DOCSLIB.ORG

The Use of Sodium Hyaluronate in the Treatment of Temporomandibular

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Use of Sodium Hyaluronate in the Treatment of Temporomandibular Rev Dor. São Paulo, 2013 out-dez;14(4):301-6 ARTIGO DE REVISÃO The use of sodium hyaluronate in the treatment of temporomandibular joint disorders* O uso do hialuronato de sódio no tratamento das disfunções temporomandibulares articulares Eduardo Grossmann1, Eduardo Januzzi2, Liogi Iwaki Filho3 *Recebido da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS. ABSTRACT Keywords: Clinical treatment, Nonreducing disk displacement, Osteoarthritis, Reducing disk displacement Sodium hyaloruna- BACKGROUND AND OBJECTIVES: Temporomandibular te, Surgical treatment, Temporomandibular joint, Viscosupple- disorder is a collective term involving clinical masticatory muscles, mentation. temporomandibular joints and/or associated structures changes. This study aimed at reviewing, using major databases, the effective- RESUMO ness and safety of sodium hyaluronate in the treatment of temporo- mandibular joint disorders, aiming at recommending or discarding JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibu- its clinical use. lar compreende um termo coletivo que envolve alterações clínicas CONTENTS: The following databases were queried: Medline, via nos músculos da mastigação, das articulações temporomandibulares Pubmed (1966-2013), Cochrane Central Registry of Controlled e/ou estruturas associadas.O objetivo deste estudo foi realizar uma Trials (2012), Embase (1980-2013) and LILACS (1982-2013). The análise crítica, utilizando as principais bases de dados, sobre a efe- strategy was a search adjusted to each database to identify the largest tividade e a segurança do hialuronato de sódio no tratamento das possible number of studies involving sodium hyalorunate to manage disfunções temporomandibulares de origem articular, a fim de reco- joint temporomandibular disorders. Language was limited to articles mendar ou refutar seu uso na prática clínica. published in English. The following keywords were crossed: tempo- CONTEÚDO: Os estudos foram obtidos através das seguintes romandibular joint management, versus sodium hyalorunate, versus bases de dados: Medline, via PubMed (1966 - 2013), Registro de acute or chronic reducing or nonreducing disk displacement, versus Ensaios Controlados Cochrane, (2012), Embase (1980 - 2013) e hyaluronic acid, versus osteoarthritis, versus viscosupplementation. LILACS (1982 - 2013). A estratégia utilizada foi a busca ajustada Inclusion criteria were randomized, blind or double-blind studies, para cada base, a fim de identificar o maior número possível de es- and case series with 15 or more participants. Exclusion criteria were tudos envolvendo o uso do hialuronato de sódio no tratamento da open label-label studies, animal model studies and articles related to disfunção temporomandibular de origem articular. Houve limitação arthrogenous disorders not being treated with sodium hyalorunate do idioma, buscando artigos em língua inglesa. Cruzaram-se os se- infiltration of the temporomandibular joint. Methodological quali- guintes descritores: tratamento da articulação temporomandibular ty of such studies was evaluated and classified according to the level versus hialuronato de sódio versus deslocamento agudo e crônico do of evidence of the Oxford Center for Evidence Based Medicine. disco com e sem redução versus ácido hialurônico versus osteoartrite CONCLUSION: According to this review, one may state that e osteoartrose versus viscossuplementação. Como critérios de inclu- sodium hyalorunate is effective and safe, being recommended to são foram analisados estudos randomizados, uni ou duplamente en- manage the following conditions: acute and chronic reducing and cobertos, série de casos, com 15 ou mais participantes. Excluíram-se nonreducing disk displacement, osteoarthritis and degenerative relato de caso, estudos abertos “open-label”, estudos em modelos joint disease. animais e artigos relacionados a tratamento da disfunção artrogênica que não possuíssem como uma das terapias a infiltração de hialuro- nato de sódio na articulação temporomandibular. A qualidade me- 1. Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. todológica desses estudos foi avaliada e classificada conforme o nível 2. Faculdade Ciodonto, Belo Horizonte, MG, Brasil. de evidência do Oxford Centre for Evidence Based Medicine. 3. Universidade Estadual de Maringá, Maringá, PR, Brasil. CONCLUSÃO: De acordo com a análise crítica dos estudos inclu- Apresentado em 16 de setembro de 2013. ídos, pode-se afirmar que o uso do hialuronato de sódio é eficaz e Aceito para publicação em 03 de novembro de 2013. seguro, sendo recomendado no tratamento das seguintes condições: Conflito de interesses: não há. deslocamento agudo e crônico do disco com redução e sem redução, Endereço para correspondência: osteoartrose, osteoartrite e doença articular degenerativa. Dr. Eduardo Grossmann Rua Coronel Corte Real, 513 Descritores: Articulação temporomandibular, Deslocamento do 90630-080 Porto Alegre, RS. Brasil. disco sem redução, Deslocamento do disco com redução, Tratamen- E-mail: [email protected] to cirúrgico, Tratamento clínico, Osteoartrose, Osteoartrite, Hialu- © Sociedade Brasileira para o Estudo da Dor ronato de sódio, Ácido hialurônico, Viscossuplementação. 301 Rev Dor. São Paulo, 2013 out-dez;14(4):301-6 Grossmann E, Januzzi E e Iwaki Filho L INTRODUÇÃO lular, sendo assim incapazes de agir nos sinoviócitos e condrócitos, o que seria necessário para reduzir a inflamação sinovial e restaurar as A disfunção temporomandibular (DTM) compreende um termo propriedades naturais do líquido sinovial, o que tem sido chamado coletivo que envolve alterações clínicas nos músculos da mastiga- de “visco-indução”14,15. De acordo com essa teoria13-15, produtos com ção, das articulações temporomandibulares (ATM) e/ou estruturas peso molecular compreendido entre 0,5 e 1 x 106Da proporcionariam associadas, as quais podem estar acompanhadas de dor, limitação da os melhores efeitos in vivo23, podendo ser capazes de promover a sínte- abertura bucal e sons articulares1,2 . Os indivíduos que apresentam se do AH endógeno pelos sinoviócitos14,15. No mesmo sentido, outros essas alterações sofrem grande impacto em sua qualidade de vida, pesquisadores24 estabeleceram uma faixa ainda mais estreita de peso com prejuízo de suas atividades funcionais e, frequentemente, apre- molecular (500-730 kDa) como aquele capaz de agir nos fibroblastos sentam alterações de humor e sono3 . A prevalência da DTM na sinoviais, restaurando sua capacidade de sintetizar o AH13. população varia entre 10 e 70%, sendo mais frequente em mulheres Devido às características mecânicas e metabólicas do AH, a técni- com faixa etária entre 20 e 40 anos de idade3,4. ca da viscossuplementação, isolada ou em combinação com outras Dentre as DTM de origem articular, os deslocamentos do disco com intervenções, apresenta uma excelente propriedade terapêutica para e sem redução, a osteoartrose e a osteoartrite são as alterações mais as condições inflamatórias e alterações biomecânicas da ATM, tor- frequentes nos pacientes que procuram por tratamento3-5. nando-a um tratamento conservador ideal, minimamente invasivo e Diferentes abordagens têm sido propostas para o controle dessas bem recomendado22,23,25,26. disfunções, havendo tratamentos classificados como conservadores As reações adversas ao emprego de AH combinado a técnicas mini- (fármacos, fisioterapia, placas oclusais estabilizadoras e reposiciona- mamente invasivas ou empregado de forma isolada são leves e tran- doras, orientações), minimamente invasivos (infiltrações de hialuro- sitórias. As principais queixas descritas na literatura são desconforto, nato de sódio, de corticosteroides, artrocentese) e invasivos (artros- edema ou dor no local da injeção que se resolve espontaneamente copia, artroplastia, artrotomia)6-8. em um curto espaço de tempo11,20,27-30. Com relação às terapias minimante invasivas, alguns estudos têm Um caso isolado de necrose óssea do tubérculo articular da ATM foi mostrado que infiltrações de hialuronato de sódio (HS) no espaço relatado após o emprego repetido de injeção de HS em um paciente articular superior e, algumas vezes, em ambos os espaços, são efetivos com DTM31. para o tratamento das alterações intra-articulares da ATM9,10. Considerando-se um trabalho de metanálise, certos autores19 con- O ácido hialurônico (AH) é um glicosaminoglicano de cadeia linear, cluíram que não há provas suficientes para apoiar ou refutar o uso de hidrofílico, poli-iônico de elevado peso molecular. É encontrado na HS para tratar pacientes com disfunção da ATM. No entanto, os re- matriz extracelular de diversos tecidos conjuntivos, incluindo a carti- sultados, em curto prazo, das injeções intra-articulares de AH, inves- lagem articular e o liquido sinovial11-13. Nesses locais, as moléculas de tigados, em estudos preliminares, foram muito promissores9,11. Esses AH são predominantemente sintetizadas pelas células sinoviais do resultados foram recentemente confirmados por outros autores32. tipo B12-15. A atividade metabólica do AH na renovação celular faci- O objetivo deste estudo foi analisar, por meio de uma busca na li- lita a nutrição das zonas avasculares do disco e da cartilagem articu- teratura nas principais bases de dados e posterior análise crítica dos lar através da sua combinação com os glicosaminoglicanos advindos artigos selecionados, a eficácia e segurança do uso do HS no trata- dos proteoglicanos produzidos pelos condrócitos. Em condições pa- mento das DTM. tológicas, há um aumento da síntese de proteoglicanos, bem como da produção
Load more

Recommended publications
  • Healon®) on a Nonregeneroting (Feline) Corneal Endothelium
    Effect of 1 % Sodium Hyoluronote (Healon®) on a Nonregeneroting (Feline) Corneal Endothelium Charles F. Bahn,* Robert Grosserode,f^: David C. Musch,f Joseph Feder,f§ Roger F. Meyer, f Donald K. MacCallum.f John H. Lillie,f and Norman M. Rich* A series of experiments were performed to investigate the effect of 1% sodium hyaluronate (Healon®) on the nonregenerating corneal endothelium of the cat. Aqueous humor replacement with 1% sodium hyaluronate resulted in mild, transient elevations of intraocular pressure compared to eyes that were injected with balanced salt solution. Sodium hyaluronate 1% protected the feline endothelium against cell loss incurred by contact with hyaluronate-coated intraocular lenses compared to endothelial contact with lenses that were not coated with sodium hyaluronate. The use of intraoperative 1% sodium hyal- uronate, however, did not protect against endothelial cell loss incurred by penetrating keratoplasty or prevent subsequent skin graft-induced corneal homograft rejections. Homograft rejections were milder, however, in some eyes that received grafts coated with 1% sodium hyaluronate. Image analysis of pho- tographs of trypan blue- and alizarin red-stained corneal buttons after trephining, stretching of Descemet's membrane, rubbing against iris-lens preparations, or immediately after penetrating keratoplasty dem- onstrated that the stretching of the posterior cornea is an important cause of endothelial damage that would not be protected against by a viscoelastic coating. Invest Ophthalmol Vis Sci 27:1485-1494,1986
    [Show full text]
  • VISCO-3 (Sodium Hyaluronate)
    Patient Information VISCO-3TM (Sodium Hyaluronate) Federal law restricts this device to sale by or on the order of a physician. Please make sure to read the following important information carefully. This information does not take the place of your doctor’s advice. If you do not understand this information or want to know more, ask your doctor. Your doctor has determined that the knee pain you are experiencing is caused by osteoarthritis and that you are a candidate for a non-surgical, non-pharmacological, pain-relieving therapy called VISCO-3TM. VISCO-3TM is used for the treatment of pain in osteoarthritis of the knee in patients who have failed to get adequate relief from simple painkillers or from exercise and physical therapy. Contents What is VISCO-3TM? 2 What are the benefits of VISCO-3TM? 2 How is VISCO-3TM given? 2 What should you expect following your series of injections? 2 What other treatments are available for osteoarthritis? 3 Are there any reasons why you should not use VISCO-3TM? 3 Possible complications: 3 Other things you should know about VISCO-3 TM: 4 Summary of Clinical Study: 4 How can you get more information about VISCO-3TM? 5 Page 1 of 5 What is VISCO-3TM? VISCO-3TM is a solution made of highly purified, sodium hyaluronate (hyaluronan). Hyaluronan is a natural chemical found in the body and is found in particularly high amounts in joint tissues and in the fluid (synovial fluid) that fills the joints. The body’s own hyaluronan acts like a lubricant and shock absorber in synovial fluid of a healthy joint.
    [Show full text]
  • Management of Joint Disease in the Sport Horse
    1 MANAGEMENT OF JOINT DISEASE IN THE SPORT HORSE Management of Joint Disease in the Sport Horse C. WAYNE MCILWRAITH Colorado State University, Ft. Collins, Colorado INTRODUCTION The joint is an organ, and there are a number of ways in which traumatic damage occurs, ultimately resulting in degradation of articular cartilage. It was recognized in 1966 that articular cartilage change that accompanied osteochondral fragmentation could also be associated with concurrent traumatic damage to the attachment of the joint capsule and ligaments (Raker et al., 1966). However, there was little association made between primary disease in the synovial membrane and fibrous joint capsule and the development of osteoarthritic change in the articular cartilage until an experimental study demonstrated that cartilage degradation could occur in the horse in the absence of instability or trau- matic disruption of tissue and that loss of glycosaminoglycan (GAG) staining was associated with early morphologic breakdown at the surface of the cartilage (McIlwraith and Van Sickle, 1984). Surveys have confirmed that approximately 60% of lameness problems are related to osteoarthritis (National Animal Health Monitoring Systems, 2000; Caron and Genovese, 2003). Rapid resolution of synovitis and capsuli- tis is a critical part of the medical treatment of joint disease because of the principal role of synovitis in causing cartilage matrix breakdown. The goal of treatment of traumatic entities of the joint is twofold: (1) returning the joint to normal as quickly as possible, and (2) preventing the occurrence or reduction of the severity of osteoarthritis. In other words, treatment is intended to (1) reduce pain (lameness), and (2) minimize progression of joint deterioration.
    [Show full text]
  • (HA) Viscosupplementation on Synovial Fluid Inflammation in Knee Osteoarthritis: a Pilot Study
    Send Orders for Reprints to [email protected] 378 The Open Orthopaedics Journal, 2013, 7, 378-384 Open Access Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammation in Knee Osteoarthritis: A Pilot Study Heather K. Vincent*,1, Susan S. Percival2, Bryan P. Conrad1, Amanda N. Seay1, Cindy Montero1 and 1 Kevin R. Vincent 1Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, 2Department of Food Sciences and Nutrition, University of Florida, Gainesville, FL 32608, USA Abstract: Objective: This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) treatment in adults and elderly adults with knee osteoarthritis (OA). Design: This was a prospective, repeated-measures study design in which patients with knee OA were administered 1% sodium hyaluronate. Patients (N=28) were stratified by age (adults, 50-64 years and elderly adults, 65 years). Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six. Materials and Methods: Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for pro-inflammatory cytokines (interleukins 1, 6,8,12, tumor necrosis factor-, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz. Results: HA improved ambulatory knee pain in adults and elderly groups by month six, but adults reported less knee pain- related interference with participation in exercise than elderly adults. A greater reduction in TNF- occurred in adults compared to elderly adults (-95.8% ± 7.1% vs 19.2% ± 83.8%, respectively; p=.044).
    [Show full text]
  • Novel Heparin-Like Sulfated Polysaccharides
    ^ ^ ^ ^ I ^ ^ ^ ^ ^ ^ II ^ ^ ^ II ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ I ^ European Patent Office Office europeen des brevets EP 0 940 410 A1 EUROPEAN PATENT APPLICATION (43) Date of publication: (51) |nt CI * C08B 37/08, A61 K 31/73, 08.09.1999 Bulletin 1999/36 A61 K 47/36 A61 1_ 27/00 (21) Application number: 99200468.9 (22) Date of filing: 23.03.1995 (84) Designated Contracting States: • Magnani, Agnese AT BE CH DE DK ES FR GB GR IE IT LI LU MC NL 153010 San Rocco A. Philli (IT) PT SE • Cialdi, Gloria Deceased (IT) (30) Priority: 23.03.1994 IT PD940054 (74) Representative: (62) Document number(s) of the earlier application(s) in Crump, Julian Richard John et al accordance with Art. 76 EPC: FJ Cleveland, 9591 31 58.2 / 0 702 699 40-43 Chancery Lane London WC2A1JQ(GB) (71) Applicant: FIDIA ADVANCED BIOPOLYMERS S.R.L. Remarks: 72100 Brindisi (IT) »This application was filed on 18 - 02 - 1999 as a divisional application to the application mentioned (72) Inventors: under INID code 62. • Barbucci, Rolando »The application is published incomplete (there is no 53100 Siena (IT) claim number 9)as filed (Article 93 (2) EPC). (54) Novel heparin-like sulfated polysaccharides (57) The invention provides sulfated derivatives of jects and pharmaceutical compositions comprising polysaccharides such as hyaluronic acid and hyaluronic these derivatives. The invention further provides for the acid esters exhbiting anticoagulant, antithrombotic and use of these derivatives in the manufacture of pharma- angiogenic activity, for use in the biomedical area. The ceutical compositions, biomedical objects, biomaterials, invention further provides complex ions, biomedical ob- and controlled drug release systems.
    [Show full text]
  • Recent Advances in Equine Osteoarthritis Annette M Mccoy, DVM, MS, Phd, DACVS; University of Illinois College of Veterinary Medicine
    Recent Advances in Equine Osteoarthritis Annette M McCoy, DVM, MS, PhD, DACVS; University of Illinois College of Veterinary Medicine Introduction It is widely recognized that osteoarthritis (OA) is the most common cause of chronic lameness in horses and that it places a significant burden on the equine industry due to the cost of treatment and loss of use of affected animals. Depending on the disease definition and target population, the reported prevalence of OA varies. It was reported at 13.9% in a cross-sectional survey of horses in the UK, but at 97% (defined by loss of range of motion) in a group of horses over 30 years of age. Among Thoroughbred racehorses that died within 60 days of racing, 33% had at least one full-thickness cartilage lesion in the metacarpophalangeal joint, and the severity of cartilage lesions strongly correlated with a musculoskeletal injury leading to death. The majority of the horses in this study were less than 3 years of age, emphasizing the importance of OA in young equine athletes. Unfortunately, a major challenge in managing OA is that by the time clinical signs occur (i.e. lameness), irreversible cartilage damage has already occurred. Although novel treatment modalities are being tested that show promise for modulation of the course of disease, such as viral vector delivery of genes that produce anti-inflammatory products, there are no generally accepted treatments that can be used to reliably reverse its effects once a clinical diagnosis has been made. Thus, there is much research effort being put both into the development of improved diagnostic markers and the development of new treatments for this devastating disease.
    [Show full text]
  • Chondroitin Sulfate/Sodium Hyaluronate Compositions
    ~" ' Nil II II II III III II III MINI Ml J European Patent Office _ © Publication number: 0 136 782 B1 Office europeen* des.. brevets , EUROPEAN PATENT SPECIFICATION © Date of publication of patent specification: 18.03.92 © Int. CI.5: A61 K 31/735 © Application number: 84305221.8 @ Date of filing: 01.08.84 © Chondroitln sulfate/sodium hyaluronate compositions. © Priority: 09.08.83 US 521575 © Proprietor: NESTLE SA Avenue Nestle 55 @ Date of publication of application: CH-1800 Vevey(CH) 10.04.85 Bulletin 85/15 @ Inventor: Chang, Allison S. © Publication of the grant of the patent: 7894 Falrview Road 18.03.92 Bulletin 92/12 Lesage West Virginia 25537(US) Inventor: Boyd, James Edward © Designated Contracting States: Route 1 P.O. Box 135 CH DE FR GB IT LI SE Barbourville West Virginia 25504(US) Inventor: Koch, Harold Otto © References cited: 1017 Big Bend Road Barbourville West Virginia 25504(US) CHEMICAL ABSTRACTS, vol. 98, no. 19, 9th Inventor: Johnson, Richard Michael May 1983, page 44, no. 155193n, Columbus, 905 Woodbine Avenue Ohio, US; S.M. MAC RAE et al.: "The effects Rochester New York 14619(US) of sodium hyaluronate, chondroitln sulfate, and methylcellulose on the corneal endo- thelium and intraocular pressure", & AM. J. Representative: W.P. Thompson & Co. OPHTHALMOL. 1983, 95(3), 332-41 Coopers Building, Church Street Liverpool L1 3AB(GB) 00 CM 00 IV CO CO O Note: Within nine months from the publication of the mention of the grant of the European patent, any person ^ may give notice to the European Patent Office of opposition to the European patent granted.
    [Show full text]
  • Why Chain Length of Hyaluronan in Eye Drops Matters
    diagnostics Review Why Chain Length of Hyaluronan in Eye Drops Matters Wolfgang G.K. Müller-Lierheim CORONIS Foundation, 81241 Munich, Germany; [email protected] Received: 21 June 2020; Accepted: 20 July 2020; Published: 23 July 2020 Abstract: The chain length of hyaluronan (HA) determines its physical as well as its physiological properties. Results of clinical research on HA eye drops are not comparable without this parameter. In this article methods for the assessment of the average molecular weight of HA in eye drops and a terminology for molecular weight ranges are proposed. The classification of HA eye drops according 1 to their zero shear viscosity and viscosity at 1000 s− shear rate is presented. Based on the gradient of mucin MUC5AC concentration within the mucoaqueous layer of the tear film a hypothesis on the consequences of this gradient on the rheological properties of the tear film is provided. The mucoadhesive properties of HA and their dependence on chain length are explained. The ability of HA to bind to receptors on the ocular epithelial cells, and in particular the potential consequences of the interaction between HA and the receptor HARE, responsible for HA endocytosis by corneal epithelial cells is discussed. The physiological function of HA in the framework of ocular surface homeostasis and wound healing are outlined, and the influence of the chain length of HA on the clinical performance of HA eye drops is illustrated. The use of very high molecular weight HA (hylan A) eye drops as drug vehicle for the next generation of ophthalmic drugs with minimized side effects is proposed and its advantages elucidated.
    [Show full text]
  • (Hyaluronic Acid) Promotes Migration of Human Corneal Epithelial Cells in Vitro J a P Gomes, R Amankwah, a Powell-Richards, H S Dua
    821 EXTENDED REPORT Br J Ophthalmol: first published as 10.1136/bjo.2003.027573 on 17 May 2004. Downloaded from Sodium hyaluronate (hyaluronic acid) promotes migration of human corneal epithelial cells in vitro J A P Gomes, R Amankwah, A Powell-Richards, H S Dua ............................................................................................................................... Br J Ophthalmol 2004;88:821–825. doi: 10.1136/bjo.2003.027573 Purpose: Sodium hyaluronate (hyaluronic acid) is known to promote corneal epithelial wound healing in vivo and in vitro, in animal experiments. Sodium hyaluronate is the ligand for CD44, a cell surface adhesion molecule which has been found on normal human corneal epithelial cells. The purpose of this study was to investigate the effect of sodium hyaluronate on human corneal epithelial cell migration, proliferation, and CD44 receptor expression. Methods: Human corneal epithelial cell cultures were established from 32 donor corneoscleral rims and See end of article for maintained separately in three different culture conditions: (1) culture medium only, (2) sodium authors’ affiliations ....................... hyaluronate enriched (0.6 mg/ml) medium, and (3) hydroxypropylmethylcellulose enriched (2.5 mg/ml) medium. The total area of migrating epithelial cell sheets in each case was measured by planimetry on Correspondence to: days 4, 8, 12, and 16. Cytospin preparations of cells cultured in the different culture conditions were Professor H S Dua, Division of Ophthalmology examined immunohistochemically for proliferation and CD44 receptor expression using antibodies and Visual Sciences, B directed against Ki67 and CD44 respectively. Floor, Eye Ear Nose Throat Results: Cells cultured in the presence of sodium hyaluronate showed significantly increased migration at Centre, University days 12 and 16 (Friedmen test: p = 0.0012, day 16; p = ,0.001, day 12) compared with cells cultured in Hospital, Queens Medical Centre, Nottingham NG7 the other media.
    [Show full text]
  • Hyaluronic Acid Viscosupplementation and Osteoarthritis
    AJSM PreView, published on January 23, 2009 as doi:10.1177/0363546508326984 Basic Science Update Hyaluronic Acid Viscosupplementation and Osteoarthritis Current Uses and Future Directions Eric J. Strauss,* MD, Jennifer A. Hart,† MPAS, PA-C, Mark D. Miller,† MD, Roy D. Altman,‡ MD, and Jeffrey E. Rosen,*§ MD From the *Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, the †Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, and the ‡Division of Rheumatology and Immunology, University of California, Los Angeles, Los Angeles, California Intra-articular hyaluronic acid viscosupplementation is gaining popularity as a treatment option in the nonoperative management of patients with osteoarthritis. Recent clinical studies have demonstrated that the anti-inflammatory, anabolic, and chondropro- tective actions of hyaluronic acid reduce pain and improve patient function. With evidence mounting in support of the efficacy of this treatment modality for patients with osteoarthritis, its potential use in additional patient populations and for other patho- logies affecting the knee is being investigated. The current article reviews the use of intra-articular hyaluronic acid viscosupple- mentation in the management of knee osteoarthritis and presents the potential for expanding its indications for other joints and alternative patient subpopulations. Additionally, future directions for the use of hyaluronic acid and areas of active research are discussed. Keywords: hyaluronic acid; viscosupplementation; osteoarthritis; knee With the aging of the “baby boomers,” the prevalence of if possible. Nonoperative treatment options for symptomatic osteoarthritis (OA) in the United States is increasing, with arthritis include lifestyle modifications, physical therapy, recent projections reporting that by the year 2030, almost systemic anti-inflammatory medications, intra-articular 67 million Americans will be affected by the disease.
    [Show full text]
  • Three Pearls for Surgery in Uveitis Patients
    Three Pearls for Surgery in Uveitis Patients Addressing these important questions can help to ensure a positive outcome. BY LISA J. FAIA, MD he main indications for surgical intervention for traction as a “third hand” to create countertraction for patients with uveitis are the same as those for any further delamination of membranes. patient: to correct a visually significant or vision- Sodium hyaluronate is a useful tool for countertraction, threatening etiology. Additionally, interventions as it shows the location of the remaining retinal contraction may be helpful to elicit a diagnosis or as a form of and it can be easily removed, even if it goes subretinal. Tinflammatory control. In uveitic patients, bleeding is the enemy, even more so The keys to success with any surgery include a thorough than in noninflammatory detachments. The inflammation preoperative evaluation, an accurate diagnosis, a proper is an issue, and hemostasis must be achieved (Figure). To surgical plan, and a meticulous approach. For surgery in watch a successful retinal detachment repair in a patient patients with uveitis, additional steps include good preopera- with uveitis, visit bit.ly/FAIA1. tive control of the inflammation and a plan for escalation of inflammatory control before surgery to better ensure suc- HOW QUIET DOES THE EYE HAVE TO BE? cess. Postoperatively, surgeons must be ready to recognize, as In an ideal world, the eye would be completely quiet— early as possible, any reactivation of inflammation and treat meaning no cell, haze, macular edema, vasculitis, etc.—for it to ensure that it does not escalate beyond control. 3 full months prior to surgery.
    [Show full text]
  • Final Report of the Safety Assessment of Hyaluronic
    International Journal of Toxicology Volume 28 Number 4S July/August 2009 5-67 Final Report of the Safety Assessment © 2009 The Author(s) 10.1177/1091 581809337738 of Hyaluronic Acid, Potassium http://ijt.sagepub.com hosted at Hyaluronate, and Sodium Hyaluronate http://orsline.sagepub.com Lillian C. Becker, MS, Wilma F. Bergfeld, MD, Donald V. Belsito, MD, Curtis D. Klaassen, PhD, James G. Marks Jr, MD, Ronald C. Shank, PhD, Thomas J. Slaga, PhD, Paul W. Snyder, DVM, PhD, Cosmetic Ingredient Review Expert Panel, and F. Alan Andersen, PhD Hyaluronic acid, sodium hyaluronate, and potassium acid was not genotoxic. Hyaluronic acid likely does not hyaluronate function in cosmetics as skin conditioning play a causal role in cancer metastasis; rather, increased agents at concentrations up to 2%. Hyaluronic acid, pri expression of hyaluronic acid genes may be a conse marily obtained from bacterial fermentation and rooster quence of metastatic growth. Widespread clinical use combs, does penetrate to the dermis. Hyaluronic acid of hyaluronic acid, primarily by injection, has been free was not toxic in a wide range of acute animal toxicity of significant adverse reactions. Hyaluronic acid and its studies, over several species and with different exposure sodium and potassium salts are considered safe for use routes. Hyaluronic acid was not immunogenic, nor was in cosmetics as described in the safety assessment. it a sensitizer in animal studies. Hyaluronic acid was not a reproductive or developmental toxicant. Hyaluronic Keywords: cosmetics; hyaluronic acid; safety he safety of ingredients used in cosmetic Chemistry formulations is reviewed by the Cosmetic T Ingredient Review (CIR) program.
    [Show full text]