ABSTRACT
Intra-articular administration of hyaluronic acid (HA) is a widely used therapy for the treatment of symptomatic osteoarthritis (OA). Analgesics remain the first-line therapy in symptomatic OA in international guidelines. However, Visco-supplementation has shown a better pain effect than that of paracetamol and comparable to that of non-steroidal anti-inflammatory drugs with better risk–benefit ratio, therefore offering a potential alternative to conventional first-line therapy especially in the elderly with multiple co-morbodities and medications. Hyaluronic acid, also called hyaluronan, is a naturally occurring polymer with a simple chemical structure that has been identified and described as a major component of all three structures of the joint functional unit: synovium, synovial fluid and extracellular cartilage matrix. The non-clinical basic science literature provides evidence for numerous mechanisms in which HA acts on joint structures and function. Although HA is used for knee osteoarthritis, it has been used in the shoulder, hip and ankle OA with studies in the literature describing effectiveness in those joints.
