Die intraartikuläre Therapie der Arthrose mit Hyaluronsäure – Stellenwert 2007

 

 Buy Article Permissions and Reprints

Zusammenfassung

Die epidemiologischen Daten unterstreichen die Bedeutung derArthrosekrankheit. Obwohl in den letztenJahren erheb- licheAnstrengungenin immunologischerund pathophysio- logischer Hinsicht unternommen wurden, steht eine zufriedenstellende konservative Behandlungsoption weiterhin aus. Anders als in der internistischen Rheumatologie, wie am Beispiel der Biologicals ersichtlich, fehlt dem Orthopäden im Fall der Arthrose eine zuverlässige Möglichkeit, den Krankheitsverlauf nachhaltig zu beeinflussen. Arthrotische Gelenke zeigen u. a. eine deutlich erniedrigte Hyaluronan- Konzentration. Neben der Möglichkeit derVerbesserung der viskoelastischen Eigenschaften sind inzwischen auch zahlreiche immunmodulatorische Mechanismen im Zusammenhang mit der Gelenkhomöostase unter dem Einfluss von Hyaluronan (überwiegend ex vivo) nachgewiesen. Trotzdem ist unter Berücksichtigung einer umfassenden Übersicht über die zahlreichen Publikationen zu diesem Thema im Sinne eines Evidenzgrades Level 1 eher nur ein moderater Effektfür die allerdings risikoarme intra-artiku- läre Hyaluronan-Therapie abzuleiten. Für eine valide Aussage im direkten Vergleich mit i.a.-Kortikosteroid reicht dagegen die aktuelle Datenlage nicht aus.

Summary

Epidemiologic data emphasise the impact of osteoarthritic disease. Although a lot of effort hasbeen made from an immunologic and pathophysiologic view, there is still no satisfactory conservative treatment option. Differentto rheum- athologists, as can be seen from biologicals, orthopedic surgeons have no reliable means to influence the course of disease in osteoarthritic disease. For example, osteoarthritic joints have a significantly lower hyaluronan concentration. In addition to the possibility to improve the viscoelastic characteristics, a number of immunomodulatory mechanisms of hyaluronan have been proven in joint homeostasis (mainly ex vivo). Yet, after extensive review of publications on this topic, it must be concluded that, while being a low-risk treatment, intraarticular hyaluronan therapy has only a moderate effect (evidence-based level 1). Currently, there is not sufficient available for a valid comparison with intraarticular corticoids.

• Literatur

• 1 Abramson SB, Attur M, Amin AC. Nitric oxide and inflammatory mediators in the perpetuation of osteoarthritis. Curr Rheumatol Rep 2001; 3: 535-341.
  CrossrefPubMedGoogle Scholar
• 2 Akmal M, Singh A, Bentley G. The effects of hyaluronic acid on articular chondrocytes. J Bone Joint Surg (Br); 2005; 87-B: 1143-1149.
  CrossrefPubMedGoogle Scholar
• 3 Antonas KN, Fraser JRE, Muirden KD. Distribution of biologically labelled hyluronic acid injected into joints. Ann Rheum Dis 1973; 3 (32) 1-103.
  Google Scholar
• 4 Arnold I. Intraartikuläre Injektionen von Corticosteroiden - Contra. Dtsch Med Wochenschr 2006; 131-2287.
  Google Scholar
• 5 Arnold W, Fullerton DS, May CS. Viscosupplemantation: managed care issues for osteoarthritis of the knee. J Manag Care Pharm 2007; 5 (13) 2-3.
  Google Scholar
• 6 Arrich J, Piribauer F, Mullner M. Intra articular hyaluronic acid for the treatment of osteoarthritis of the knee. Systematic review and meta-analysis. Canad Med Assoc J 2005; 8 (172) 1039-1043.
  Google Scholar
• 7 Bagga H. Long term effects of intraarticular Hya- luronan on synovial fluid in osteoarthritis of the knee. J Rheumatol 2006; 33: 946-950.
  Google Scholar
• 8 Bellamy N, Campbell J, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2005 Issue 2 Art No: CD005321.DOI:10.1002/14651858.
  PubMedGoogle Scholar
• 9 Bellamy N, Campbell J, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006 2. CD 005328.
  PubMedGoogle Scholar
• 10 Belo JN, Berger MY, Bierma-Zeinstra SM. Prognostic factors of progression of osteoarthritis of the knee: a systematic review of observational studies. Arthritis Rheum 2007; 2 (15) 2-13.
  Google Scholar
• 11 Campbell J, Bellamy N, Gee T. Differences between systematic reviews/meta-analyses of hyaluronic acid/hyaluronan/hyalan in osteoarthritis of the knee. Osteoarthritis Cartilage 2007; 4 (19) 2-11.
  Google Scholar
• 12 Cantor JO, Nadkarni PP. Hyaluronan: the Jekyll and Hyde molecule. Inflamm Allergy Drug Targets 2006; 12 (05) 2-257.
  Google Scholar
• 13 Corbett M, Seifert MH, Hacking C, Webb S. Comparison between local injections of silicone oil and hydrocortisone acetate in chronic arthritis. Br Med J 1970; 1: 24-25.
  CrossrefPubMedGoogle Scholar
• 14 Divine JG, Bohdanna TZ, Hewett TE. Viscosupplementation for knee osteoarthritis. A systematic review. Clin Orthop 2006; 455: 113-122.
  Google Scholar
• 15 Fraser JR, Laurent TC, Laurent UB. Hyaluronan; ist nature, distribution, functions and turnover. J Intern Med 1997; 242: 27-33.
  CrossrefPubMedGoogle Scholar
• 16 Guidolin DD, Ronchetti IP, Frizziero L. Morphological analysis of articular cartilage biopsies from a randomized, clinical study comparing the effects of 500-730 k Da sodium hyaluronate and methylprednisolone acetate on primary osteoarthritis of the knee. Osteoarthritis Cartilage 2001; 5 (09) 2-371.
  Google Scholar
• 17 Karatay S, Senel K. Effects of different hyaluronic acid products on synovial fluid levels of intracellular adhaesions molecule-1 and vascular cell adhaesions molecule-1 in knee osteoarthritis. Ann Clin Lab Sci 2004; 3 (34) 330-335.
  Google Scholar
• 18 Li Z, Yao S, Grad S. Different response of articular chondrocyte subpopulations to surface motion. Osteoarthritis Cartilage 2007; 4 (16) 2-12.
  Google Scholar
• 19 Lo GH, La Valley M, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis. A meta-analysis. JAMA 2003; 290: 3115-3121.
  CrossrefPubMedGoogle Scholar
• 20 Modawal A, Ferrer M, Castle JA. Hyaluronic acid injections relieve knee pain. J Fam Pract 2005; 54: 758-767.
  Google Scholar
• 21 Moreland LW. Intra-articular hyaluronan and hyalans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther 2003; 5 (02) 54-67.
  CrossrefPubMedGoogle Scholar
• 22 Ottaviani RA, Wooley P, Markel DC. Inflammatory and immunological responses to hyaluronan preparations. J Bone Jt Surg Am 2007; 1: 148-155.
  Google Scholar
• 23 Petrella RJ, Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee. J Rheumatol 2006; 5 (33) 2-951.
  Google Scholar
• 24 Peyron JG, Balazs EA. Preliminary clinical assessment of Na-hyaluronate injection into human arthritic joints. Pathol Biol (Paris) 1974; 22: 731-736.
  PubMedGoogle Scholar
• 25 Pozo MA, Balazs EA, Belmonte C. Reduction of sensory response to passive movements of inflamed knee joints by hyalan. Exp Brain Res 1999; 116: 3-9.
  Google Scholar
• 26 Rydell NW, Balazs EA. Effect of intra-articular injction of hyaluronic acid on the clinical symptoms of osteoarthritis and granulation tissue formation. Clin Orthop 1971; 80: 25-32.
  CrossrefPubMedGoogle Scholar
• 27 Salter DM, Godolphin JL, Gourlay MS. Analysis of human articular chondrocyte CD 44 isoform expression and function in health and disease. J Pathol 1996; 179: 396-402.
  CrossrefPubMedGoogle Scholar
• 28 Santangelo KS, Johnson AL. A Bertone. Effects of hyaluronan treatment on lipopolysaccharid-challenged fibroblast-like synovial cells. Arthritis Res Th 2007; 9: 1-11.
  Google Scholar
• 29 Schmidt TA, Gastelum NS, Sah RL. Boundary lubrication of articular cartilage: role of synovial fluid constituents. Arthritis Rheum 2007; 3 (56) 2-882.
  Google Scholar
• 30 Smith MM, Ghosh P. The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatol Int 1987; 7 (03) 1-113.
  CrossrefPubMedGoogle Scholar
• 31 Taylor KR, Yamasaki K, Gallo RL. Recognition of hyluronan released in sterile injury involves a unique receptor complex dependent onTLR4, CD44 and MD-2. J Biol Chem 2007; 3 (30) 2-23.
  Google Scholar
• 32 Vitanzo PC, Senett BJ. .Hyaluronans: is clinical effectivness dependent on molecular weight?. Am J Orthop 2006; 9 (35) 421-428.
  Google Scholar
• 33 Wang CT, Lin J, Hou SM. Therapeutics effects of hyaluronic acid of osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Jt Surg Am 2004; 86: 538-545.
  CrossrefPubMedGoogle Scholar