Effects of repeated intra-articular hyaluronic acid on cartilage degeneration evaluated by T1ρ mapping in knee osteoarthritis

Could Hyaluronic Acid Be Considered as a Senomorphic Agent in Knee Osteoarthritis? A Systematic Review

BACKGROUND

Knee osteoarthritis (KOA) is one of the most common causes of disability in elderly patients and tends to be a major burden on social and health care spending. Despite its severe socioeconomic impact, KOA remains, to date, an incurable disease. Due to its proper characteristics, KOA represents a favorable disease model for experimenting with senotherapeutics, a group of treatments that counteract the development of age-related disorders and chronic diseases. In recent years, the use of intra-articular hyaluronic acid (IAHA) in the treatment of diseases related to the wear and tear of the articular cartilage has been gaining popularity. Given its ability in joint lubrification, shock absorption, and cell signaling, our aim is to investigate, through the existing scientific literature, its potential role as a senomorphic agent, emphasizing its crucial function in KOA patients. Indeed, senomorphics are a particular group of senotherapeutics capable of modulating the functions and morphology of senescent cells to those of young cells or delaying the progression of young cells to senescent cells in tissues.

METHODS

A search in the scientific literature (PubMed, Cochrane Library, and Google Scholar) was carried out from 2019 to 2023, thus the last 5 years.

RESULTS

One hundred thirty-eight articles were found concerning the role of hyaluronic acid injections in KOA patients. In these studies, its therapeutic efficacy, its anti-inflammatory properties, and its low risk of side effects emerged.

CONCLUSION

IAHA injections are a valuable treatment option for KOA while they can provide pain relief, improve joint function, and slow the progression of joint degeneration. The inhibitory effect of HA on MMP13 and its action as a senomorphic agent suggests that it may have additional benefits beyond its lubricating and shock-absorbing properties. In order to clarify its mechanisms of action and to optimize its clinical use, further studies are definitely needed.

Comparison of the Efficacy of Two High-Molecular-Weight Hyaluronic Acid Products for Patients With Knee Osteoarthritis

In Japan, hyaluronic acid (HA) is often used to treat patients with relatively mild knee osteoarthritis (OA). The use of HA in and the physique and lifestyle of the Japanese population differ from those of other populations. Therefore, clinical reports of HA from around the world must be interpreted with caution for application in Japan. We compared the clinical efficacy of two HA products, with average molecular weights of 900,000 (HA90) and 1.9 million (HA190), for Japanese patients with knee OA. There were 49 patients and 54 knees (27 patients received both HA90 and HA190 injections). We used a disease-specific/patient standing-type knee OA function evaluation scale that was developed earlier and later improved considering the uniqueness of the Japanese lifestyle. The assigned HA product was injected into the joints of patients with knee OA with Kellgren-Lawrence classification system grades I to III once a week, for 5 consecutive weeks. Effects were subjectively self-evaluated using the Japanese Knee Osteoarthritis Measure (JKOM) and a visual analog scale. The average age of the patients was 65.4 years (range, 42-88 years). Both HA products alleviated walking pain and improved JKOM scores, and symptoms continued to improve with continued injections for 6 months. The continued administration of HA90 improved general activity more than that of HA190. In contrast, HA190 improved initial pain more, but its continued administration did not contribute to improving general activity. These results suggest that it may be effective to use different HA products depending on the symptoms and conditions of patients with knee OA. [Orthopedics. 2022;45(1):13-18.].