Changes in synovial fluid biomarkers and clinical efficacy of intra-articular injections of hyaluronic acid for patients with knee osteoarthritis.

Kusayama, Yoshihiro; Akamatsu, Yasushi; Kumagai, Ken; Kobayashi, Hideo; Aratake, Masato; Saito, Tomoyuki · J Exp Orthop · 2014

prospective_cohort · Level II

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Abstract

The changes in synovial fluid biomarkers after intra-articular injection of hyarulonic acid (IA HA) remain controversial. We investigate the changes in the properties of synovial fluid (SF) and clinical symptoms before the first and fifth IA HA. A total of 73 patients (73 knees) with symptomatic knee osteoarthritis were treated with five weekly intra-articular injections of HA and 55 patients (55 knees) were analyzed. The SF total volume, viscosity, and levels of HA, chondroitin 4-sulfate (C4S), chondroitin 6-sulfate (C6S), keratin sulfate, and interleukin (IL)-6 were measured before the first and fifth injections. Clinical evaluations were performed using the American Knee Society score for physician-based outcome measurements and Knee injury and Osteoarthritis Outcome Score for patient-based outcome measurements before the first and fifth injections. The SF viscosity and levels of HA were significantly increased, and the total SF volume and levels of chondroitin 4-sulfate, chondroitin 6-sulfate, and interleukin-6 were significantly decreased. The physician-based and patient-based outcome scores were improved. Our findings speculate that HA injections significantly modulate levels of intra articular biomarkers which may indicate beneficial effect for articular cartilage and synovium membrane.