Synovial Fluid Prosthesis: Drugs for Joint Mobility

Today, not only medications, physical procedures and surgery are used to treat many diseases. Innovative methods appear every year, and one of them is artificial liquids, analogues of natural human ones. This is exactly what we are talking about when we talk about “synovial fluid prosthesis”. Its introduction into the joint cavity not only relieves the symptoms of arthrosis, but also affects the root cause.

Prostheses based on hyaluronic acid are produced in disposable syringes for single use

How it works

A sterile solution of the prosthesis is injected into the joint capsule, where it becomes a substitute for natural synovial fluid. The product improves the physiological characteristics of joints affected by arthrosis:

• normalizes the elasticity and viscosity of natural lubricant;
• restores metabolism in tissues and hydrodynamics in joints;
• improves nutrition of tissues around cartilage and bones;
• reduces mechanical impact on the joint;
• supports adequate functioning of cartilage.

The prosthesis compensates for the lack of natural synovial fluid in the joint

The effectiveness of chondroprotectors

These medications are classified as slow-acting. The course of treatment consists of several months (the exact duration is determined by the doctor). The first results appear after two to three weeks, but replenishing the joints must be repeated periodically.

When treating arthrosis, two main tasks are solved: suppressing the inflammatory response and normalizing metabolism in cartilage tissue. Accordingly, drugs are divided into two groups: symptomatic and structure-modifying. The former include non-steroidal anti-inflammatory drugs, analgesics and glucocorticoids, the latter - chondroprotectors. Efficiency is guaranteed only in combination.

How long does the effect last?

After completing a course of intra-articular injections, the effect lasts on average for several months - from 6 to 12. One course involves 3-5 injections at a certain interval. How long the therapeutic effect will last depends on the severity of the lesion and the molecular weight of the substance.

Synovial fluid prostheses bring maximum positive results in the initial stages of arthrosis. If degenerative-dystrophic changes have seriously progressed, it will not be possible to completely restore cartilage tissue. Replenishing the volume and viscosity of synovial fluid will alleviate symptoms and prevent complications.

Synovial fluid grafts help delay joint surgery

General information about drugs

A prosthesis is a liquid preparation whose biologically active substance is hyaluronic acid. It is widely used in various areas of medicine, including orthopedics. A sterile solution of the corresponding component is injected into the joint capsule (intra-articularly), due to which the rheological properties of the natural fluid are actively restored and the physiological criteria of the structural parts of the joint affected by arthrosis are improved. The therapeutic effect is achieved through:

• normalization of viscosity and elasticity of natural lubricant;
• restoration of tissue metabolism and hydrodynamics in the joint;
• improving the nutrition of tissues of osteochondral formations;
• reducing mechanical impact on the joint;
• maintenance and long-term protection of cartilage.

synvisc one

The source for obtaining a unique substance, as a rule, is animals: HA is synthesized from cockscombs, the vitreous substance of the eyes of cattle, the umbilical cord, and the trachea of ​​mammals. That is, the synovial fluid prosthesis is made from natural products. The produced bio-compositions have good compatibility with the human body, but sometimes they can cause allergic reactions and some other complications, which we will inform you about a little later. The product is available in disposable syringes for single use.

Injection into the knee joint.

The effect of intra-articular injection of synovial fluid prosthesis is temporary, but quite long-lasting. The duration of action after completing one course is on average from 6 to 12 months, after which it is necessary to repeat the procedure. To fully complete 1 course, you will need to make 3-5 injections of sodium hyaluronate with a certain sequence. The duration of the therapeutic effect and the specifics of the course depend on the molecular weight of the ingredient used.

Direct saturation of the joint with HA helps to significantly reduce pain and increase the range of motion in the problem area. Such therapy is most beneficial at the initial signs of degenerative-dystrophic changes, since in the early stages almost complete restoration of cartilage tissue can be achieved. In case of moderate and severe pathologies, the prosthesis replenishes the volume and viscosity of the synovial fluid, which softens the symptoms and prevents the progression of destruction. Therefore, sometimes its use is advisable, for example, if it is necessary to delay surgery for total joint replacement.

Attention! Replacement synovial fluid, preparations containing sodium hyaluronate produce a positive symptomatic effect. They have been proven to reduce the severity of symptoms, reducing pain and improving the functional abilities of the affected locomotor part, but do not restore damaged structures and deformities in advanced osteoarthritis and rheumatoid arthritis. Therefore, experts do not consider intra-articular injection of synovial fluid prostheses as an alternative to endoprosthetics.

To whom are they shown?

Since 2003, WHO has officially recommended the use of hyaluronic acid-based drugs for the treatment of mild and moderate forms of osteoarthritis. Most often, this technique is used when conservative methods are ineffective.

The main indications for the use of prostheses are degenerative and post-traumatic diseases of the joints (arthrosis, osteoarthritis, arthrosis deformans), which are accompanied by painful discomfort and stiffness.

For the purpose of prevention, injections are prescribed in order to stop the progression of destructive processes in cartilage, when age-related changes in the joints lead to a deficiency of natural lubrication.

Synovial fluid prostheses are a real godsend for older people

Detailed description of the study

Synovial fluid is a very thick substance that acts as a lubricant for joints. Normally, it fills cavities in human joints, provides shock absorption and protection of cartilage from excessive loads, and reduces the coefficient of friction in joints. During inflammatory processes inside the joints, the properties of the synovial fluid may change.

Joint pathologies for which microscopic examination of synovial fluid may be prescribed can be divided into the following 5 groups:

1. Infectious diseases of joints and bones. The reason is the entry of bacteria or other microorganisms into the joint cavity. As a result, acute or chronic inflammation of the joint develops - arthritis.
2. Crystalline arthritis. Characterized by the formation and subsequent accumulation of crystals of uric acid (gout), calcium dihydrogen pyrophosphate (calcium pyrophosphate arthritis), monobasic calcium phosphate or calcium oxalate. Usually in this case there is inflammation in the joints of the legs.
3. Autoimmune conditions that cause joint inflammation, such as rheumatoid arthritis or systemic lupus erythematosus.
4. Degenerative joint diseases, such as osteoarthritis/osteoarthritis.
5. Blood clotting disorder. In this case, blood can enter the joint cavity. This is typically seen in people with bleeding disorders such as hemophilia or von Willebrand disease.

Synovial fluid for examination is obtained by puncture of the affected joint. Both the macroscopic properties of the liquid - color, transparency - and microscopic ones are assessed.

Macroscopic examination allows the fluid to be classified as non-inflammatory, inflammatory, infectious or hemorrhagic. Synovial fluid analysis may also detect crystals indicating microcrystalline arthritis.

Most often, during the study, needle-shaped crystals of monosodium urate, which are characteristic of gout, or diamond-shaped and rectangular crystals, characteristic of the disease of deposition of calcium pyrophosphate crystals, are found. In addition, atypical crystals may be found that are formed by other, rarer substances (cholesterol, oxalates or cryoglobulins) or artifacts, for example, glucocorticoid crystals.

The following may also be found:

1. Ragocytes are modified neutrophils, a sign of rheumatoid arthritis;
2. Mononuclear cells may indicate joint tuberculosis;
3. Sickle erythrocytes - sickle cell hemoglobinopathy;
4. Bone marrow particles or fat globules (from bone fractures);
5. Bacteria.

Depending on the objects found in the biomaterial during microscopic examination, the study helps the doctor establish the correct diagnosis and prescribe adequate treatment for the identified joint disease.

Are there any contraindications

Injections of preparations based on hyaluronic acid are contraindicated if:

• there is local inflammation in the joint, because against the background of the inflammatory process, hyaluronic acid is destroyed and does not work;
• there is a history of autoimmune pathologies, since an organism with an impaired immune response may react negatively to such therapy;
• intolerance to synovial fluid of animal origin has been recorded (to prevent serious allergic reactions, including anaphylactic shock, it is necessary to undergo a tolerance test for the analogue);
• the patient is under 18 years of age.

During pregnancy and lactation, injections of hyaluronic fluid prostheses are contraindicated

Features of application

Joint pain due to arthrosis can affect anyone, regardless of age. Don't think that this is only a problem for older people. However, it is important to take into account the specifics of the use of chondroprotectors in different groups of patients:

• For athletes whose joints experience increased stress, these drugs are prescribed as a preventive measure. The duration of the course and the necessary active ingredients are selected by a sports doctor. • Previously, they were practically not used in the treatment of adolescents. However, given the spread of osteochondrosis among schoolchildren, the inclusion of these drugs in the course of therapy is becoming increasingly justified. • Such medications are contraindicated for pregnant women. However, cartilage tissue suffers during gestation. If there is severe pain and permission from the obstetrician-gynecologist, it is allowed to take dietary supplements with a similar effect.

Additional joint protection is needed by overweight people, women during menopause, and representatives of professions that require standing work. Their use is justified both when pain occurs and for preventive purposes.

What to prepare for: are there any complications?

Products based on hyaluronic acid sometimes cause unwanted reactions:

• itching and heat at the injection site;
• skin irritation;
• hives;
• swelling of soft supra-articular tissues;
• soreness in nearby muscles;
• numbness and tingling in the limb (during the treatment of gonarthrosis);
• local inflammatory reactions;
• rarely – anaphylactic shock.

Each body responds to therapy individually, so it is impossible to be 100% sure of the success of treatment. Injections should be carried out in a medical office, under the supervision of a specialist. The procedure is technically different from standard intramuscular injections and is performed under ultrasound guidance. It should be done by a rheumatologist or orthopedic traumatologist with the appropriate skills.

Prostheses are most often inserted into the knee, hip and shoulder joints

Possible side effects

This innovative invention, despite its minimally invasive nature and high degree of safety, is not without side effects. Analogue synovial fluid prostheses, often prescribed for arthrosis of the knee joint, rarely cause negative reactions. But they cannot be called completely harmless, if only because the main category of products sold by pharmaceutical companies has not been subjected to clinical trials.

Based on the minimal experimental clinical database and personal experience of patients who encountered problems after intra-articular use of hyaluronic acid, conclusions were drawn about the possible likelihood of developing the following consequences:

• feeling of heat, itching at the injection site;
• burning and irritation of the skin;
• nettle fever;
• swelling and redness of soft supra-articular tissues;
• painful signs in nearby muscles;
• local infectious and inflammatory reaction;
• numbness, tingling, feeling of “pins and needles” in the limbs;
• anaphylactic shock.

As we see, with all their positive qualities, innovative drugs produced as “synovial fluid” can also harm health. Efficiency is also not 100% guaranteed. Do not forget that each organism has its own individual characteristics, so there is no absolute guarantee of a successful outcome. In addition, it is unlikely that such therapeutic measures will produce results in pathofunctional changes in articular elements at terminal stages. Hence the conclusion: far from cheap treatment may well be ineffective.

Manufacturers of synovial fluid prostheses based on hyaluronic acid

Preparations based on hyaluronic acid have very different effects. How these drugs differ from each other, how effective drugs from different manufacturers are - the opinion of a specialist, supported by the arguments of evidence-based medicine:

Liquid implants: price and analogues

Before we list the most commonly used HA agents intended for intra-articular administration, we draw attention to an important point: all therapeutic manipulations must be carried out by a highly competent doctor in the rheumatology department, in compliance with all aseptic standards. In addition, in technical terms, this procedure is completely different from intramuscular injections, so only a professional medical professional can ensure correct, non-traumatic and safe insertion of the needle into the joint capsule. The session is carried out under ultrasound control.

Synvisc's analogues

Comparison of natural and artificial hyaluronic acid by molecular weight

Is there an alternative

The human body contains the enzyme hyaluronidase, which breaks down hyaluronic acid even with high molecular weight. In addition, drugs can cause allergic and infectious reactions due to animal origin. Therefore, despite the innovative approach, they are not a perfect therapeutic agent.

It is safer and more effective to use the synovial fluid prosthesis “Noltrex”. In terms of molecular weight (more than 10,000,000 Da), it outperforms absolutely all products based on hyaluronic acid. Since specific enzymes do not act on the polymer, it remains in the body longer than other analogues, while also effectively restoring the properties of the joint fluid.

Noltrex reduces pain, improves the biomechanics of movements and stabilizes the joint for a long time - sometimes the effect lasts up to two years, which is impossible to achieve with hyaluronic acid.