Early decrease of serum biomarkers of type II collagen degradation (Coll2-1) and joint inflammation (Coll2-1 NO2 ) by hyaluronic acid intra-articular injections in patients with knee osteoarthritis: A research study part of the Biovisco study
Henrotin Y, Chevalier X, Deberg M, Balblanc JC, Richette P, Mulleman D, Maillet B, Rannou F, Piroth C, Mathieu P, Conrozier T; Osteoarthritis Group of the French Society of Rheumatology. J Orthop Res. 2013 Jun;31(6):901-7. doi: 10.1002/jor.22297. Epub 2013 Feb 19.
Take Home Message: Hyaluronic acid injections decrease factors related to collagen degradation. Some blood tests may differentiate responders and nonresponders to these injections.
Knee osteoarthritis, one of the leading causes of disability, has no cure and current treatments commonly involve medications to decrease inflammation and pain. Hyaluronic acid (HA) injections have become a popular form of treatment for knee osteoarthritis. However, the mechanism of action has yet to be determined. Therefore, the authors examined serum biomarkers of collagen breakdown (Coll2-1 and Coll2-1 NO2) in 45 patients with various stages of knee osteoarthritis before (-15 days), at the time of injection, and following treatment (30 and 90 days) with HA injections. The authors collected serum and demographic data (age, sex, height, weight, date of diagnosis, osteoarthritis in other joints, and concomitant treat for osteoarthritis) and examined the knee (pain, stiffness, swelling, effusion, walking and global pain using a VAS). They determined the stage of knee osteoarthritis based on x-rays obtained for both knees at the start of the study. Walking and global pain decreased from day 1 to day 90. Of the 45 patients 26 responded well to the injections (based on a greater than 50% reduction in walking and global pain) while the remaining 19 patients did not. The response was unrelated to age, sex, body mass index, disease duration, stage of knee osteoarthritis, or previous treatments. The serum biomarkers of cartilage breakdown decreased following HA injections with patients with end-stage knee osteoarthritis having a more substantial decrease. At baseline (-15 days) the responsive group had lower levels of one of the markers of collagen turnover (Coll2-1) compared with the unresponsive group.
This study was successful at identifying that biomarkers of collagen breakdown, which are typically associated with knee osteoarthritis, can be reduced with HA injections. The authors also found that there were two categories of patients: responders and non-responders. This is observed clinically as well with some patients having great results while others do not benefit. When dividing the patients into these groups they found that one specific biomarker was lower at the baseline measure (-15 days) in the responsive group. This is a clinically relevant finding that demonstrates a possible effective way of identifying patients that will respond favorably to the HA injections. The ability to identify patients that will benefit from a specific treatment would significantly improve patient outcomes and reduce healthcare costs. These type of biomarkers could also be helpful for other treatments in sports medicine. Research like this will help to advance the medical field to provide more patient specific treatment and improve our ability to help patients.
Questions for Discussion: Do your patients have success with HA injections? Do you think the use of biomarkers and genetics will be used routinely to guide our treatment options?
Written by: Stephen Thomas
Reviewed by: Jeffrey Driban