Spontaneous osteoarthritis in dogs - clinical effects of single and multiple intra-articular injections of hyaluronic acid

Background: The treatments of osteoarthritis (OA) are commonly conservative and multimodal to relieve pain and improve movement. Intra-articular injection of hyaluronic acid (IAHA) has been studied as a treatment option for OA in dogs. IAHA helps restore the viscoelasticity of the synovial fluid and relieves the clinical symptoms of OA. However, the efficacy of IAHA in dogs is still a controversial subject. This study aims to confirm the IAHA effect in dogs with spontaneous OA and to compare the effectiveness depending on the number of injections. Materials, Methods & Results: Thirty dogs with spontaneous OA were assigned to a single injection group (n=17) and a 3-weekly injections group (n=13). Dogs weighing less than 10 kg were injected 1 mL of HA to the OA joint, and more than 10 kg dogs were injected 2 mL of HA. In the case of the 3-weekly injections group, the same amount was administered 3 times at 1-week intervals. After the injection, physical and orthopedic examinations were performed to check for complications. Radiographic OA score was evaluated before and 3 months after the injection to confirm and to evaluate the progression of OA. Clinical symptom evaluations were performed on pre-injection, 1-, 2-, and 3-months post-injection. They consisted of the clinical lameness score by veterinarians and Canine Brief Pain Inventory (CBPI) by owners. Results were compared with unpaired t-test, repeated-measures ANOVA with Tukey's or Sidak's multiple comparison test, or Wilcoxon test, with P < 0.05. Patients had a median age of 9 years (range 3 to 16 years) and a bodyweight of 4.8 kg (range 2 to 48 kg). No systemic side effects or major complications were detected during the trial period. IAHA produced temporary pain and discomfort in 6 cases. There was no change in the radiographic OA score before and 3 months after injections in both groups, and the difference between groups was not confirmed. In both groups, the clinical lameness score significantly decreased at 1, 2, 3 months after injection compared with pre-injection. The score was lower at 3 months after the injection than at 1 month. The clinical lameness score had no significant difference between the groups. Similarly, CBPI was all decreased in the single injection group and 3-weekly injections group compared to pre-injection, and the score at 3 months post-injection was lower than at 1 month. No significant differences between the groups were found in CBPI. Discussion: Most studies on the efficacy of IAHA in canine OA have been conducted using an experimental model, so studies on spontaneous canine OA are insufficient. This study confirmed that IAHA improves clinical symptoms such as pain relief and movement improvement in spontaneous OA dogs using CBPI and clinical lameness score. In order to confirm the optimal IAHA protocol, a single IAHA and 3-weekly IAHA were compared. The result shows that clinical symptoms improved in both single and 3-weekly injections groups, but no significant difference was confirmed during the 3-month study period. These findings may suggest that a single IAHA may have a similar effect to multiple IAHA, and repeated injections are unnecessary. In humans and canine OA models, it is reported that the effect of IAHA was maintained for 6 months. This study showed that the effect of IAHA was maintained for 3 months study period and that clinical symptoms improved at 3 months than at 1 month. In conclusion, these findings suggested that IAHA improves clinical symptoms in dogs with spontaneous OA, and a single IAHA showed a similar effect to 3 weekly IAHA.

Use of hyaluronic acid associated with triamcinolone acetonide or ozone gas in the treatment of induced osteoarthritis in rabbits

Purpose: To evaluate the effects of the intra-articular application of hyaluronic acid associated with triamcinolone acetonide, and ozone gas in the treatment of induced osteoarthritis in rabbit’s stifles.Methods: Twenty-one Norfolk rabbits were submitted to cranial cruciate ligament transection of the left stifle. After six weeks of the surgery, the rabbits were randomized assigned into three groups: G1 (control) – saline solution (0.9%); G2 – hyaluronic acid associated with triamcinolone; G3 – ozone gas, submitted to three intra-articular applications every seven days. Results: Significant differences occurred: osteophytes at medial femoral condyle (G2 > G1, G2 > G3) on radiography exam; thickening of the medial condyle (G1 > G3, G2 > G3) on ultrasound exam; osteophytes at lateral tibial condyle (G2 > G1, G2 > G3), and medial femoral condyle (G1 > G2, G3 > G1) on computed tomography. Histologically, mean values of chondrocytes in the femur and tibia in G3 and G2 were statistically lower. Conclusions: The intra-articular injection of hyaluronic acid associated with triamcinolone accentuated degenerative joint disease by imaging and macroscopic evaluations, and by histological findings, this treatment and the ozone gas treatment showed similar effects and were inferior to the saline solution (0.9%).

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

Purpose: To evaluate the effect of a new cross-linked hyaluronan (NCHA) gel on healing of the staple line in an experimental sleeve gastrectomy.Methods: Eighteen rats were randomly divided into three groups. The control group (n = 6) received no medication. In the saline group (n = 6) and NCHA gel group (n = 6), saline and NCHA gel were respectively administered onto the staple line and intraperitoneally into the abdominal cavity after the standard stapling procedure.Results: The fibroblast activity and collagen deposition were significantly higher in the NCHA gel group than in the control group (p = 0.00, p = 0.017) and saline group (p = 0.004, p = 0.015). The tissue hydroxyproline protein level was significantly higher in the NCHA gel group than in the control group (p = 0.041). Adhesion formation was significantly lower in the NCHA gel group than in the control and saline groups (p = 0.015, p = 0.041).Conclusions: New cross-linked hyaluronan gel could be an effective approach to improve staple line wound healing and prevent potential leakage after sleeve gastrectomy. Moreover, NCHA gel helps to prevent adhesion formation without compromising healing of the staple line.(AU)

Hyaluronic acid and synovial fluid in preventing adhesion formation after tenorrhaphy: An in vivo study on rabbit Achilles tendon / Ácido hialurônico e líquido sinovial na prevenção da formação de aderências após tenorrafia: Um estudo in vivo sobre o tendão de Aquiles de coelho

Peritendinous adhesions are a significant problem in tendon surgery. One of the most preferred methods for preventing adhesion formation is anti-adhesive applications. This study aimed to investigate the efficacy of natural synovial fluid as an alternative viscoelastic agent for preventing adhesion in the healing period compared to hyaluronic acid. Thirty adult New Zealand rabbits were used in the study to form three experimental models. In all groups, a rupture was induced in the Achilles tendons. Following tenorrhaphy, hyaluronic acid was applied in one group and synovial fluid in the other group for anti-adhesive purposes. In the control group, no viscoelastic application was made. Bandage was applied to the operated extremities for three weeks post-operatively. At the end of five weeks, euthanasia was performed on the animals using pentobarbital sodium. Surgical sites in all groups were macroscopically examined for healing status as well as the presence and extent of adhesions. Biomechanical tests and histopathological examinations were then performed on the tendons in all groups. Findings established once again the positive contribution of hyaluronic acid to preventing adhesion formation as well as to healing and tensile strength in tendon surgery. Although, we found that it is possible to use synovial fluid, which is a natural source of hyaluronic acid, as a viscoelastic material, it is not superior to commercial hyaluronic acid preparation.(AU)

Asderências peritendinares são um problema significativo na cirurgia tendínea. Um dos métodos mais empregados para evitar a formação de adesão são as aplicações anti-adesivas. Este estudo tem como objetivo investigar a eficácia do líquido sinovial natural como um agente viscoelástico alternativo para prevenir a adesão no período de cicatrização comparado ao ácido hialurônico. Trinta coelhos adultos da Nova Zelândia foram utilizados no estudo para formar três modelos experimentais. Em todos os grupos, uma ruptura foi induzida nos tendões de Aquiles. Após tenorrafia, o ácido hialurônico foi aplicado em um grupo e o líquido sinovial no outro grupo para fins anti-adesivos. No grupo controle, não foi feita qualquer aplicação viscoelástica. A bandagem foi aplicada às extremidades operadas por três semanas pós-operatório. No final de cinco semanas, a eutanásia foi realizada nos animais utilizando pentobarbital sódico. Os locais cirúrgicos em todos os grupos foram examinados macroscopicamente quanto ao estado de cura, bem como a presença e extensão das aderências. Testes biomecânicos e exames histopatológicos foram realizados nos tendões em todos os grupos. Os achados estabeleceram mais uma vez a contribuição positiva do ácido hialurônico para prevenir a formação de aderências, bem como para a cicatrização e resistência à tração na cirurgia do tendão. Embora se tenha constatado que é possível utilizar fluido sinovial, que é uma fonte natural de ácido hialurónico, como material viscoelástico, não é superior à preparação de ácido hialurónico comercial.(AU)

Bullous keratopathy in a yellow-headed caracara (Milvago chimachima) treated with a modified third eyelid flap / Ceratopatia bolhosa em caracará (Milvago chimachima) tratado com flap de terceira pálpebra modificado

A Yellow-headed Caracara (Milvago chimachima) was submitted to the Ophthalmology Service of the Federal University of Bahia with a corneal abnormality. During ophthalmic evaluation the right cornea was stained positively with fluorescein; a blurred bullous lesion, with irregular surface, compatible with the diagnosis of bullous keratopathy was found. This is a rare condition in a bird which was treated successfully with a modified third eyelid flap associated with antibiotic and hyaluronic acid eye drops. The adopted therapeutic proved to be simple to implement and viable for repair of the bullous keratopathy in the Yellow-headed caracara.(AU)

Um gavião carrapateiro (Milvago chimachima) foi encaminhado ao Serviço de Oftalmologia Veterinária da Universidade Federal da Bahia com alteração em córnea. Durante a avaliação oftálmica a prova da fluoresceína foi positiva no olho direito e foi observado lesão bolhosa de aspecto irregular, compatível com o diagnóstico de ceratopatia bolhosa. Esta é uma alteração rara em aves e no presente caso foi tratada através de "flap" modificado de terceira pálpebra associado a utilização de colírio antibiótico e ácido hialurônico. A terapêutica adotada foi de fácil implementação e viável no reparo da ceratopatia bolhosa em gavião carrapateiro.(AU)

Bullous keratopathy in a yellow-headed caracara (Milvago chimachima) treated with a modified third eyelid flap / Ceratopatia bolhosa em caracará (Milvago chimachima) tratado com flap de terceira pálpebra modificado

A Yellow-headed Caracara (Milvago chimachima) was submitted to the Ophthalmology Service of the Federal University of Bahia with a corneal abnormality. During ophthalmic evaluation the right cornea was stained positively with fluorescein; a blurred bullous lesion, with irregular surface, compatible with the diagnosis of bullous keratopathy was found. This is a rare condition in a bird which was treated successfully with a modified third eyelid flap associated with antibiotic and hyaluronic acid eye drops. The adopted therapeutic proved to be simple to implement and viable for repair of the bullous keratopathy in the Yellow-headed caracara.(AU)

Um gavião carrapateiro (Milvago chimachima) foi encaminhado ao Serviço de Oftalmologia Veterinária da Universidade Federal da Bahia com alteração em córnea. Durante a avaliação oftálmica a prova da fluoresceína foi positiva no olho direito e foi observado lesão bolhosa de aspecto irregular, compatível com o diagnóstico de ceratopatia bolhosa. Esta é uma alteração rara em aves e no presente caso foi tratada através de flap modificado de terceira pálpebra associado a utilização de colírio antibiótico e ácido hialurônico. A terapêutica adotada foi de fácil implementação e viável no reparo da ceratopatia bolhosa em gavião carrapateiro.(AU)

Effects of sodium hyaluronate and carboxymethylcellulose membrane on collagen and fibroblast formation in bowel suture healing: experimental study in rats

OBJETIVO: Analisar os efeitos da membrana de hialuronato de sódio e carboximetilcelulose, na formação de colágeno e fibroblastos na colorrafia de ratos. MÉTODOS: Foram utilizados 48 ratos machos da linhagem Wistar, com peso entre 250 e 343g, distribuídos em dois grupos: grupo I colorrafia sem aplicação de membrana bioabsorvível e grupo II colorrafia com aplicação de membrana bioabsorvível; tendo sido divididos em subgrupos de 3, 14 e 30 dias de observação, com 8 animais em cada um dos subgrupos, todos submetidos à eutanásia após o período correspondente. RESULTADOS: Não foi observada morbimortalidade. A quantidade de colágeno no grupo I foi de 23,4 por cento, 72,1 por cento e 67,6 por cento; no grupo II 22,5 por cento, 52,5 por cento e 51,6 por cento, ambos os grupos nos 3, 14 e 30 dias, respectivamente, tendo na comparação intergrupos demonstrado que os subgrupos 14 (p=0,0013) e 30 (p=0,0587) obtiveram variância significativa, apresentando zona de colágeno maior nos animais nos quais não se usou a membrana; entretanto, em relação à quantidade de fibroblastos, o grupo I obteve 2 por cento, 13 por cento e 8 por cento; o grupo II obteve 2 por cento, 10 por cento e 8 por cento, ambos os grupos nos 3 (p=1,0), 14 (p=0,3184) e 30 (p=0,5995) dias, respectivamente, demonstrando não haver variância significativa. CONCLUSAO: A utilização da membrana bioabsorvível determinou diminuição da formação de colágeno e não alterou o número de fibroblastos na cicatrização de colorrafias, sem apresentar morbi-mortalidade, em ratos. (AU)