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Rheumatology International
Published in: Rheumatology International 4/2011

01-04-2011 | Review

The role of intra-articular hyaluronan (Sinovial®) in the treatment of osteoarthritis

Authors: Antonio Gigante, Leonardo Callegari

Published in: Rheumatology International | Issue 4/2011

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Abstract

Osteoarthritis (OA) leads to significant pain and disability. For pain relief, a tailored approach using non-pharmacological and pharmacological therapies is recommended. If adequate symptom relief is not achieved with acetaminophen, other pharmacological options include non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, intra-articular corticosteroids and intra-articular hyaluronic acid (HA) viscosupplementation. Most of these therapies generally do not improve functional ability or quality of life or are associated with tolerability concerns. In OA patients, concentration and molecular weight (MW) of HA are reduced, diminishing elastoviscosity of the synovial fluid, joint lubrication and shock absorbancy, and possibly anti-inflammatory, analgesic and chondroprotective effects. In knee OA, viscosupplementation with 3–5 weekly intra-articular HA injections diminishes pain and improves disability, generally within 1 week and for up to 3–6 months and is well tolerated. HAs have comparable efficacy as NSAIDs, with less gastrointestinal adverse events, and compared with intra-articular corticosteroids, benefits last generally longer. High MW hylans provide comparable benefits versus HA, albeit with an increased risk of immunogenic adverse events. In mild-to-moderate hip OA, intra-articular injection of HA moderately improved pain and function, generally for up to 3 months with no serious adverse events. Efficacy in other joints is being evaluated. Viscosupplementation with intra-articular Sinovial® (other trade names: Yaral®, Intragel®) injections (an HA of low-medium MW) relieves pain and improves function in OA of the knee, and other joints including the carpometacarpal joint of the thumb and the shoulder. HA viscosupplementation, including use of Sinovial®, is a valuable treatment approach for OA patients, if other therapies are contraindicated or have failed.
Literature
1.
2.
3.
4.
Hochberg MC (2000) Role of intra-articular hyaluronic acid preparations in medical management of osteoarthritis of the knee. Semin Arthr Rheum 30(2 Suppl 1):2–10CrossRef
5.
Strauss EJ, Hart JA, Miller MD, Altman RD, Rosen JE (2009) Hyaluronic acid viscosupplementation and osteoarthritis: current uses and future directions. Am J Sports Med 37(8):1636–1644PubMedCrossRef
6.
Altman RD (1990) Osteoarthritis. Differentiation from rheumatoid arthritis, causes of pain, treatment. Postgrad Med 87(3):66–72 7-8PubMed
7.
Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P et al (2003) EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 62(12):1145–1155PubMedCrossRef
8.
Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP et al (2005) EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 64(5):669–681PubMedCrossRef
9.
Balazs EA, Denlinger JL (1993) Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl 39:3–9PubMed
10.
Dahl LB, Dahl IM, Engstrom-Laurent A, Granath K (1985) Concentration and molecular weight of sodium hyaluronate in synovial fluid from patients with rheumatoid arthritis and other arthropathies. Ann Rheum Dis 44(12):817–822PubMedCrossRef
11.
Balazs E (ed) (1982) The physical properties of synovial fluid and the specific role of hyaluronic acid
12.
Castellacci E, Polieri T (2004) Antalgic effect and clinical tolerability of hyaluronic acid in patients with degenerative diseases of knee cartilage: an outpatient treatment survey. Drugs Exp Clin Res 30(2):67–73PubMed
13.
Moreland LW (2003) Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthr Res Ther 5(2):54–67CrossRef
14.
Vitanzo PC Jr, Sennett BJ (2006) Hyaluronans: is clinical effectiveness dependent on molecular weight? Am J Orthop 35(9):421–428PubMed
15.
Dixon AS, Jacoby RK, Berry H, Hamilton EB (1988) Clinical trial of intra-articular injection of sodium hyaluronate in patients with osteoarthritis of the knee. Curr Med Res Opin 11(4):205–213PubMedCrossRef
16.
Maheu E, Ayral X, Dougados M (2002) A hyaluronan preparation (500–730 kDa) in the treatment of osteoarthritis: a review of clinical trials with Hyalgan. Int J Clin Pract 56(10):804–813PubMed
17.
Hamburger MI, Lakhanpal S, Mooar PA, Oster D (2003) Intra-articular hyaluronans: a review of product-specific safety profiles. Semin Arthr Rheum 32(5):296–309CrossRef
18.
Brzusek D, Petron D (2008) Treating knee osteoarthritis with intra-articular hyaluronans. Curr Med Res Opin 24(12):3307–3322PubMedCrossRef
19.
Migliore A, Granata M (2008) Intra-articular use of hyaluronic acid in the treatment of osteoarthritis. Clin Interv Aging 3(2):365–369PubMed
20.
ACR (2000) Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthr Rheum 43(9):1905–1915CrossRef
21.
Roddy E, Doherty M (2003) Guidelines for management of osteoarthritis published by the American College of Rheumatology and the European League Against Rheumatism: why are they so different? Rheum Dis Clin North Am 29(4):717–731PubMedCrossRef
22.
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G (2006) Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2:CD005321PubMed
23.
IBSA (2009) Sinovial®: summary of product characteristics
24.
Theiler R, Bruhlmann P (2005) Overall tolerability and analgesic activity of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis. Curr Med Res Opin 21(11):1727–1733PubMedCrossRef
25.
Roux C, Fontas E, Breuil V, Brocq O, Albert C, Euller-Ziegler L (2007) Injection of intra-articular sodium hyaluronidate (Sinovial) into the carpometacarpal joint of the thumb (CMC1) in osteoarthritis. A prospective evaluation of efficacy. Joint Bone Spine 74(4):368–372PubMedCrossRef
26.
Gomis A, Pawlak M, Balazs EA, Schmidt RF, Belmonte C (2004) Effects of different molecular weight elastoviscous hyaluronan solutions on articular nociceptive afferents. Arthr Rheum 50(1):314–326CrossRef
27.
Weiss C, Band PA (1999) Basic principles underlying the development of viscosupplementation for the treatment of osteoarthritis. J Clin Rheumatol 3:S2–S11
28.
Lo GH, LaValley M, McAlindon T, Felson DT (2003) Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA 290(23):3115–3121PubMedCrossRef
29.
Wobig M, Bach G, Beks P, Dickhut A, Runzheimer J, Schwieger G et al (1999) The role of elastoviscosity in the efficacy of viscosupplementation for osteoarthritis of the knee: a comparison of hylan G-F 20 and a lower-molecular-weight hyaluronan. Clin Ther 21(9):1549–1562PubMedCrossRef
30.
Ghosh P, Guidolin D (2002) Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: are the effects molecular weight dependent? Semin Arthr Rheum 32(1):10–37CrossRef
31.
Reichenbach S, Blank S, Rutjes AW, Shang A, King EA, Dieppe PA et al (2007) Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis. Arthr Rheum 57(8):1410–1418CrossRef
32.
Onel E, Kolsun K, Kauffman JI (2008) Post-Hoc analysis of a head-to-head hyaluronic acid comparison in knee osteoarthritis using the 2004 OMERACT-OARSI responder criteria. Clin Drug Investig 28(1):37–45PubMedCrossRef
33.
Kotevoglu N, Iyibozkurt PC, Hiz O, Toktas H, Kuran B (2006) A prospective randomised controlled clinical trial comparing the efficacy of different molecular weight hyaluronan solutions in the treatment of knee osteoarthritis. Rheumatol Int 26(4):325–330PubMedCrossRef
34.
Brun P, Panfilo S, Daga Gordini D, Cortivo R, Abatangelo G (2003) The effect of hyaluronan on CD44-mediated survival of normal and hydroxyl radical-damaged chondrocytes. Osteoarthr Cartil 11(3):208–216PubMedCrossRef
35.
Wang CT, Lin YT, Chiang BL, Lin YH, Hou SM (2006) High molecular weight hyaluronic acid down-regulates the gene expression of osteoarthritis-associated cytokines and enzymes in fibroblast-like synoviocytes from patients with early osteoarthritis. Osteoarthr Cartil 14(12):1237–1247PubMedCrossRef
36.
Chou CL, Li HW, Lee SH, Tsai KL, Ling HY (2008) Effect of intra-articular injection of hyaluronic acid in rheumatoid arthritis patients with knee osteoarthritis. J Chin Med Assoc 71(8):411–415PubMedCrossRef
37.
Leopold SS, Warme WJ, Pettis PD, Shott S (2002) Increased frequency of acute local reaction to intra-articular hylan GF-20 (synvisc) in patients receiving more than one course of treatment. J Bone Joint Surg Am 84-A(9):1619–1623PubMed
38.
Pullman-Mooar S, Mooar P, Sieck M, Clayburne G, Schumacher HR (2002) Are there distinctive inflammatory flares after hylan g-f 20 intraarticular injections? J Rheumatol 29(12):2611–2614PubMed
39.
Goldberg VM, Coutts RD (2004) Pseudoseptic reactions to hylan viscosupplementation: diagnosis and treatment. Clin Orthop Relat Res 419:130–137PubMedCrossRef
40.
Carrabba M, Paresce E, Angelini M et al (1995) The safety and efficacy of different dose schedules of hyaluronic acid in the treatment of painful osteoarthritis of the knee with joint effusion. Eur J Rheumatol Inflamm 15:25–31
41.
Dougados M, Nguyen M, Listrat V, Amor B (1993) High molecular weight sodium hyaluronate (hyalectin) in osteoarthritis of the knee: a 1 year placebo-controlled trial. Osteoarthr Cartil 1(2):97–103PubMedCrossRef
42.
Listrat V, Ayral X, Patarnello F, Bonvarlet JP, Simonnet J, Amor B et al (1997) Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthr Cartil 5(3):153–160PubMedCrossRef
43.
Novaes AC, Schaiquevich P, Nasswetter G (2005) Multicenter study of hyaluronic acid obtained by biotechnology to evaluate clinical efficacy and safety in knee osteoarthritis. Int J Clin Pharmacol Res 25(1):1–7PubMed
44.
Petrella RJ (2005) Hyaluronic acid for the treatment of knee osteoarthritis: long-term outcomes from a naturalistic primary care experience. Am J Phys Med Rehabil 84(4):278–283 quiz 84, 93PubMedCrossRef
45.
Altman RD, Moskowitz R (1998) Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatol 25(11):2203–2212PubMed
46.
Jones AC, Pattrick M, Doherty S, Doherty M (1995) Intra-articular hyaluronic acid compared to intra-articular triamcinolone hexacetonide in inflammatory knee osteoarthritis. Osteoarthr Cartil 3(4):269–273PubMedCrossRef
47.
Wobig M, Dickhut A, Maier R, Vetter G (1998) Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther 20(3):410–423PubMedCrossRef
48.
Adams ME, Atkinson MH, Lussier AJ, Schulz JI, Siminovitch KA, Wade JP et al (1995) The role of viscosupplementation with hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone. Osteoarthr Cartil 3(4):213–225PubMedCrossRef
49.
Dickson DJ, Hosie G, English JR et al (2001) A double-blind, placebo-controlled comparison of hylan G-F 20 against diclofenac in knee osteoarthritis. J Drug Assess 4:179–190
50.
Leopold SS, Redd BB, Warme WJ, Wehrle PA, Pettis PD, Shott S (2003) Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee. A prospective, randomized trial. J Bone Joint Surg Am 85-A(7):1197–1203PubMed
51.
Karatosun V, Unver B, Gocen Z, Sen A (2005) Comparison of two hyaluronan drugs in patients with advanced osteoarthritis of the knee. A prospective, randomized, double-blind study with long term follow-up. Clin Exp Rheumatol 23(2):213–218PubMed
52.
Karlsson J, Sjogren LS, Lohmander LS (2002) Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology 41(11):1240–1248PubMedCrossRef
53.
Pourbagher MA, Ozalay M, Pourbagher A (2005) Accuracy and outcome of sonographically guided intra-articular sodium hyaluronate injections in patients with osteoarthritis of the hip. J Ultrasound Med 24(10):1391–1395PubMed
54.
Abate M, Pelotti P, De Amicis D, Di Iorio A, Galletti S, Salini V (2008) Viscosupplementation with hyaluronic acid in hip osteoarthritis (a review). Ups J Med Sci 113(3):261–277PubMedCrossRef
55.
Fernandez Lopez JC, Ruano-Ravina A (2006) Efficacy and safety of intraarticular hyaluronic acid in the treatment of hip osteoarthritis: a systematic review. Osteoarthr Cartil 14(12):1306–1311PubMedCrossRef
56.
Gaston MS, Tiemessen CH, Philips JE (2007) Intra-articular hip viscosupplementation with synthetic hyaluronic acid for osteoarthritis: efficacy, safety and relation to pre-injection radiographs. Arch Orthop Trauma Surg 127(10):899–903PubMedCrossRef
57.
Migliore A, Tormenta S, Massafra U, Martin Martin LS, Carloni E, Padalino C et al (2006) 18-month observational study on efficacy of intraarticular hyaluronic acid (Hylan G-F 20) injections under ultrasound guidance in hip osteoarthritis. Reumatismo 58(1):39–49PubMed
58.
Berg P, Olsson U (2004) Intra-articular injection of non-animal stabilised hyaluronic acid (NASHA) for osteoarthritis of the hip: a pilot study. Clin Exp Rheumatol 22(3):300–306PubMed
59.
Qvistgaard E, Christensen R, Torp-Pedersen S, Bliddal H (2006) Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthr Cartil 14(2):163–170PubMedCrossRef
60.
Conrozier T, Couris CM, Mathieu P, Merle-Vincent F, Piperno M, Coury F et al (2009) Safety, efficacy and predictive factors of efficacy of a single intra-articular injection of non-animal-stabilized-hyaluronic-acid in the hip joint: results of a standardized follow-up of patients treated for hip osteoarthritis in daily practice. Arch Orthop Trauma Surg 129(6):843–848PubMedCrossRef
61.
Richette P, Ravaud P, Conrozier T, Euller-Ziegler L, Mazieres B, Maugars Y et al (2009) Effect of hyaluronic acid in symptomatic hip osteoarthritis: a multicenter, randomized, placebo-controlled trial. Arthr Rheum 60(3):824–830CrossRef
62.
Moskowitz RW, Blaine TA (2005) An overview of treatment options for persistent shoulder pain. Am J Orthop 34(12 Suppl):10–15PubMed
63.
Silverstein E, Leger R, Shea KP (2007) The use of intra-articular hylan G-F 20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med 35(6):979–985PubMedCrossRef
64.
Shibata Y, Midorikawa K, Emoto G, Naito M (2001) Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg 10(3):209–216PubMedCrossRef
65.
Blaine T, Moskowitz R, Udell J, Skyhar M, Levin R, Friedlander J et al (2008) Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am 90(5):970–979PubMedCrossRef
66.
Itokazu M, Matsunaga T (1995) Clinical evaluation of high-molecular-weight sodium hyaluronate for the treatment of patients with periarthritis of the shoulder. Clin Ther 17(5):946–955PubMedCrossRef
67.
Leardini G, Perbellini A, Franceschini M, Mattara L (1988) Intra-articular injections of hyaluronic acid in the treatment of painful shoulder. Clin Ther 10(5):521–526PubMed
68.
Calis M, Demir H, Ulker S, Kirnap M, Duygulu F, Calis HT (2006) Is intraarticular sodium hyaluronate injection an alternative treatment in patients with adhesive capsulitis? Rheumatol Int 26(6):536–540PubMedCrossRef
69.
Tamai K, Mashitori H, Ohno W, Hamada J, Sakai H, Saotome K (2004) Synovial response to intraarticular injections of hyaluronate in frozen shoulder: a quantitative assessment with dynamic magnetic resonance imaging. J Orthop Sci 9(3):230–234PubMedCrossRef
70.
Lee HJ, Lim KB, Kim DY, Lee KT (2009) Randomized controlled trial for efficacy of intra-articular injection for adhesive capsulitis: ultrasonography-guided versus blind technique. Arch Phys Med Rehabil 90(12):1997–2002PubMedCrossRef
71.
Karatosun V, Unver B, Ozden A, Ozay Z, Gunal I (2008) Intra-articular hyaluronic acid compared to exercise therapy in osteoarthritis of the ankle. A prospective randomized trial with long-term follow-up. Clin Exp Rheumatol 26(2):288–294PubMed
72.
Cohen MM, Altman RD, Hollstrom R, Hollstrom C, Sun C, Gipson B (2008) Safety and efficacy of intra-articular sodium hyaluronate (Hyalgan) in a randomized, double-blind study for osteoarthritis of the ankle. Foot Ankle Int 29(7):657–663PubMedCrossRef
73.
Salk RS, Chang TJ, D’Costa WF, Soomekh DJ, Grogan KA (2006) Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg Am 88(2):295–302PubMedCrossRef
74.
Sun SF, Chou YJ, Hsu CW, Hwang CW, Hsu PT, Wang JL et al (2006) Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study. Osteoarthr Cartil 14(9):867–874PubMedCrossRef
75.
Filkova M, Senolt L, Braun M, Hulejova H, Pavelkova A, Sleglova O, et al. (2009) Serum hyaluronic acid as a potential marker with a predictive value for further radiographic progression of hand osteoarthritis. Osteoarthritis Cartilage
76.
Schumacher HR, Meador R, Sieck M, Mohammed Y (2004) Pilot Investigation of Hyaluronate Injections for First Metacarpal-Carpal (MC-C) Osteoarthritis. J Clin Rheumatol 10(2):59–62PubMedCrossRef
77.
Stahl S, Karsh-Zafrir I, Ratzon N, Rosenberg N (2005) Comparison of intraarticular injection of depot corticosteroid and hyaluronic acid for treatment of degenerative trapeziometacarpal joints. J Clin Rheumatol 11(6):299–302PubMedCrossRef
78.
Bahadir C, Onal B, Dayan VY, Gurer N (2009) Comparison of therapeutic effects of sodium hyaluronate and corticosteroid injections on trapeziometacarpal joint osteoarthritis. Clin Rheumatol 28(5):529–533PubMedCrossRef
79.
Fuchs S, Monikes R, Wohlmeiner A, Heyse T (2006) Intra-articular hyaluronic acid compared with corticoid injections for the treatment of rhizarthrosis. Osteoarthr Cartil 14(1):82–88PubMedCrossRef
80.
van Brakel RW, Eygendaal D (2006) Intra-articular injection of hyaluronic acid is not effective for the treatment of post-traumatic osteoarthritis of the elbow. Arthroscopy 22(11):1199–1203PubMedCrossRef
81.
Bjornland T, Gjaerum AA, Moystad A (2007) Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J Oral Rehabil 34(8):583–589PubMedCrossRef
82.
Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Mullner M (2005) Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ 172(8):1039–1043PubMed
83.
Divine JG, Zazulak BT, Hewett TE (2007) Viscosupplementation for knee osteoarthritis: a systematic review. Clin Orthop Relat Res 455:113–122PubMedCrossRef
84.
Wang CT, Lin J, Chang CJ, Lin YT, Hou SM (2004) Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am 86-A(3):538–545PubMed
85.
Modawal A, Ferrer M, Choi HK, Castle JA (2005) Hyaluronic acid injections relieve knee pain. J Fam Pract 54(9):758–767PubMed
86.
Bellamy N (2006) Hyaluronic acid and knee osteoarthritis. J Fam Pract 55(11):967–968PubMed
87.
Salini V, De Amicis D, Abate M, Natale MA, Di Iorio A (2009) Ultrasound-guided hyaluronic acid injection in carpometacarpal osteoarthritis: short-term results. Int J Immunopathol Pharmacol 22(2):455–460PubMed
88.
Clerc D (2006) Sinovial® dans la gonarthrose: une étude en situation réelle d’utilisation chez 408 patients. Rhumatos 3(Suppl. 1):1–4
89.
Pavelka K (2010) Efficacy evaluation of a highly purified intra-articular hyaluronic acid obtained by bacterial fermentation vs. hylan G-F20 in the treatment of symptomatic knee osteoarthritis: a double-blind, controlled, randomized, parallel-group non-inferiority study [abstract]. Osteoporos Int 21(Suppl 1):S387
90.
Wei N, Delauter SK, Sheila JB (2002) Arthroscopic debridement and visco-supplementation: a minimally invasive treatment for symptomatic osteoarthritis involving the base of the thumb. J Clin Rheumatol 8(3):125–129PubMedCrossRef
91.
Lohmander LS, Dalen N, Englund G, Hamalainen M, Jensen EM, Karlsson K et al (1996) Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, double blind, placebo controlled multicentre trial. Hyaluronan Multicentre Trial Group. Ann Rheum Dis 55(7):424–431PubMedCrossRef
92.
Puhl W, Bernau A, Greiling H, Kopcke W, Pforringer W, Steck KJ et al (1993) Intra-articular sodium hyaluronate in osteoarthritis of the knee: a multicenter, double-blind study. Osteoarthr Cartil 1(4):233–241PubMedCrossRef
93.
Wu JJ, Shih LY, Hsu HC, Chen TH (1997) The double-blind test of sodium hyaluronate (ARTZ) on osteoarthritis knee. Zhonghua Yi Xue Za Zhi (Taipei) 59(2):99–106
Metadata
Title
The role of intra-articular hyaluronan (Sinovial®) in the treatment of osteoarthritis
Authors
Antonio Gigante
Leonardo Callegari
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Rheumatology International / Issue 4/2011
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-010-1660-6

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