An Oral Preparation Containing Hylauronic Acid (Oralvisc) Can Reduce Osteoarthritis Knee Pain and Serum and Synovial Fluid Bradykinin.

An Oral Preparation Containing Hylauronic Acid (Oralvisc) Can Reduce Osteoarthritis Knee Pain and Serum and Synovial Fluid Bradykinin.

Article specifications

This prospective randomized double-blind placebo controlled study was published in 2013 in Osteoarthritis and Cartilage journal (IF 2014:4.165) by American and Spanish orthopedics. The purpose of this study was to compare placebo to oral HA. The three hypotheses were: (1.) supplementation with oral HA would significantly improve knee pain and function over a 3 months period, (2.) clinical response to oral HA would be related to metabolic syndrome, and (3.) clinical response to oral HA would be related changes in serum and synovial fluid levels of bradykinin. Subjects were between 50-75 years old, had OA based on imaging, a visual analog score (VAS) >50 mm, and an effusion where a joint aspiration or intra-articular injection would be clinically indicated. 576 patients were screened and 51 recruited and randomized. All patients took their preparation daily for 3 months. They were evaluated monthly for VAS and WOMAC pain and joint function. Serum and synovial fluid was collected at the beginning and at 12 weeks. Bradykinin was measured by an ELISA. Patients were assessed each month for any unused capsules receiving capsules for the next four weeks.

Results

The reduction in VAS score, WOMAC pain and WOMAC function was significant for those taking HA but not for those taking placebo, showing significant differences on the time evolution of the studied parameters. The final serum bradykinin levels were significantly lower for oral HA with synovial fluid decrease significantly more for oral HA. Change in bradykinin was inversely related to MS.

Intra-articular HA may improve the symptoms of OA by mitigating the activities of proinflammatory mediators and pain producing neuropeptides released by activated synovial cells. Bradykinins participate in innate immunity, inflammation, and pain. Chondrocyte receptors increase interleukin on stimulation. The relationship of reduction of bradykinin and decreased pain in the oral HA group is consistent with the role of bradykinin in joint pain. Further research will be required to determine how this very promising agent leads to changes in bradykinin levels.

Tags: USA Spain osteoarthritis and cartilage Clinical trial 2013

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