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Hyaluronic Acid / Viscosupplementation
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Hyaluronic Acid / Viscosupplementation

Hyaluronic acid (HA) is a naturally occurring large molecule that helps to calm down inflammation. It also increases the expression of anti-inflammatory molecules in the knee and in cartilage cells, or ‘chondrocytes’.

HA stimulates the cells that generate the synovial fluid in the knee, called synoviocytes. This, in turn, promotes the release of HA into the synovium and the synovial fluid. Together, these effects support the regulation (homeostasis), of the joints by calming down inflammation and helping to promote anti-inflammatory factors or proteins in the joints.

HA helps to regulate the equilibrium of those factors if they are unbalanced, which can occur in patients with acute articular cartilage damage, and especially in both early and late osteoarthritis.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about hyaluronic acid/viscosupplementation, as well as anyone interested in cartilage problems.

What is Hyaluronic Acid / Viscosupplementation?

HA is a treatment concept that was proposed 70 years ago by Hungarian scientist Endre A Balasz, who used it first in horses. HA was known to occur in the synovial fluid and the articular, or joint, cartilage. Within the synovial fluid, HA was considered to be the main constituent that allowed the sliding properties of the joint. Scientifically speaking, HA decreases the coefficient of friction on the joint surface and allows for the smooth motion to occur between the two opposing articular cartilage surfaces. Therefore, the use of HA injections into the joint is a method of supplementing the viscous properties of the joint, or ‘viscosupplementation,’ and it aims to facilitate better gliding properties within the joint during movement.

In the 1960s, scientists learned how to extract HA from animal material, such as a rooster’s comb or other tissues where you can isolate HA in large quantities. The HA was then chemically formulated into very large molecules known as macromolecules and injected into the joint. Then, in the 1980s, scientists learned how to synthesise HA using an artificial form of DNA called recombinant DNA through the genetic manipulation of cells, which made them produce HA. This helped clinicians move away from animal-derived HA, and led to the widespread introduction of the drug that is now commonly used throughout the world.

HA is typically registered as a medicinal product, rather than as a pharmaceutical drug. The reason for this is that it was introduced purely for viscosupplementation to help the joint, similar to the way oil is used in an engine. There has been a lengthy debate about the classification of HA has a drug, because some studies have shown that it has some pharmacological, or drug-like, properties. However, this discussion is ongoing and there are only a few HA products that are registered as a drug, while the large majority of these products are still classified as a medicinal product. It is possible that this debate will be settled once the results of the ongoing research that is focused on how HA modulates the inflammatory cascade located in the joint is published.

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