Avances en la terapia basada en ácido hialurónico para pacientes con osteoartritis / Advances in hyaluronic acid-based therapy for patients with osteoarthritis

La osteoartritis se considera una de las principales causas de discapacidad funcional. Es una enfermedad crónica y degenerativa que presenta un pico de incidencia en personas mayores de 60 años. El propósito de este trabajo es mostrar los avances en la terapia de pacientes con osteoartritis basada en ácido hialurónico para pacientes con osteoartritis. El ácido hialurónico posee funciones en la articulación que abarcan la lubricación, servir como relleno de espacio para permitir que la articulación permanezca abierta y la regulación de actividades celulares como la unión de proteínas. Cada vez hay más pruebas de que, dentro del espectro de derivados disponibles del ácido hialurónico, la eficacia de los productos de ácido hialurónico con un alto peso molecular es superior a la eficacia de los derivados con un bajo peso molecular. Aprovechando el control espacial de ciertos tipos de hidrogeles de ácido hialurónico, se están desarrollando sistemas de microdispositivos que pueden encapsular células madre embrionarias viables y luego recuperarlas mediante interrupción mecánica. Estas células madre podrían usarse para el tratamiento de enfermedades como la osteoartritis. El ácido hialurónico es un fármaco que puede para ayudar a reducir los efectos secundarios de la osteoartritis(AU)

Osteoarthritis is considered one of the main causes of functional disability. Osteoarthritis conceptualized as a chronic and degenerative disease that presents a peak incidence in people older than 60 years. To show advances in hyaluronic acid-based therapy for patients with osteoarthritis. Hyaluronic acid has functions in the joint that include lubrication, which serves as a filling of space to allow the joint to remain open and the regulation of cellular activities such as protein binding. Hyaluronic acid is a potential drug to help reduce the side effects of osteoarthritis(AU)

Impact of intravesical hyaluronic acid treatment on bladder inflammation in interstitial cystitis rat model

ABSTRACT Objective: To evaluate the effect of intravesical hyaluronic acid (HA) treatment on inflammatory cells and the severity of inflammation in an interstitial cystitis rat model created with hydrogen chloride (HCL) via immunohistochemical studies and myeloperoxidase activity for the first time in the literature. Materials and Methods: A total of 30 adult female white Rattus Norvegicus rats were divided into 3 groups as the HCL group, hyaluronic acid treatment (HCL-HA) group and control group. Chemical cystitis was created by administering HCL(400 microL,10 mM) except control group. A single dose of intravesical HA(0.5 mL,0.8 mg/mL) was administered to the treatment group. The bladder tissues of all subjects were immunohistochemically stained. The cell surface markers were used to evaluate inflammatory cell infiltration. Mast cell activation and IL-6 was evaluated to assess the inflammation and severity of inflammation, respectively. Myeloperoxidase activity was measured as it shows neutrophil density. Statistical significance was accepted as P<0.05. Results: It was observed that there was rich monocyte, T lymphocyte, B lymphocyte, and Natural Killer cells infiltration and high IL-6 levels in the bladder tissue after the intravesical hydrogen chloride instillation, especially in the stroma layer(p<0.005). In the HCL-HA group, severity of inflammation had statistically significantly regressed to the levels of the control group(p<0.005). An increase was observed in the bladder myeloperoxidase activity of the HCL group compared to the other two groups(p<0.05). Conclusions: Single dose intravesical hyluronic acid instillation reduces inflammatory cell infiltration and the severity of bladder inflammation in the rat model of bladder pain syndrome/interstitial cystitis.

Viscosuplementación con ácido hialurónico en gonartrosis moderada a severa: seguimiento clínico a 3 años / Intra-articular hyaluronic acid theray in moderate to severe knee osteoarthritis. a 3-year follow-up

Introducción: La utilidad y eficacia de la viscosuplementación con Ácido Hialurónico (AH) en el tratamiento de la gonartrosis es debatida. La evidencia regional sobre esta terapia es limitada. Objetivo: Describir una cohorte de pacientes con gonartrosis moderada a severa, viscosuplementados con AH, objetivando su sobrevida en términos de artroplastía total de rodilla (ATR). Metodología: Estudio retrospectivo. Criterios de inclusión: gonartrosis tricompartimental moderada a severa sintomática, 60 años o más, al menos 1 infiltración con AH de alto peso molecular y seguimiento mínimo de 2 años. Se analizaron datos demográficos, clínicos, indicación de ATR previo a la infiltración. Se utilizaron las pruebas estadísticas de Kaplan-Meier y Test Exacto de Fisher (significancia de p<0,05). Resultados: Setenta y tres pacientes (88 rodillas), edad media de 71 años (60-91) fueron reclutados. Seguimiento promedio de 3 ± 0,60 años (2-3,60). Rodillas infiltradas libre de prótesis: 95,45%. De estas, 33,33% siguen en consulta por la misma rodilla y 78,6% se han vuelto a infiltrar. Tiempo promedio a ATR en las 4 rodillas operadas: 1,03 ± 0,75 años...

Introduction: The clinical importance of intra-articular hyaluronic acid (IAHA) therapy in knee osteoarthritis (KOA) has been challenged. There is limited evidence in our region. Objective: Describe the experience of a cohort of patients with moderate and severe KOA, treated with IAHA injections, evaluating its survivorship in terms of total knee arthroplasty (TKA) as end point result. Methodology: Retrospective study. Inclusion criteria: moderate and severe tricompartmental KOA, age of 60 years or more, at least 1 IAHA injection and a minimum follow-up of 2 years. Demographic and clinical data and TKA indication before the first IAHA injection were considered for analysis. Statistics included the Kaplan-Meier and Fisher exact test (significance of p<0.05). Results: Seventy three patients (88 knees), mean age: 71 years (60-91), were followed up for 3 ± 0.60 years (2-3.60). Injected knees without TKR: 95.45%. From these, 33.33% continue in medical attention for knee pain and 78.6% have received another injection. Average time to TKR in the four operated knees: 1.03 ± 0.75 years...

Endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer and dextranomer/hyaluronic acid in adults

Purpose Aim of this study is to examine the effectiveness of dextranomer/hyaluronic acid copolymer and polyacrylate polyalcohol copolymer in endoscopic treatment of vesicoureteral reflux disease in adult patients with and without chronic renal failure. Materials and Methods Thirty two patients (12 female, 20 male) with a total of 50 renal units were treated for vesicoureteral reflux. There were 26 (81%) chronic renal failure patients. The success of treatment was evaluated by voiding cystouretrography at 3rd and 12th months after subureteric injection. The persistence of reflux was considered as failure. Patients were divided into two groups according to injected material. Age, sex, grade of reflux and treatment results were recorded and evaluated. Results Reflux was scored as grade 1 in seven (14%), grade 2 in 16 (32%), grade 3 in 21 (42%) and grade 4 in six (12%) renal units. There was not patient with grade 5 reflux. Fourteen renal units (28%) were treated with dextranomer/hyaluronic acid copolymer (group 1) and 36 renal units (72%) were treated with polyacrylate polyalcohol copolymer (group 2). The overall treatment success was achieved at 40 renal units (80%). The treatment was successful at 11 renal units (79%) in group 1 and 29 renal units (81%) in group 2 (p = 0.71). There was not statistically significant difference between two groups with patients with chronic renal failure in terms of treatment success (p = 1.00). Conclusions The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure. .

Viscosuplementación para el tratamiento de la artrosis de rodilla / Viscosupplementation in knee osteoarthritis

Introducción: Presentar los resultados a corto plazo de la inyección de ácido hialurónico (AH) en 20 pacientes seleccionados de forma retrospectiva y realizar una revisión de la literatura. Materiales y Métodos: Se tomó retrospectivamente una serie de 20 pacientes que fueron sometidos a viscosuplementación de rodilla entre agosto y noviembre de 2012. Diecisiete mujeres y 3 hombres. Edad promedio de 75 años. Evaluamos a los pacientes previa infiltración con AH y 6 meses posteriores a la misma con el score de' Lequesne y la escala numérica para el dolor. Resultados: La escala numérica del dolor (EN) fue 7 ~ en promedio pre infiltración y 5,6 post infiltración. El score de Lequesne fue en promedio 12 pre infiltración y 9 post infiltración. Cinco pacientes empeoraron su sintomatología (3 de estos pacientes requirieron reemplazo total de rodilla). Conclusión: La viscosuplementación con ácido hialurónico mostró una mejoría en la sintomatología de nuestra serie de pacientes con artrosis de rodilla a corto plazo. Siendo un procedimiento con bajo riesgo. Estos resultados, junto con la revisión literaria, nos impulsan a realizar un estudio de mayor rigor metodológico. Nivel de Evidencia: IV. Estudio de serie de casos...

Diclofenac in hyaluronic acid gel: an alternative treatment for actinic cheilitis

OBJECTIVE: Actinic cheilitis (AC) is a precancerous lesion of the lip vermillion caused by prolonged exposure to ultraviolet light. The aim of this study was to evaluate the effect of 3 percent diclofenac in 2.5 percent hyaluronic acid gel in the treatment of AC. METHODS: Thirty-four patients with chronic AC were treated twice a day with topical diclofenac during a period of 30 to 180 days. The individuals were followed up every 15 days by means of clinical examination and digital photographic documentation. RESULTS: Of the 27 patients that completed the study, 12 (44 percent) showed complete remission of the whitish plaques and exfoliative areas, and 15 (56 percent) had partial remission of the clinical picture of cheilitis. The latter group was submitted to excision of the leukoplakic areas which diagnosis varied from mild to moderate epithelial dysplasia. CONCLUSIONS: The results suggest a promising role for diclofenac in hyaluronic acid gel in the treatment of AC. This treatment has the advantages of not being invasive and showing few side effects.

Viscosuplementaçäo de hialuronato de sódio em pacientes com osteoartrose em quadril / Viscosupplementation of the natriun hyaluronate in the patients with osteoarthritis in the hip

A osteoartrose é considerada uma das principais causas dei ncapacidades funcionais para pacientes na faixa etária após cinquenta anos, em decorrência de quadros inflamatórios gerados por áreas de compressäo articulares, principalmente em articulaçöes de descarga de peso.Selecionamos dezesseis pacientes com quadro de dor articular crônica em quadris, na faixa etária compreedida entre cinquenta a setenta anos, todos do sexo feminino, os quais foram submetidos a infiltraçäo intraarticular, em quadris, de hialuronato de sódio, sendo acompanhados por um período de dez meses pós infiltraçäo, no Serviço de Reabilitaçäo da Santa Casa de Säo Paulo. Após o procedimento de infiltraçäo em quadris, os pacientes foram colocados em programas de reabilitaçäo, em fisioterapia e terapia ocupacional, visando melhora do quadro álgico, das amplitudes de movimento, padräo postural, assim como melhora para as AVDs, e neste estudo, conseguimos melhor funcional nas AVDs, assim como quadro álgico. Concluímos,pelos bons resultados apresentados, que a osteoartrose mesmo sendo uma doença degenerativa, pode-se alcançar bons resultados funcionais nos pacientes quando o hialuronato de sódio é incluído em um programa de reabilitaçäo