matrix.The contraindications for HA injection are similar to any other injection therapy, and adverse events are usually mild, local, and transient. Viscosupplementation (VS) is effective over placebo and more effective than NSAIDs and corticosteroids in pain reduction and improved functionality; however, guidelines recommend neither for nor against its use, demonstrating variability in the existing evidence base.Current VS options divide primarily into native vs. cross-linked and low-molecular-weight vs. high-molecular-weight. Current treatment options include Hylan g-f-20, Sodium Hyaluronate preparations (Suparts Fx, Euflexxa, Gelsyn-3, Durolane, Hyalgen), single-use agents (Gel-One, Synvisc-One, Monovisc), and Hyaluronan (Orthovisc, Monovisc, Hymovic). They share a common safety profile, and all have evidence supporting their efficacy. Their specific details are reviewed here.
OA is the most common form of arthritis. It is a chronic, debilitating illness with a high impact on the functionality and quality of life of a significant part of the population in the western world. Treatments include medical management, physical therapy, activity modification, injection, and surgery. VS effectively reduces pain, increases functionality, and delays surgery in the knee to treat osteoarthritis. While previous studies have demonstrated variable results, more evidence is becoming available generally supportive of the benefit of VS in the treatment of knee OA.
本系统综述旨在探讨骨关节炎（OA）继发慢性膝关节疼痛的粘弹性补充疗法领域的新证据。本综述重点关注目前临床可用的粘弹性补充疗法的类型、支持其使用的证据、禁忌症和不良事件。
OA，也称为退行性关节病，是美国最常见的关节炎形式，影响着5440万人，占成年人口的22.7%。膝关节是OA中最常受累的关节，高达41%的患者受累，手部为30%，髋部为19%。OA的病理生理学很复杂，促成因素包括关节的机械应力，以及许多个体特异性因素，如遗传易感性、种族、营养和性别。治疗方式包括体重控制、运动、非甾体和甾体抗炎药、阿片类药物、关节内注射富血小板血浆、安慰剂、皮质类固醇注射、关节内粘弹性补充疗法和手术。粘弹性补充疗法包括将透明质酸（HA）注射到受影响的关节中，旨在在无炎症的情况下恢复滑液（SF）的生理粘弹性。HA还被证明可以下调促炎因子，如前列腺素E2和核因子κB，以及已知会分解关节基质的蛋白酶。HA注射的禁忌症与任何其他注射疗法相似，不良事件通常较轻、局部且短暂。粘弹性补充疗法（VS）在减轻疼痛和改善功能方面比安慰剂有效，且比非甾体抗炎药和皮质类固醇更有效；然而，指南既不推荐也不反对使用，这表明现有证据存在差异。目前的VS选项主要分为天然型与交联型以及低分子量与高分子量。目前的治疗选择包括海兰G-F-20、透明质酸钠制剂（苏帕瑞克斯Fx、优维显、吉尔辛3、杜罗蓝、海吉尔）、一次性使用制剂（凝胶一号、施沛特-优）和透明质酸（奥多明、施沛特-优、海莫维）。它们具有共同的安全性概况，并且都有支持其疗效的证据。在此对它们的具体细节进行综述。
OA是最常见的关节炎形式。它是一种慢性、使人衰弱的疾病，对西方世界很大一部分人口的功能和生活质量有很大影响。治疗方法包括药物治疗、物理治疗、活动调整、注射和手术。VS有效地减轻疼痛、增加功能并延迟膝关节治疗骨关节炎的手术。虽然以前的研究结果各不相同，但总体上有更多证据支持VS在治疗膝关节OA方面的益处。
