Reumatología Clínica Reumatología Clínica
Reumatol Clin 2006;2:36-43 - Vol. 2 Núm.1 DOI: 10.1016/S1699-258X(06)73018-2
Revisiones
El ácido hialurónico en el tratamiento de la artrosis
Hyaluronic acid in the treatment of osteoarthritis
J. Monforta, P. Benitob,??,
a Osteoarthritis Research Unit. Centre de Recherche du CHUM. Centre Hospitalier de l’Université de Montréal-Hôpital Notre-Dame. Montreal. Quebec. Canadá
b Servicio Reumatología del IMAS. Hospital del Mar. Barcelona. España
Recibido 06 junio 2005, Aceptado 13 junio 2005
Resumen

El ácido hialurónico (AH) es un glucosaminoglucano compuesto de disacáridos de ácido glucurónico y Nacetilglucosamina, presente a altas concentraciones en el tejido conectivo de los mamíferos. En la artrosis (AO), la longitud y la concentración del AH se hallan disminuidas. A principios de los años setenta empezaron a utilizarse las inyecciones intraarticulares de AH con el fin de restaurar las propiedades reológicas del líquido sinovial. Sin embargo, a pesar de su amplia utilización en clínica, numerosas cuestiones sobre su mecanismo de acción y sus propiedades como fármaco continúan sin esclarecerse. La revisión de la literatura médica realizada en este artículo pone de manifiesto las propiedades del AH como modificador lento de los síntomas en la atrosis (SYSADOA) y, a su vez, evidencia la no existencia de suficientes estudios que permitan calificarlo como fármaco modificador de la estructura (DMOAD). El AH posee una amplia variedad de mecanismos de acción que van desde su interacción con los mecanismos nociceptivos del dolor hasta su capacidad para modular la homeostasis de la matriz extracelular.

A pesar de que el AH de bajo peso molecular presenta un mejor perfil de seguridad y se muestra ligeramente superior en los estudios in vitro y de experimentación animal, los ensayos clínicos que valoran la eficacia del fármaco no aportan la suficiente evidencia para aconsejar el uso del AH de un determinado peso molecular en detrimento del resto.

Resumen

Hyaluronic acid is a glycosaminoglycan composed of disaccharides of glucuronic acid and N-acetylglucosamine. It is present at high concentrations in mammalian connective tissues. Since the length and concentration of HA decrease in osteoarthritis (AO), intraarticular HA injections began to be used in the early 1970s to restore the rheological properties of synovial fluid. Despite the widespread use of HA, many questions about its mechanism of action and properties remain to be clarified. A literature review presented in this article reveals that HA is a symptomatic slow-acting drug in osteoarthritis (SYSADOA) and that there is insufficient evidence to qualify it as a disease modifying osteoarthritis drug (DMOAD).

HA is involved in many mechanisms of action ranging from interaction with mechanosensitive articular pain receptors to its ability to modulate extracellular matrix homeostasis. Although low molecular weight HA has a better safety profile and is slightly superior in in vitro studies and animal experimentation, clinical trials evaluating the efficacy of the drug show insufficient evidence to enable one type of HA to be recommended in preference to any other.

Palabras clave
Hialurónico Hialuronato, Viscosuplementación, Ácido hialurónico, Artrosis
Key words
Hyaluronan, Hyaluronate, Viscosupplementation, Hhyaluronic acid, Osteoarthritis
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Reumatol Clin 2006;2:36-43 - Vol. 2 Núm.1 DOI: 10.1016/S1699-258X(06)73018-2