Efficacy of a treatment for gonarthrosis based on the sequential intra-articular injection of linear and cross-linked hyaluronic acids

Abstract

Background. This study evaluates the clinical and biochemical effects of sequential intra-articular (IA) injections of linear (LHA) and cross-linked hyaluronic acid (CLHA) in patients with Gonarthrosis (GA). Methods. Thirty-nine (39) patients (age 64.89 ± 8.83) received first the LHA injection (0.8-1.2 MDa, 32mg/2ml) and after 1 week the CLHA (1.0 MDa and 2.0 MDa, 75mg/3ml) one; this round was repeated after 6 months. Clinical assessments-i.e. ultrasonography, visual analogic scale (VAS) for pain, range of motion (ROM) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index-were performed at baseline and at specific time points up to 12 months. Relevant markers were determined in blood and synovial fluid (SF) at selected intervals. SF from patients with recurrent effusion was subjected to proteomic analysis. Results. This schedule improved joint pain and function, and promoted a reduction of inflammatory cytokines (IL-1β, IL-9 and IL-17) in plasma and SF; cartilage thickness increased at 12 months and the increase negatively correlated with the baseline levels of C-telopeptide of type II collagen (CTX-II). SF proteomic revealed that proteins associated with inflammation (Apolipoprotein A-1, α-1 antitrypsin and IgK) decreased, while the IL-1 inhibitor Transthyretin increased. Conclusions. This schedule represents an effective treatment whose benefits persist up to 12 months after baseline.