In the treatment of osteoarthritis, specialists actively use the American chondroprotective agent Synvisc and its analogues based on hyaluronic acid. This drug is a synovial fluid prosthesis and is intended for introduction into the cavity of the affected joints. It quickly relieves pain, returns flexibility and mobility to the affected joints, allowing a person to return to an active lifestyle.
The high efficiency of Synvisc is confirmed by many positive reviews about it. However, the drug is not without its drawbacks, the main of which is its price, which exceeds 23 thousand rubles for a package with three injections (almost 8 thousand rubles for 1 injection).
Inexpensive synovial fluid prostheses and their effect
The high cost of Synvisc makes patients look for its cheaper and equally effective counterparts. Synovial fluid prostheses that have proven themselves well among specialists and patients include:
- Ostenil (Germany);
- Fermatron (UK);
- Gialgan Phidia (Italy);
- Sinokorm (Germany).
Also, in domestic pharmacies, you can purchase the Russian substitute for Synvisk Giastat, which is much cheaper than its foreign counterparts.
The active component of all Synvisc analogues is the sodium salt of hyaluronic acid (sodium hyaluronate). When injected into the cavity of the joint capsule, this substance allows you to fully replace the synovial fluid - a natural lubricant that provides the joint with mobility and protects it from destruction.
With osteoarthritis synovial fluid loses its viscosity and elasticity, due to which its shock-absorbing properties are reduced. Bones and cartilage, which make up connective tissue, do not receive the necessary lubrication and, when moving, begin to rub against each other. This process leads to inflammation and pain in the joint and entails its gradual destruction.
The progression of osteoarthritis leads to a complete loss of joint mobility and disability. The only way out of this situation is endoprosthetics - an operation to establish an artificial joint.
To avoid the sad consequences of osteoarthritis, at its initial stages, doctors recommend that patients be treated with artificial synovial fluid substitutes, which are obtained with the help of hyaluronic acid. Such drugs are produced in the form of viscous solutions placed in 2 ml syringes. The content of the active ingredient in each syringe is 20 mg. Synvisc and other synovial fluid prostheses inhibit the progression of osteoarthritis, restore cartilage tissue, relieve pain and inflammation in the joint and restore mobility to it.
Drugs in this group are intended for intra-articular administration in medical institutions.
Injections must be performed by a qualified specialist.
Indications and contraindications for injections
Fermatron, Ostenil, Giastat and other structural analogs of Synvisc are used for:
- treatment of mild to moderate osteoarthritis;
- restoration of joints affected by trauma;
- relief of pain syndrome in articular pathologies;
- increasing the mobility of the knee, hip and other synovial joints.
Synovial fluid prostheses are applied topically and do not have a systemic effect on the body, so they can be used for different categories of patients. It is forbidden to carry out therapy with drugs of this group when:
- hypersensitivity to their components;
- infectious processes at the injection site;
- joint hemorrhage;
- synovite.
Method of application, adverse reactions and average cost
Giastat, Ostenil and other substitutes for Synvisc are intended exclusively for intra-articular administration. It is prohibited to use them in any other way.
The use of synovial fluid prostheses is always carried out in the same way. During the procedure, a health worker injects a syringe with a medicine into the cavity of the joint capsule of the joint affected by the pathology. Treatment of osteoarthritis involves setting 1 injection per week. The duration of therapy depends on the severity of the lesion of the articular joints and is determined by the doctor. To maintain joint mobility, the course of treatment with artificial synovial fluid substitutes must be repeated every six months.
Synvisc's analogs rarely cause adverse reactions in patients, however, the possibility of their occurrence cannot be completely ruled out. Undesirable symptoms that can occur in patients include:
- swelling, soreness and redness at the injection site;
- an increase in the volume of effusion in the cavity of the articular bag;
- systemic allergic manifestations (urticaria, skin rash, itching, anaphylactic shock).
Local adverse reactions develop within 24 hours after the injection and are not a reason for discontinuing therapy. To eliminate them, the patient should apply cold to the problem area, take medicine with anti-inflammatory and analgesic effects. With an increase in the amount of exudate inside the joint, the patient must refrain from subsequent injections until its volume decreases. If allergic reactions develop, the introduction of synovial fluid prostheses should be discontinued and measures should be taken to relieve the symptoms that have arisen.
Preparations with a similar Synvisc chemical composition and action can be bought in pharmacies with a medical prescription. The average price of one Ostenil injection reaches 3,600 rubles. The average cost of Sinokorm, Fermatron and Gialgan is 3900, 4300 and 4500 rubles, respectively. The Russian analogue of Synvisk Giastat costs about 2,430 rubles.
Synovial fluid has the properties of a shock absorber and a natural lubricant. These properties are provided to her by hyaluronic acid, which is able to change the molecular state under the action of stress. Synovial fluid protectors based on this acid compensate for the deficiency of natural joint lubrication. Their use enables millions of patients around the world to forget about pain and limited mobility in the joints.
Normal and abnormal synovial fluid
Hyaluronic acid is the main constituent of synovial fluid. This fluid is synthesized by the synovial membrane of the joints. It looks like a viscous thick gel, transparent and colorless. The substance is retained inside the joint due to intra-articular negative pressure.
Universal hyaluronic acid
It is present everywhere in the body - in the nervous, connective and epithelial tissue. If you examine the mucous membrane of any organ, then its presence will be found there. It is found in the cornea of the eye, vitreous humor, in all tendons and joints. The elasticity and youth of the skin is also her merit. One acid molecule can bind and hold 10,000 times its own weight of water.
An adult's body contains about 15 g of hyaluronic acid.
Hyaluronic acid is so necessary for all organs because it is capable of forming a gel. The acid consists of long disaccharide chains linked to each other by glucuronic acid and acetylglucosamine molecules. Under an electron microscope, it looks like a volumetric mesh. The biological properties of hyaluronic acid provide the cartilage with a smooth glide during movement.
Functions of the synovial fluid
Normally, large joints contain up to 4 ml of fluid, small ones - less. The function of the synovial fluid is to provide cushioning and nourishment of the joint. Cartilage has no blood supply, so everything you need is dissolved in the synovial fluid.
The constant movement of fluid, its movement and mixing ensure the supply of all nutrients to the cartilage.
Degenerative-dystrophic changes in the joint begin with a decrease in the molecular weight and concentration of hyaluronic acid. When these two indicators reach critically low values, slip conditions deteriorate and cartilage destruction begins.
The lumen of the joint space decreases. Bone epiphyses form bony outgrowths, or osteophytes. This leads to an even greater decrease in the ability to move. The less movement, the poorer the circulation of synovial fluid. The resulting vicious circle cannot end on its own.
The way out of the pathological situation is obvious: you need to return hyaluronic acid to the joint.
This is done using drugs of natural or synthetic origin.
Artificial synovial fluid is supplied in sterile syringes with a fine needle. The introduction of exogenous hyaluronic acid stimulates the start of its own synthesis. The nourished cartilage has favorable conditions for regeneration.
Artificial synovial fluid is produced either from natural raw materials or by using biotechnology. Chicken combs or vitreous bodies of cattle eyes are natural raw materials.
Artificial synovial fluid: drugs, prices, application
They are subdivided according to the molecular weight of hyaluronic acid, which is measured in daltons.
There are drugs of low and high molecular weight... A mass of 500,000-730,000 daltons is considered low, above 1,000,000 - high.
Low molecular weight drugs:
- Gialgan Phidia, Italy, 4630 rubles;
- Suplazin, Bionikhe Pharma, 3015 rubles;
- Intragel, Italy, 4500 rubles.
Preparations with a mass of 1,000,000 daltons:
- Dyuralan, solution for small joints, Bioventus, 15 400 rubles;
- Dyuralan, Implant 3 ml, RUB 21,470;
- Viscosil 10 ml, Hemedika, 5,000 rubles;
- Ostenil mini 1 ml, Hemedica, 2 160 rubles;
- Fermatron plus, Russia, 5000 rubles
Drugs with a molecular weight of 2 to 3 million daltons:
- Giastat 2 ml, Russia, 2,430 rubles;
- Hialux 2 ml, South Korea, 4 100 rubles;
- Sinokrom forte 2 ml, Croma Pharma GMbH, 14,050 rubles;
- Synvisc 6 ml, USA, 19,500 rubles;
- Visco plus 2 ml, Biomedical, Germany, 6 800 rubles.
Medicines with a maximum molecular weight of 6-7,000,000 daltons:
- Synvisc one 6 ml, USA, 23,700 rubles;
- Synvisc Gilan G-F 20, 23 600 rubles.
The choice of the drug is determined by the attending physician, depending on the specific clinical picture, length of illness, degree of deterioration of the joint, age and occupation of the patient. The timing and frequency of administration of the drug into the joint are determined individually. Some drugs need to be administered 3-5 times a month, others once a year.
High-weight formulations have multiple intermolecular cross-links. This allows you to enter them once a year. They dissolve for a long time, providing anesthetic, wound healing, anti-inflammatory effect.
Introduction rules
It can be administered only into the joint cavity. The introduction is preceded by a thorough examination using instrumental diagnostic methods. The presence of an effusion is not a contraindication; it is previously removed.
Before the introduction of the drug in the syringe, warm to room temperature. There may be slight pain and swelling at the injection site. It is necessary to take care of the joint for a week, you can apply ice, sometimes, as prescribed by the doctor, a light plaster splint is applied or an orthosis is put on for several days.
If on the first day after the injection the temperature rises and pains bother you, you need to urgently consult a doctor.
Relief should come in a week. Sometimes it comes earlier, but a week is considered a target date. There are no rejection reactions. Sometimes there may be an allergic reaction to a preparation from the combs of chickens.
For which joints are the drugs intended?
It is impossible to say that this or that drug is "better", each has its own purpose.
Hyalgan Phidia is an aqueous solution of hyaluronic acid, the course requires 5 injections, the advantage is rapid distribution in the capsule, some of the drug is absorbed into the adjacent muscles and ligaments. Sometimes it gives a local reaction in the form of edema and redness, it goes away within a day. Designed for large joints.
Ostenil Mini contains native hyaluronate and mannitol, which protects against free radicals. Thanks to this, the action is prolonged. The course requires 3-5 injections. Immediately after the injection, there is a feeling of heat, it is advisable to use ice. Suitable for large joints.
Dyuralan is injected once a year, it is used for all joints. 3 ml is injected into large joints, 1 ml into small joints with an interval of 6 months. Optimally administered during remission.
Synvisc is a hydrated gel. Do not administer for effusion.
Fermatron prevents joint destruction, the action lasts up to 6 months. It is introduced for moderate osteoarthritis. Do not administer to pregnant women and children under 18 years of age.
Artificial synovial fluid postpones the need for surgical treatment or endoprosthetics.
Hyaluronic acid (HA) is an irreplaceable component of the joint fluid, which is responsible for its nutritional value, viscosity and elasticity. Perhaps everyone knows what value synovial fluid is for joints. Of course, first of all, it is the main food for the hyaline cartilage, which lines the surfaces of the bones interacting with each other. At the same time, the synovium that fills the articular cavity acts as a lubricating and moisturizing material for working bone surfaces, preventing their excessive friction, contributing to smooth sliding and good shock absorption.
In arthritis and arthrosis, there is an excessively low concentration and distorted structure of HA molecules in the fluid content of the problem joint, which causes its viscoelastic properties to suffer. It is easy to understand that pathological dysfunction of the joint against the background of degenerative-dystrophic disease, complicated in addition by an acute violation of the consistency of synovia (the level of viscosity is reduced), is critically aggravated every day, which leads to accelerated destruction of cartilage. To stop the destructive pathogenesis, doctors often recommend a synovial fluid prosthesis to their patients. 
General information about drugs
A prosthesis is understood as a liquid preparation, the biologically active substance of which is hyaluronic acid. It is widely used in various fields of medicine, including orthopedics. A sterile solution of the corresponding component is injected into the joint capsule (intra-articular), due to which the rheological properties of the natural fluid are actively restored and the physiological criteria of the structural parts of the joint affected by arthrosis are improved. The therapeutic effect is achieved through:
- normalization of the viscosity and elasticity of natural lubricants;
- restoration of tissue metabolism and hydrodynamics in the joint;
- improving the nutrition of the tissues of the bone-cartilaginous formations;
- reducing mechanical stress on the joint;
- maintenance and long-term protection of cartilage.
The source for obtaining a unique substance, as a rule, is animals: HA is synthesized from cock's combs, the vitreous substance of the eyes of cattle, the umbilical cord, the trachea of mammals. That is, the synovial fluid prosthesis is a product of natural origin. The produced bio-compositions have good indicators of compatibility with the human body, but sometimes they can cause allergic reactions and some other complications, which we will inform about a little later. The product is available in disposable syringes for single use.
The effect of intra-articular injection of a synovial fluid prosthesis is temporary, but rather long-lasting. The duration of action after completing one course is on average from 6 to 12 months, after which it is necessary to re-implant. To fully complete 1 course, you will need to make 3-5 injections of sodium hyaluronate with a specific sequence. Duration therapeutic effect and the specifics of the course depend on the indicators of the molecular weight of the ingredient used.
Direct saturation of the articulation with HA helps to significantly reduce pain and increase the range of motion in the problem area. Such therapy brings the greatest benefit with the initial signs of degenerative-dystrophic changes, since in the early stages almost complete restoration of cartilage tissue can be achieved. In moderate and severe pathologies, the prosthesis replenishes the volume and viscosity of the synovial fluid, which softens the symptoms and prevents the progression of destruction. Therefore, sometimes its use is advisable, for example, if it is necessary to postpone total joint replacement surgery.
Attention! Substituting synovial fluid, preparations containing sodium hyaluronate, produce a positive symptomatic effect. It has been proven that they reduce the aggression of symptoms, reducing pain and improving the functional ability of the affected locomotor part, but do not restore damaged structures and deformities in advanced osteoarthritis and rheumatoid arthritis... Therefore, experts do not consider the intra-articular introduction of synovial fluid prostheses as an alternative to the indicated surgical intervention.
Indications and contraindications
Synovial fluid prostheses in injectable preparations can be offered to patients who experience painful discomfort and stiffness against the background of degenerative and post-traumatic diseases. As a rule, such a technique is used when traditional conservative methods do not bring relief in deforming arthrosis. It is also used for prophylactic purposes to suppress the progression of destructive processes in the articular cartilage. Such injections will be beneficial for people who, due to the age factor, have natural lubrication, or synovia, produced in unacceptably low quantities.
According to observations, at present, synovial fluid prostheses are more in demand. knee joint, and this is not surprising at all. Let's explain why. Per last years there was a sharp increase in injuries and a jump in the incidence of gonarthrosis of the bone joint of the knee. If earlier the hip section of the musculoskeletal system occupied a dominant position in terms of the frequency of lesions, today everything has changed radically. Unfortunately, these are the statistics, and it clearly shows a steady increase in the percentage of patients with serious injuries of the knee articulation.
As for contraindications, we first note that it is useless to treat the knee joint and other segments with synovial fluid prostheses in the presence of local inflammation. The thing is that the acid that is part of the liquid implant is destroyed with pronounced inflammatory foci in the place of the proposed implantation zone, and there will be zero sense from it. Therefore, first, the joint ailment, accompanied by inflammation, is brought into a state of remission, and only then hyaluronotherapy is used. This method is contraindicated for pregnant women and women during lactation. There is no official confirmation that it is safe for the fetus and newborn baby.
Important! It is undesirable to inject hyaluronate for any autoimmune pathologies, since it is not known how an organism with an impaired immunological system will react and what health consequences such treatment will result in. In case of intolerance to biosynthesized or animal origin synovial fluid, it is strictly forbidden to contact the drugs! Cases of anaphylactic shock have been reported. Before using intra-articular prostheses, everyone needs to undergo a tolerance test for a synovial fluid analogue.
Possible side effects
This innovative invention, despite its minimally invasiveness and high degree of safety, is not devoid of side effects... Adverse reactions of analog synovial fluid prostheses, often prescribed for arthrosis of the knee joint, rarely cause. But they cannot be called completely harmless, if only because the main category of products sold by pharmaceutical companies has not undergone clinical trials.
Based on the minimal experimental clinical database and personal experience of patients who encountered problems after intra-articular use of hyaluronic acid, conclusions were drawn about the possible likelihood of the following consequences:
- feeling of heat, itching at the injection site;
- burning and irritation of the skin;
- nettle fever;
- swelling and redness of the soft supra-articular tissues;
- painful signs in nearby muscles;
- local infectious and inflammatory reaction;
- numbness, tingling, a feeling of "creeping" in the limb;
- anaphylactic shock.
As you can see, with all their positive qualities, innovative drugs produced as "synovial fluid" can harm health. Efficiency is also not 100% guaranteed. Do not forget that each organism has its own individual characteristics, so there is no absolute guarantee of a successful outcome. In addition, it is unlikely that such therapeutic measures will give results in case of patho-functional changes in the articular elements at the terminal stages. Hence the conclusion: far from expensive treatment may well turn out to be ineffective.
Liquid implants: price and country of origin
Before we list the most commonly used HA agents intended for intra-articular administration, let us pay attention to an important point: all therapeutic manipulations should be carried out by a highly competent doctor in the rheumatology department, in compliance with all aseptic standards. In addition, in technical terms, this procedure is completely different from intramuscular injections, so only a professional medical professional can ensure the correct, non-traumatic and safe entry of the needle into the joint capsule. The session is carried out under ultrasound control.
|
Nameproduct |
1 doseHA / mg | Production |
| Adant | 25 | Japan |
| Fermatron | 20 | Great Britain |
| Gialgan Phidia | 20 | India |
| Sinocorm | 20 | Austria |
| Go-on | 25 | Ireland |
| Ostenil | 20 | Germany |
| Giruan Plus | 10 | Korea |
| Synvisc (3 syringes) | 16 | USA |
| Hyalurom CS | 60 | Romania |
| Visko Plus | 20 | Sweden |
| RusVisk | 16 | Russia |
| Giastat | 20 | Russia |