Fermatron. Hyaluronic acid injections.

When prescribing intra-articular injections of synovial fluid substitute to patients, many doctors traditionally recommend drugs that everyone knows. These include, for example, “Fermatron” and “Sinokrom” - medications based on sodium hyaluronate.

Aggressive marketing has done its job: today people trust advertising more than common sense. Meanwhile, these popular drugs also have a downside. What is the fundamental difference between Fermatron, Sinocron and the synthetic endoprosthesis Noltrex? What are manufacturers keeping silent about?

The relevance of hyaluronic acid injections into the knee and other joints

Joint diseases are widespread among people around the globe. Recently, there has been a tendency towards an increase in the incidence of this group of pathologies, as well as its “rejuvenation”.

This is due to many factors, in particular:

deterioration of the environmental situation, and, as a consequence, disruption of bone mineralization and other metabolic processes in all human tissues;
an increase in average life expectancy, which, of course, leads to an increase in the number of diseases in older people, which include degenerative joint pathologies;
obesity is a problem that is increasing in scale and causing increased stress on the joints;
hormonal changes in the body of both men and women are associated not only with age-related changes in the body, but also, often in our time, with the use and receipt of hormonal and other drugs with food that change a person’s hormonal profile;
receiving specific sports loads, and for professional athletes they are often excessive and lead to injuries, and for amateurs they are unsystematic and often without observing safety precautions, which ultimately also leads to injuries;
a sedentary lifestyle is becoming more and more common; muscle weakness progresses over the years and, as a result, the risk of joint injury increases;
an increase in the number of people with genetic and immune diseases who have various disorders of the structure and function of joints as a symptom;

The joint has a complex structure, and disruption of at least one of its elements leads, over time, to the spread of the problem to all its structures. That is why the relevance of new solutions is growing not only in surgical traumatology and orthopedics, but also in the means of conservative treatment of joints. These agents include hyaluronic acid, which is part of the synovial fluid and is an important component of articular cartilage, contributing to its elasticity.

Molecular weight of drugs: why you need to know about it

Molecular weight is information that manufacturers of many synovial fluid endoprostheses deliberately keep silent. Instead, various marketing information about hyaluronic acid injections is presented, often not supported by facts.

Let's look at the problem from a scientific point of view. High molecular weight drugs have multiple intermolecular cross-links. In order for the endoprosthesis to dissolve in the joint, they must be neutralized - the molecules gradually disintegrate and are eliminated from the body. The higher the molecular weight of the drug, the longer the period of molecular breakdown, which means the drug will remain inside the joint longer . In analogues with low molecular weight (including Fermatron, Sinokrom), this process occurs very quickly, so the person is forced to go for the procedure again and again.

The main task of liquid endoprostheses, be it Fermatron or Noltrex, is to stay in the joint capsule for as long as possible, cover damaged cartilage and prevent their friction. The longer they remain in the joint, the longer a person diagnosed with osteoarthritis will not experience pain during movement. This period does not directly depend on the name of the drug or on the dosage of hyaluronic acid, and not even on the country of origin: only the molecular weight matters.

Preparations based on hyaluronic acid “Fermatron” and “Sinokrom” have a molecular weight of 1 and 1.6 million Da, respectively. The molecular weight of Noltrex is more than 10 million Yes, that is, the synthetic synovial fluid substitute is absorbed and excreted from the body almost 10 times longer! This explains its longer effect - up to two years, as well as quick results - after the first injection.

Noltrex is the only drug on the market with a high molecular weight (more than 10 million Da)

Operating principle

When joint pathology occurs, an acute or chronic inflammatory process usually occurs in it. At the same time, the amount of enzymes that destroy hyaluronic acid in the synovial fluid increases, as a result of which its viscous properties decrease. As the disease progresses, when cartilage is destroyed and thinned due to progressive osteoarthritis, hyaluronate production decreases. This also affects the performance of the synovium, which works as a “lubricant” for the joints, promoting their sliding relative to each other, preventing friction and damage, which, in turn, is accompanied by inflammation. Intra-articular injection of hyaluronate helps break this vicious circle, improves the viscoelastic properties of synovial fluid, and protects articular cartilage from destruction.

How long does the effect last?

The main difference between the drugs is the duration of the effect after injections, as well as the period from the start of the course of treatment, after which the result is noticeable (pain decreases).

Preparations based on hyaluronic acid - Fermatron, Sinokrom - are produced using autoclaving technology. Under the influence of high temperatures, molecules quickly disintegrate, so to achieve the effect it is necessary to take a course of several injections, on average up to five. The result is not noticeable immediately, but only after 2-3 weeks, that is, after the second or third procedure - depending on the severity of the disease. After the first procedure, there is often no improvement, and the patient only complains of side effects - discomfort at the injection site.

Noltrex is a drug of synthetic origin for the treatment of osteoarthritis, which is characterized by its highly resistant molecules to decay. Once inside the joint, it remains there for a long time, which explains its long-lasting effect, as well as its almost instantaneous action. Noticeable pain relief occurs after the first injection of this artificial synovial fluid substitute. What's the secret?

To relieve pain, you need to make 3 injections of Fermatron.

The effectiveness of hyaluronic acid in the treatment of joints

Sodium hyaluronate administered intra-articularly is also called synovial fluid prosthesis and acts as follows:

Protects cartilage from destruction, especially where it is already damaged.
Stimulates the synthesis of its own hyaluronic acid, the level of which may decrease over time or due to the development of arthrosis.
Improves the shock-absorbing properties of the joint.
Helps improve the properties of intra-articular fluid, increases viscoelastic indicators.
Reduces stiffness, improves gliding of articular surfaces.
Helps stop the inflammatory process.

Numerous clinical trials have proven the safety of hyaluronic acid preparations. They practically do not cause allergic reactions or side effects.

Comparison of the characteristics of the drugs "Fermatron", "Sinokrom" and "Noltrex"

Sinokrom	Fermatron	Noltrex
Molecular mass	1.6 million Yes	up to 1 million Yes	more than 10 million Yes
Compound	1% sodium hyaluronate solution	1% or 1.5% sodium hyaluronate solution	4.5% solution of artificial biopolymer
Number of injections per course	3-5	3-4	1-3
After what number of injections does improvement occur?	after the third	after the third	after the first
Number of injections for severe osteoarthritis	5	5	2-4
Duration of effect for moderate to moderate severity of osteoarthritis	up to 6 months	up to 6 months	6-24 months
Rate of elimination from the body	average	average	slow
Potential to cause allergies	Yes	Yes	No
Indications	moderate to moderate osteoarthritis	moderate to moderate osteoarthritis	osteoarthritis of any severity
Local phenomena after administration (redness, pain)	periodically	periodically	very rarely
Duration of side effects	1-3 days	a few days	12-24 hours
Manufacturer	Kroma Pharma GmbH (Austria)	Hyaltech Ltd (UK)	"Bioform" (Russia)
Shelf life	3 years	3 years	3 years

When are hyaluronic acid injections prescribed?

Experts prescribe a course of injections according to indications:

When the integrity of the articular cartilage is damaged.
To reduce motor dysfunction.
For osteoarthritis as one of the methods to prevent the development of the disease.
For the treatment of pain and reduction of inflammation.
To normalize the composition of intra-articular fluid after joint surgery, including after arthroscopy.

At the SportClinic, doctors use only high-quality drugs strictly according to indications for injection into large joints (knee, shoulder, elbow, hip, ankle), they have extensive experience in such prescriptions with results of their high effectiveness in complex treatment.

Fermatron synovial fluid prosthesis 20mg/ml 2ml

Compound

sodium hyaluronate, mg/ml - 9.75 - 11.0;
sodium chloride, mg/ml - 7.6 - 9.5;
phosphates, mg/ml - 0.15-0.25;
water for injection - sufficient quantity.

Indications for use

For pain relief and improvement of mobility of the knee joint and other synovial joints in patients suffering from mild or moderate osteoarthritis caused by degenerative changes or traumatic injuries of the synovial joint.

Contraindications

Do not administer if there is inflammation or signs of skin disease at the injection site.
Do not use in patients with known hypersensitivity to sodium hyaluronate.

Directions for use and doses

The drug Fermatron is administered intra-articularly (into the joint cavity) by a traumatologist. A single dose is equal to 2 ml of 1% sodium hyaluronate solution, the medicine is administered once a week, the course of treatment consists of 3-4 injections. A positive result is visible after the first administration of the drug; the therapeutic effect lasts for a year.

Storage conditions

Store in a place protected from light, at a temperature from 2ºС to 25ºС.
Do not freeze. The product is sterile - for single use only. Do not use after expiration date. The product should be transported under the same conditions as storage conditions.

Best before date

3 years.

special instructions

Do not use if packaging is damaged.
The syringe included in the composition is a disposable device intended for one patient only. If used on a second patient, sterility would be compromised and there would be a risk of foreign body reaction or infection.
Cannot be re-sterilized because this may interfere with the functioning of the device.
A sterile needle must be used and discarded after a single use.
Do not use after expiration date.
Sodium hyaluronate is obtained by fermentation of Streptococcus equi bacteria and is carefully purified. However, the clinician must consider the immunological effects and potential risks associated with injecting any biological substance.
Not intended for children.
National and local rules and regulations must be followed to ensure the safe use and disposal of needles.

Description

Fermatron® Synovial Fluid Prosthesis is a clear, sterile solution of 1% sodium hyaluronate in phosphate buffered saline, placed in a pre-filled syringe for a single intra-articular injection into the synovial space of the joint.

Pharmacodynamics

The effect of the drug is due to biocompatibility and physicochemical properties. Sodium hyaluronate, which is part of the drug, is a biopolymer consisting of repeating disaccharide residues of N-acetylglucosamine and glucuronic acid, biosynthesized by a strain of bacteria Streptococcus equi and equivalent to natural human sodium hyaluronate. Hyaluronan replenishes synovial hyaluronan damaged by degenerative or traumatic changes in the joint.

Side effects

With intra-articular injection, temporary passing pain and swelling are possible.
In patients with inflammatory osteoarthritis, after administration of the drug, inflammation of the synovial joint may temporarily increase.
In rare cases, an inflammatory reaction is possible, which may or may not be associated with the administration of Fermatron.

Use during pregnancy and breastfeeding

Safety of use during pregnancy and lactation has not been established.

Interaction

The compatibility of simultaneous intra-articular administration with other substances has not been tested. Therefore, mixing or simultaneous administration of other intra-articular drugs is not recommended.

How to store the drug

The instructions for the medicine say that it must be stored in a dark place where light does not penetrate.
The storage temperature is quite flexible ( from 2 to 25 °C ).
It can be stored in the refrigerator, but the drug should not be frozen, otherwise it will spoil.
If the temperature drops below 2 and rises above 25 ° C, then the medicine deteriorates and is no longer suitable for use.
It is forbidden to hide the substance in the freezer.
It is also best to avoid storing in an area near a stove or other heat source.
The humidity of the storage area should be no more than 75% . Otherwise, the cardboard packaging in which the drug is located will lose its appearance.
From the date of release, the medicine (provided that it is sealed) can be stored for up to 48 months .
The shelf life of the opened product is several minutes . That is, the injection should be given no more than 5 minutes after the substance was opened.
It is strictly forbidden to divide one dose of the drug into several and try to use it in the future.
The injection should not be used several days before the expiration date. At best, the drug will simply lose all its therapeutic functions, and at worst, it will harm the person , worsening his condition and destroying the joint.
The syringe, placed in a plastic blister, is disposable and cannot be reused. Otherwise, sterility will be compromised.
The syringe cannot be re-sterilized.
It is best to hide the substance from children and pets in an inaccessible place.
You can also store the medicine in the closet. There is not much difference between it and the refrigerator.