Buy Duralan viscoelastic implant. syringe 60mg/3ml in pharmacies

Stoparthrosis

» Treatment methods

» Drug Duralan

Orthopedist

Litvinenko A. S.

December 7, 2021 4982

Many people seek help only when piercing joint pain makes it impossible for them to move normally and lead an active lifestyle. One of the promising methods of treating osteoarthritis and arthritis, used in the Stoparthrosis clinic, is the intra-articular injection of the American chondroprotector - Duralan. Doctors note that the maximum effect of treatment with Duralan is achieved in the early stages of the disease. Therefore, experts recommend that at the first suspicion and symptoms of arthrosis of the hip, knee, shoulder and other synovial joints, undergo an examination and consultation with a doctor. Many people are interested in the answer to the question of where to buy Duralan in Moscow. Experts note its high availability in domestic pharmacies for over-the-counter purchase.

IT IS PROFITABLE TO TREAT WITH US!

• 20 years of experience
  in treating diseases of the joints and spine
• All in 1 day

  — diagnostics, consultation and we will begin treatment

• Doctor's appointment 0 RUB! until October 10!

  when treated with us - PROMOTION

Sign up for treatment
Sign up for treatment

Old price:

duration

— a course of treatment

Duralan: medicine or placebo

Duralan, whose price is reasonable, belongs to drugs that prosthetic synovial fluid. It contains biosynthesized sodium hyaluronate, which is the main component of intra-articular fluid. It is this substance that ensures normal viscosity of the lubricant and protects cartilage from destruction. Synthesized hyaluronic acid Duralan undergoes additional purification and is well tolerated by patients.

Duralan is sold in pharmacies in sterile syringes, ready for use. In the package, the dose of the medicine is 3 ml and 60 mg of the active ingredient. One syringe is intended for a single injection into the cavity of one affected joint.

Doctors recommend taking one course of treatment every 6-12 months with 1 injection of medication.

Administration of Duralan, the price of which is affordable in Moscow, should be carried out by experienced specialists in a medical clinic, if necessary, with ultrasound guidance. Contraindications to the procedure are: childhood, pregnancy and lactation, hypersensitivity, dermatological diseases in the acute stage.

Sign up for treatment

Duralan (Dyurolan) syringe 60 mg/3 ml - Instructions

Compound

1 ml of product contains: sodium hyaluronate 20.0 mg, sodium chloride 9 mg, disodium hydrogen phosphate 0.14 mg, sodium dihydrogen phosphate monohydrate 0.03 mg, water for injection qs 1 ml.

Release form

The drug is produced as an injection solution in a pre-filled syringe. There is 1 injection per package.

Pharmacological properties

The drug is injected into joints affected by osteoarthritis to reduce pain and restore the lubricating and shock-absorbing layer, improving the quality of life. Hyaluronic acid has viscoelastic properties, which allows it to soften and soften the inner surface of joint structures and also helps maintain the correct proportion of fluid in the body. When administered intra-articularly, it improves the condition of the joint, relieves pain and increases its mobility.

Pharmacokinetics

Data not provided.

Indications for use

Symptomatic treatment in combination with the treatment of mild to moderate pain associated with osteoarthritis of the ankles, elbows, wrists and interphalangeal fingers and toes.

The drug is also indicated for the treatment of pain caused by arthroscopic procedures for osteoarthritis for three months after the procedure.

Contraindications

The drug should not be injected if the joint is infected or severely inflamed. The medication should also not be injected if there is active disease or skin infection at or near the injection site.

Duralan should not be used in patients with hypersensitivity to the composition.

If the patient has been diagnosed with an allergy or hypersensitivity to a contrast agent, the drug should not be administered under fluoroscopy if the use of such a contrast agent is necessary.

The drug should be used with caution in patients with existing chondrocalcinosis, as the injection can lead to an acute attack of the disease.

Side effects

As a rule, the drug is well tolerated and does not cause negative reactions.

Drug interactions

Duralan does not affect the action of other medications, so it can be taken together with other medications, after consultation with your doctor.

Application and dosage

The drug is in disposable packaging - one injection. It can only be administered once during the entire treatment cycle.

The recommended dose for knee, hip and shoulder joints is 3 ml.

For medium-sized joints (eg elbow, ankle) the recommended dose is 1-2 ml, and for small joints (eg big toe) about 1 ml.

Overdose

No data received.

special instructions

The drug cannot be administered intravenously or extra-articularly, into the synovium and joint capsule.

Duralan should be used with extreme caution in patients with stagnation of the pedicle of venous or lymphatic origin.

A separate syringe should be used for each joint treated.

Due to the invasive nature of intra-articular injection, there is a small risk of infection.

Use during pregnancy and breastfeeding

The drug has not been tested in pregnant or lactating women.

Impact on the ability to drive vehicles and operate machinery

No special precautions are required.

Terms of sale

As prescribed by a doctor.

Storage conditions

In a temperature range of 15 to 25 degrees Celsius, in a place away from children.

Duralan: patient reviews

Clients of the Stoparthrosis medical clinic have been observing the therapeutic effect of intra-articular injections of Duralan for six months.

They note that immediately after administration, the pain gradually subsides, and the need for taking anti-inflammatory and analgesic medications decreases. Over time, after administering the medicine to the knee joint, lameness disappears, and patients return to normal life. According to patient reviews, Duralan not only relieves pain, but also heals and for many is a real salvation from surgery and joint replacement.

Sign up for treatment with us by phone +7 495 134 03 41

or leave a request on the website.

Author of the article:

Litvinenko Andrey Sergeevich

Orthopedist

Make an appointment

Recent publications by the author:

• Ostenil injections
• Chondroprotectors for joints
• Chondroprotector for osteoarthritis
• Fermatron analogues

Osteoarthritis of the knee joint

Osteoarthritis (OA) is the most common disease of synovial joints, caused by the action of biological and mechanical factors that upset the balance between the processes of degradation and synthesis of chodrocytes, extracellular matrix of articular cartilage and subchondral bone, which are the main cause of chronic pain syndrome, causing gait disturbances, disability and significant deterioration in the quality of life of patients. Osteoarthritis occurs predominantly in 65-85% of people in the older age group (over 65-65 years old). The general trend towards an increase in the proportion of older people in the population is accompanied by an increase in the prevalence of osteoarthritis, significant financial costs for its treatment and disability of patients, which determines the high socio-economic significance of this problem.

There are predispositions to the development of OA, which can be divided into modifiable and non-modifiable. Modifiable factors include: obesity, injury, disruption of the biomechanics of movements in a particular joint, habitual overload of the joints. Non-modifiable risk factors for development include: age, gender, heredity, race, congenital diseases, endocrine and metabolic disorders.

There are two forms of OA: idiopathic (when the exact cause of the disease is unknown) and secondary (when the cause is known).

The development of osteoarthritis always begins with pathological microscopic changes in cartilage tissues, which are not clinically manifested, while the period of subclinical manifestations can vary in duration - from 2 to 6 years. Cartilage tissue is damaged under the influence of mechanical or metabolic changes, it becomes thinner, with the formation of ulcers. Subsequently, the meniscus, ligamentous apparatus, periarticular bursa and proliferation of adjacent bone structures occur in the process. The narrowing of the joint space is accompanied by a decrease in the production of synovial fluid, friction of the articular surfaces and additional secondary destruction of cartilage tissue.

Inflammatory markers (cytokines, tumor necrosis factor) contribute to the appearance of pain. At the early stage of OA, interleukins 1.6 (IL-1.6), tumor necrosis factor-a (TNF-a) increase the synthesis of serum CRP and amyloid A. In the later stages of OA, the presence of synovitis correlates with both plasma CRP and the level of IL-6 in synovial fluid. In addition, the intensity of pain in gonarthrosis increases with increasing levels of serum CRP, TNF-a and IL-6.

In addition, blood circulation in the joint and adjacent tissues is simultaneously impaired, which leads to the development of secondary osteoporosis. Reflex muscle disorders occur around the joint, which create an additional mechanism for the formation of pain and limitation of mobility.

In turn, a decrease in motor activity in the joint leads to a decrease in the production of synovial fluid in it, which provides nutrition to the cartilage tissue and the removal of metabolic products from the joint cavity. A “vicious circle of osteoarthritis” is formed - a decrease in the production of synovial fluid increases the degree of damage to cartilage tissue.

Treatment of patients with OA includes a complex of measures consisting of a physical rehabilitation program (load limitation, correction of orthopedic disorders, physical therapy regimens), drugs with anti-inflammatory activity and drugs aimed at reducing pain and slowing down structural damage in joint tissues (SYSADOA - Symptomatic slow acting drugs for osteoarthritis). Of great importance is the impact on the metabolism of cartilage tissue in order to restore the balance between the load and the reparative capabilities of chondrocytes. For this purpose, slow-acting symptom-modifying or neuroprotective drugs are used. Currently, a large number of international and national recommendations for the treatment of OA have been proposed. According to these recommendations, in addition to the general principles of managing patients with OA, which include educational programs for weight loss and aerobic exercise, the prescription of not only paracetamol, NSAIDs, glucosamine sulfate and chondroitin sulfate, but also intra-articular administration of hyaluronic acid and topical glucocorticoids is indicated. In recent years, hyaluronic acid (HA) preparations, having a minimal risk of systemic side effects, have found widespread use in OA of the knee joints. Intra-articular therapy using GLA derivatives is approved by the world's professional rheumatology and orthopedic organizations as a symptomatic treatment for patients under 65 years of age who have not responded to non-pharmacologic treatments and simple analgesics or who have contraindications to nonsteroidal anti-inflammatory drug (NSAID) therapy (ACR, 2000, 2012 ; OARSI, 2010; EULAR 2003, ESCEO 2014).

So what is hyaluronic acid and through what mechanisms does it act on the disease?

Hyaluronan is a biological fluid that occurs in synovial fluid and is quite ubiquitous throughout the body. Hyaluronan is a polyanionic (negatively charged) polysaccharide, also known as glycosaminoglycan, which consists of alternating units of N-acetylglucosamine and sodium glucuronate molecules. The length of such a polysaccharide chain can reach 12 thousand disaccharide units, and the molecular weight is 4-6 million daltons. Biosynthesis of hyaluronan occurs on the inner surface of the cell membrane of fibroblastic differential cells with the participation of hyaluronan synthase (HAS). As the concentration of polysaccharides increases (above the saturation point), the long chains begin to overlap and become entangled, forming a cross-linked network or matrix.

In synovial joints, hyaluronan is produced by hyalocytes (mononuclear phagocytic cells) and released into the synovial fluid. Constant movement in the joint promotes the passage of hyaluronan into the acellular superficial layer of articular cartilage, where it is present in a concentration 5 times higher than in the deep layers of cartilage. Hyaluronan also penetrates into the extracellular matrix of the extracellular synovial tissue and capsule, filling the collagen matrix of the extracellular substance, where proteoglycans attach to it. The concentration of hyaluronan in normal synovial fluid is 2-4 mg/ml, which is 10 times higher than required for saturation. At such a high concentration, hyaluronan forms a continuous network of polysaccharide molecules surrounding collagen fibers. The primary function of haluronan in a healthy joint is to coat and protect the synovium and superficial collagen structure of cartilage from mechanical damage caused by friction due to flexion or body weight loading of the joint. The elastic-viscous nature of the network formed by hyaluronan allows it to adapt to applied mechanical load (both low-energy (flexion), where the hyaluronan molecules align in the direction of flow and behave like a viscous fluid, dissipating mechanical energy in the form of heat; and high-energy (impact) , exhibiting elastic properties, being absorbed to such a level that the energy is dissipated in a viscous flow.)

In addition to its rheological and mechanical functions, hyaluronan is able to physically inhibit the passage of large molecules such as fibrinogen into the joint space.

Currently, the pharmaceutical market offers more than twenty types of GLA preparations for intra-articular administration, differing in molecular weight (from 5 to 10,000 kDa), origin (natural, biosynthetic), molecular structure (linear or cross-linked), concentration (from 1 to 2%), the volume of the administered drug (from 1 to 3 ml), the number of injections per course (from one to five).

By origin they distinguish: 1) preparations obtained from cockscombs: Gialgan, Gialux, Atri Inzh, Rusvisk, Giruan Plus. 2) biosynthetic, obtained by bacterial fermentation: Ostenil, Fermatron, Sinokrom, Visco Plus, Suplazin. Preparations obtained from rooster combs can cause allergic reactions because they contain protein fragments and other pyrogens.

According to the structure of the molecule, hyaluronates are divided into: 1) native (from the word - nature-natural) long molecules obtained by bacterial synthesis: Fermatron, Ostenil, Sinokrom, Fermatron Plus, Suplasin. 2) so-called modified, cross-linked molecules: Duralan, Fermatron S, Synvisc. (Cross-linking of HA molecules is provided by two mechanisms: physical, due to electrostatic interaction, and chemical, due to the formation of covalent bonds. Since chemical stabilization is more resistant to temperature changes, it is preferable .

Hyaluronic acid preparations, which can be divided into 3 groups, depending on molecular weight. Molecular weight is one of the main characteristics that ensures the duration of the therapeutic effect of medications for intra-articular injections.

The rate of polymer degradation depends on the molecular weight. At low molecular weight, the polymer will quickly undergo separation until the molecular weight is reduced to critical values ​​and the drug is excreted from the body in the form of monomers and short linear polymers.

In the case of a high molecular weight, the degradation of the polymer will occur slowly, and accordingly the therapeutic effect will be prolonged.

The main preparations of HA depending on the molecular weight, structure of the molecules and accompanying additives.

Molecular weights are based on data published by the manufacturer or in the scientific press.

Low molecular weight HA drugs are quite well tolerated by patients when administered intra-articularly. Low molecular weight causes rapid breakdown of HA molecules in the joint and tissues. Literature data provide grounds for intentionally using low molecular weight HA preparations (500-750 kDa) of animal origin for extra-articular injections. We are talking about localizations where there is synovial tissue and HA is naturally produced to carry out metabolic processes, in particular the synovial sheaths and synovial membranes of tendons during chronic inflammation in this area (tendinitis, tenosynovitis, bursitis).

Medium molecular weight HA preparations represent the largest group. All of them are products of bacterial fermentation and in most cases are well tolerated by patients, but just like drugs with low molecular weight, they require 3 to 5 injections per course. A distinctive feature of some drugs from this group is the possibility of their use for injection into the joint cavity immediately after arthroscopic intervention for the speedy restoration of intra-articular metabolism.

HA preparations with active accompanying additives form a separate group, since along with the described properties they acquire new qualities.

A special group consists of GC preparations with the presence of cross-linked molecules. The presence of a significant number of intermolecular cross-links makes it possible to achieve a more pronounced analgesic effect by improving the shock-absorbing properties of the synovial fluid. Innovative technologies used in the production of this group of drugs have provided unique properties. The large number of cross-links and molecular structure allow for a single injection into the joint. The half-life can approach 4 weeks, which creates the preconditions for long-term catabolism. The transition from 3-5 injections to a single injection is a significant clinical benefit.

Let's consider the evidence for a broader role for NA in the treatment of OA beyond joint shock absorption and lubrication. Exogenous HA may reduce pain transmission and blunt the inflammatory cascade through the CD44 receptor, which is associated with OA, as well as stimulate the synthesis and deposition of extracellular matrix molecules, which are suppressed and degraded in the osteoarthritic joint. The effect of HA depends on the fragment size. In particular, long-chain high molecular weight HA is anti-inflammatory and can stimulate endogenous HA production, whereas shorter chain HA fragments are pro-inflammatory and can inhibit HA production at high concentrations.

The role of GC on disease progression.

Decreased HA synthesis, increased HA degradation, and increased oxidative stress lead to a decrease in both the concentration and average molecular weight of HA present in the synovium. Several studies have shown that exposure of chondrocytes and fibroblasts to HM HA fragments (<400 kDa) can cause increased activity of proinflammatory cytokines. In addition, it has been shown that the levels of IL-18 and IL-33 increase in mouse synovial fibroblasts after exposure to HA fragments, and that HA fragments enhance the inflammatory activity of macrophages. In contrast, high molecular weight hyaluronic acid has the opposite effect on some of these systems, inhibiting mediators such as TNF-α and IL-1β. HA receptor activity may be responsible for the long-lasting pain-relieving effect of intra-articular HA therapy, although the residence time of the exogenous molecule in the joint is quite short.

Hyaluronan products have certain rheological properties that inhibit nociceptors, acting as an elastic filter. There is also a reaction to chemical sensitization of nociceptors in inflamed joint tissues, possibly related to HA concentrations. Results from a study in cats with experimental arthritis showed that intra-articular injection of high molecular weight GC reduced the activity of nociceptive primary afferents at the onset and during movement, suggesting that joint lubrication is not solely responsible for the antinociceptive effects of NA.

Recently, single intra-articular injections of NA were shown to reduce pain by more than 50% compared with saline in the bradykinin/prostaglandin E2 (PGE2) model. Use of an anti-CD44 antibody abolished the inhibitory effects of NA on LPS-mediated increase in PGE2 production and COX-2 induction , indicating that the anti-inflammatory effect of GC was CD44 receptor mediated. Additional mechanisms that may contribute to the antinociceptive effects of GCs include inhibition of arachidonic acid release from fibroblasts and activation of opioid receptors. Exposure to GCs has been shown to reduce the secretion of arachidonic acid from fibroblasts taken from patients with knee OA and is stimulated by bradykinin. The results of one study showed that, in contrast to anti-inflammatory drugs, pain reduction resulting from GC administration was associated with stimulation of cartilage regeneration. The effects of NA and loxoprofen in the joint were experimentally compared. Both HA and loxoprofen significantly reduced pain in the rabbit OA model (partial menisectomy) and also reduced PGE2 production. Hyaluronic therapy also significantly inhibited cartilage degeneration, whereas loxoprofen did not.

Inflammatory effects.

High molecular weight HA may inhibit the inflammatory processes involved in OA by interfering with the effects of HM HA fragments on CD44, RHAMM, and TLR-2 and TLR-4. Results from in vitro and in vivo studies indicate that administration of high molecular weight GC has significant anti-inflammatory effects that are mediated, at least in part, by CD44 blockade. Administration of high molecular weight hyaluronic acid leads to suppression of IL-8 and NO synthase gene expression in cells that were not stimulated by IL-1. In cells that were stimulated with IL-1, TNF-α gene expression was also suppressed. Blocking CD44 with a specific antibody inhibited the effects of high molecular weight HA on proinflammatory gene expression. Recently, high molecular weight hyaluronic acid has also been shown to suppress IL-1β production in monocyte/macrophage cultures under various inflammatory conditions. Provision of IL-1β and TNF-α by GCs has important downstream effects on the expression of proinflammatory and catabolic molecules. IL-1β induces ADAMTS through p38 mitogen-activated protein kinase and NH2-terminal kinase phosphorylation in human fibroblast-like synovocytes. ADAMTS degrade aggrecan in cartilage; High molecular weight hyaluronic acid also suppresses ADAMTS expression. IL-1β suppresses peroxime proliferation-activating receptors. (PPARγ) . ( Peroxisome proliferator-activated receptors (PPARs), ligand-activated nuclear transcription factors (NTFs) from the hormonal receptor family, regulate the metabolism of fats and carbohydrates, cholesterol and bile acids, inflammation, regeneration and differentiation/proliferation of liver cells. All PPAR isoforms ( PARα, PPARβ/δ, PPARγ) are present in the liver, Activation of PPARs receptors most effectively reduces chronic inflammatory processes and has a lesser effect on acute inflammation. PPARα not only affects lipid metabolism and transport, FA oxidation and glucose homeostasis, but also exhibits anti-inflammatory effects effects. These effects are associated with inhibition of proinflammatory cytokines, adhesion molecules and extracellular matrix proteins or stimulation of the production of anti-inflammatory molecules. In general, PPARα reduces the production of proinflammatory cytokines, which limits inflammatory reactions and atherogenesis). PPAR activity is regulated by products of lipid metabolism and other natural and synthetic activators and increases the expression of MMPs. Results from a study examining the expression of inflammatory genes in human chondrosarcoma cells induced by IL-1β show that high molecular weight hyaluronic acid increases the expression of PPARγ and decreases that of COX-2, MMP-1 and MMP-13. Additional anti-inflammatory effects of GC are achieved through the suppression of mitogen-activated protein kinases and nuclear factor signaling. In a rabbit model that induced OA through injection of sterile papain into the knee, intra-articular injection of HA resulted in a significant decrease in IL-1β and TNF-α expression and an increase in TIMP-1 expression compared with intra-articular saline controls. GC treatment also resulted in chondrocyte proliferation in this model. Exogenous HA also reduces levels of inflammatory cytokines and MMPs in tissues collected from patients with OA and other conditions associated with joint damage. In one study, subacromial synovial fibroblasts were taken from patients with rotator cuff disease and stimulated with IL-1β. The addition of GC resulted in a dose-dependent decrease in the expression of IL-1β, TNF-α and IL-6. These effects of GC were lost when CD44 was blocked by anti-CD44 antibody. Incubation with GC has also been shown to inhibit IL-1β-induced MMP activity in synovial tissue from patients.

Changes in the extracellular matrix alter the biomechanical environment of chondrocytes and lead to disease progression. The ECM is integrally involved in the development and progression of OA, and its preservation and restoration have become the focus of treatment. The results of several studies have shown that exogenous NA can increase the synthesis of ESM molecules. Exogenous HA stimulates synovial fibroblasts to produce new HA. When synovial fibroblasts from the knees of osteoarthritis rabbits were cultured with HA formulations of varying molecular weights, the amount of newly synthesized HA depended on both the concentration and molecular weight of exogenous HA. Higher molecular weight agents stimulated GA synthesis more strongly, while low molecular weight GAs suppressed GA synthesis when used in high concentrations. Two additional studies showed that intra-articular injection of HA in patients with OA increased endogenous NA production. In in vitro experiments, treatment of bovine articular chondrocytes with HA caused a significant increase in the synthesis of sulfated glycosaminoglycan and hydroxyproline, which coincided with an increase in matrix deposition of chondroitin-6-sulfate and type II collagen. Mechanical stress leading to injury has been shown to result in the loss of proteoglycans from cartilage and may play a role in the development and progression of OA, whereas administration of HA has been shown to increase proteoglycan synthesis in cartilage exposed to mechanical stress. In 2007, a review of disease-modifying drugs for OA devoted only one paragraph to HA, stating that there was no evidence that HA provided a disease-modifying effect. This conclusion was based on the observation that intra-articular injection of HA into the knee had no significant effect on radiographic progression versus intra-articular saline over 1 year of follow-up.

A 2006 Cochrane review of randomized trials concluded that viscofilling with HA (or hylan derivatives) was superior to placebo in improving pain and function over several weeks. In addition, viscosupplementation has generally demonstrated benefits over a longer period of time compared with intra-articular corticosteroid injections. Systematic reviews have also shown the safety and effectiveness of GC over non-steroidal anti-inflammatory drugs and other non-surgical treatments. It is becoming increasingly clear that NA influences a wide range of biological processes through multiple molecular pathways.

In October 2021, J Arthroplasty published one interesting study that compared injections of low-, moderate-, and high-molecular-weight hyaluronic acid during surgical delay. The study included 30,417 patients. The effectiveness of low molecular weight (MW) hyaluronic acid injections, moderate molecular weight HA (MMWHA) injections, and high molecular weight HA (HMWHA) injections for preventing or delaying knee surgery in patients with knee osteoarthritis was compared. According to the study results, there was no significant difference in the likelihood of surgery between LMWHA, MMWHA, and HMWHA users after controlling for empirically based factors.

Another study (double-blind, randomized, multicenter) (BMC Musculoskelet Disord, 2021 May 26) tested the efficacy and safety of a single injection of cross-linked sodium hyaluronate versus three injections of high molecular weight sodium hyaluronate for knee osteoarthritis.

Two hundred eighty-seven patients with osteoarthritis (Kellgren-Lawrence grades I-III) were randomized to each group. Three weeks of injections were given in both groups, but two physiological injections were preceded by cross-linked hyulronate injections to maintain double blindness. The primary endpoint was change in severe weight-bearing pain (WBP) 12 weeks after the last injection. Secondary endpoints included the Western Ontario and McMaster Osteoarthritis Index; global patient and investigator assessment; pain at rest, at night or with movement. This study showed that a single injection of cross-linked hyaluronan was as effective as three injections of high molecular weight sodium hyaluronate in reducing WBP.

In a review and analysis of 68 studies, products with an average molecular weight ≥3000 kDa provided favorable efficacy results compared with products with an average molecular weight <3000 kDa. Products with molecular weights ≥3000 kDa demonstrated significantly lower rates of discontinuation due to treatment-related side effects than their counterparts ≤1500 kDa. In addition, biological fermentation HA had a significantly lower incidence of effusion than HA obtained from poultry. Biological fermentation HA demonstrated fewer inflammatory responses at the injection site than avian-derived HA products. In the available literature, IA-GCs products with molecular weight ≥ 3000 kDa and those derived from biological fermentation show excellent clinical observations and minimal side effects.

Another interesting study was published in the journal Int J Mol Sci 2021 Mar 17, which compared the effectiveness and cost of treatment with stabilized hyaluronic acid (Durolane) in one injection with standard hyaluronic acid (HA) preparations in five injections for osteoarthritis (OA) of the knee. Patients were randomized into two groups: group I with intra-articular injection of NANA (Durolane®) and group II with HA (Go-ON®). Control examinations of patients were at the 1st, 2nd, 4th, 8th, 12th and 26th week after treatment. A statistically significant improvement in WOMAC score was observed in patients receiving NAHA compared to those receiving GC at week 26. In addition, the need for analgesia was significantly reduced at week 26 in the NANA-treated group. Finally, economic analysis showed an increased cost of overall treatment with HA injections. Our data supports the use of the ANAS class of products for the treatment of the knee joint

A systematic review and meta-analysis of electronic database data, including PubMed and Embase, conducted from January 1980 to November 2015 evaluated the effectiveness of 3 injections of sodium hyaluronate (Hyalgan) compared with 5 injections into the knee joint. The review included studies that assessed the effectiveness of a course of 3 or 5 weeks of intra-articular injections of Hyalgan for the treatment of OA knee pain. Clinical studies evaluating the effectiveness of a 3-week course of other US-approved hyaluronic acid products were also included. 24 studies were identified, including 2168 study participants in 30 cohorts processed. Meta-analysis results indicated that knee pain relief with a 3-week course of Gialgan was similar to a 5-week course of Gialgan (P = 0.916). The level of pain reduction from baseline pain with a 3-week course of Hyalgan is similar to a 3-week course of other HA products. There was no statistical difference between the reduction in knee pain with a 3-week course of Hyalgan compared to the reduction in OA knee pain with a 5-week course of Hyalgan or a three-week course of other HA products.

Groups of scientists conducted a meta-analysis of 20 studies with 3034 patients that compared the effectiveness of Synvisc with low molecular weight hyaluronic acids. According to the results, limited data showed a superior effect for hylan GF 20 compared to low molecular weight hyaluronic acid at 2 to 3 months after injection (assessed by VAS and WOMAC scores). There was no evidence of an increased risk of treatment-related side effects for hylan GF 20 injections.

Hylan GF 20 is a product of animal origin and consists of two fractions. Their molecular weight is 6 million Da, which is very close to healthy synovial fluid. This makes it possible to restore the viscoelastic properties of the synovial fluid to a greater extent and improve the functional state of the joint. The clinical effect of the drug has been demonstrated in numerous clinical studies: the analgesic effect of hylan GF 20 was longer lasting compared to standard NSAID therapy. - persisted in 28% of patients versus 6% of patients who took only NSAIDs and compared with intra-articular corticosteroids. — 56% of patients versus 37% of patients; this effect lasted significantly longer and also made it possible to delay endoprosthetics of the affected joint by 3.8 years. The use of hylan GF 20 for the treatment of OA has allowed patients to reduce the need for other medications. The design of the studies conducted with hylan GF 20 underscores their high degree of reliability. The clinical effectiveness of the drug is confirmed by the dynamics of laboratory parameters both in vitro and in vivo. In vitro, in a rabbit model of osteoarthritis, not only the chondroprotective effect of hylan GF 20 was shown, but also a decrease in the formation of osteophytes. It has also been found that hylan GF 20 can stimulate cartilage repair by increasing Col II and inhibits IL-1p-mediated cartilage matrix degradation by decreasing metalloproteinase activity. The chondroprotective effect of hylan GF 20 was also confirmed by the dynamics of serum levels of Coll2-1 and Coll2-1 NO2, which are biomarkers of OA. Three intra-articular injections of 2 ml of Synvisc led to a statistically significant decrease in their levels, while their dynamics were more pronounced in patients with stages III-IV of OA according to Kellgren.

Side effects with intra-articular administration of GC drugs rarely develop - on average in 1-13% of patients and are, as a rule, local in nature. Most often, pain occurs at the injection site. Any intra-articular injections may be accompanied by an inflammatory response, but the literature describes cases of the development of a clinically isolated reaction, known as a spontaneous acute inflammatory reaction (SAIR), during intra-articular administration of GC drugs to patients with OA. It is not yet clear, however, whether these pseudoseptic reactions are directly related to GC.

The technique of intra-articular administration of the drug is important: when using an anterior approach to the knee joint, the frequency of side effects is usually higher than when introducing GC into the joint through a lateral approach. This can be explained by the fact that in the first case the drug is sometimes administered not into the joint cavity, but paraarticularly.

The analysis of the literature on the role and properties of HA, the use of synovial fluid replacement agents based on it, indicates the high significance of this segment of therapy in the relief of articular and periarticular pain syndrome, and high efficiency in the complex treatment of OA. Drugs with high molecular weight demonstrate the longest analgesic effect up to 8-12 months and a more pronounced improvement in functional activity. Recent data and observations have made it possible to better understand the mechanisms of GC metabolism and determine the features of the use of GC preparations depending on the characteristics of production, molecular weight and other pharmacological and pharmacodynamic properties.

Price for intra-articular injection of Duralan

Buy Duralan viscoelastic implant. syringe 60mg/3ml in pharmacies

Instructions for use Duralan Buy Duralan viscoelastic sterile implant for intra-articular injection 60 mg/3 ml Manufacturers Smith & Nephew Medical Limited (United States of America) Group Means that replace synovial and tear fluid Composition Each milliliter contains: hyaluronic acid, stabilized 20 mg of physiological sodium chloride solution pH7. Pharmacological action Hyaluronic acid is identical in all living organisms. It is a natural polysaccharide present in all tissues of the body, especially high concentrations are observed in synovial fluid and skin. Duralan consists of hyaluronic acid obtained by biosynthesis, which has gone through the stages of purification and stabilization. It breaks down in the body along the same metabolic pathway as endogenous hyaluronic acid. Mechanism of action. The body's own hyaluronic acid is a natural component of synovial fluid and serves as a lubricant for cartilage and ligaments in joints, and also performs a shock-absorbing function. Injecting hyaluronic acid into the joint to restore the viscosity and elasticity of the synovial fluid can reduce pain and improve joint mobility. Indications for use Symptomatic treatment of mild to moderate osteoarthritis of the knee or hip joint. In addition, DUROLANE is approved in the EU for the symptomatic treatment of mild to moderate pain associated with osteoarthritis of the ankle, shoulder, elbow, wrist, finger, temporomandibular and facet joints. The drug is also indicated for pain relief after arthroscopy, either for existing osteoarthritis, or after surgical treatment for 3 months after the procedure. Contraindications Not identified. Side effects Most adverse reactions recorded during clinical studies of osteoarthritis of the knee and hip joints were described as transient pain, swelling and/or limitation of joint mobility. The intensity of these adverse reactions was mild to moderate, and only in some cases did the reactions require the use of painkillers or NSAIDs. When using other preparations containing hyaluronic acid on other joints, no additional adverse events were recorded. None of the reported adverse reactions were interpreted as acute inflammatory arthritis or an allergic reaction, and these reactions did not require medical intervention in the form of surgery or systemic or intra-articular steroids or antibiotics. Interaction The safety and effectiveness of simultaneous use of Duralan with other injectable drugs for intra-articular administration has not been established. Directions for use and dosage Duralan is a single-dose, single-injection preparation that should only be administered once per course of treatment. The recommended dose is 3 ml for the knee, hip or shoulder joint. The recommended dose for intermediate joints (eg, elbow, ankle) is 1-2 ml, and for small synovial joints (eg, thumb, temporomandibular joint, facet joints) is approximately 1 ml. Administration of the drug. General information about drug administration. The drug should only be administered by an appropriately licensed physician (or other specialists as required by local law) who is familiar with the technique of injecting drugs into the synovial joint being treated, and in a medical facility equipped to administer intra-articular injections. When administering, it is necessary to strictly adhere to the rules of asepsis. The drug should be administered only into the joint cavity. Injections into some synovial joints require imaging guidance to ensure accurate needle placement and to avoid damage to adjacent vital structures. The trajectory of the needle for intra-articular injections, performed with or without visualization, should be chosen to avoid damage to adjacent vital structures. Before injection, the injection site must be wiped with a cotton swab containing alcohol or another suitable antiseptic solution. If there is effusion in the joint, it should be removed before administering the drug. Removal of effusion and administration of the drug must be performed through the same needle. It is recommended to use needles with a diameter of 18-22 G and of sufficient length. The use of smaller diameter needles increases the pressure required to administer the drug. Overdose No data available. Special instructions The drug should not be administered in case of infection or severe inflammation of the synovial joint. Should not be administered if there is an active skin disease or infection at or close to the intended injection site. It should not be injected into vessels, tissue outside the joint, into synovial tissue or the joint capsule. Do not re-sterilize Duralan, as this may impair the properties of the drug. Precautionary measures. The drug should be used with caution in patients with venous or lymphatic stasis in the leg. Not tested on pregnant or lactating women or children. A separate syringe should be used for each joint to be treated. As with any invasive procedure on a joint, there is a small risk of infection. Should not be administered to patients with known sensitivity to preparations based on hyaluronic acid. Local anesthetics should not be used if the patient has hypersensitivity to local ones. anesthetics or allergies to them. If the patient has a history of allergic reactions or hypersensitivity to contrast media, fluoroscopically guided injections using contrast media should not be performed. Clinical trials examined the effects of repeated injections of the drug into the knee joint, given at least 6 months after the first injection. An increase in pressure during injection may indicate that the needle is not in the correct position and has moved beyond the joint, or that the joint is full. The effectiveness of the drug after arthroscopy for diagnostic and research purposes only has not been established. The drug should be used with caution in patients with existing chondrocalcinosis, since administration of the drug may lead to an acute attack of the disease. Additional information on the treatment of synovial joints requiring imaging monitoring. To ensure correct placement of the needle in the joint cavity, injections into the hip and facet joints should be performed under fluoroscopic (preferably with contrast) or ultrasound guidance. The decision about the need to monitor injections into other synovial joints with visual aids is made by the doctor performing the procedure. Injection discomfort can be minimized through the use of local anesthetics applied to the surface of the skin or injected subcutaneously. Image-guided injections should only be performed by physicians experienced in administering drugs by this route. As with any invasive joint procedure, it is recommended that you avoid strenuous physical activity (eg, playing tennis, jogging, long walks) for the first two days after the injection. During the first week after injection, you can expect some mild to moderate transient reactions associated with Duralan injection, such as pain and/or swelling/limitation of joint motion. If these symptoms do not disappear within a week, you should consult a doctor. Storage conditions Do not freeze. Store in original packaging at a temperature not exceeding 30 C.

Our doctors

• LITVINENKO Andrey Sergeevich
  Traumatologist orthopedist Sports medicine doctor Experience: 19 years

  Sign up

• SKRYPOVA Irina Viktorovna
  Physiotherapist rehabilitator Experience: 20 years

  Sign up

• MOISEENKO Alexey Yurievich
  Traumatologist orthopedist Sports medicine doctor Experience: 17 years

  Sign up

  Read also:  Benefits of using synovial fluid protectors for gonarthrosis
• KHOLIKOV Timur Vyacheslavovich
  Traumatologist orthopedist Sports medicine doctor Experience: 19 years

  Sign up