Durolane RPU 2010t

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VISKOSUPLEMEN INTRAARTIKULER PADA OSTEOARTRITIS

JOAcid injection for Osteoarthritis

OSTEOARTHRITIS Most common joint disease in human Suffering of pain Causing disability in 2% of population in the world

Grading of knee OAKellgren-Lawrence Grade I Grade II Grade III Grade IV

Treatment of OA Non Pharmacological - Patient education & empowerment

- Physiotherapy , occupational therapy & joint protection Pharmacological

- Painkillers : Paracetamol, opioid, NSAIDs- Intra-articular injection : corticosteroid, Hyaluronic acid (viscosupplementation)

Surgery- Arthroscopy, osteotomy, Arthrodesis, joint replacement

ViscosupplementationEuropean League Against Rheumatism (EULAR) Recommends viscosupplementation for pain reduction and function improvement in the management of OA1

American College of Rheumatology (ACR) Recommends viscosupplementation for patients who have not responded to nonpharmacologic therapy or simple analgesics21. Jordan KM, Arden NK, Doherty M, et al. 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. 2003;62:1145-1155. 2. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendation for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum. 2000;43:1905-1915.

Viscosupplementations1. Rooster combs hyaluronic acid (Hyalgan)2. Synthetic cross-linked hyaluronic acid

(Synvisc)3. Bacterial fermentation (Nuflexa) 4. NASHATM / Non Animal Stabilized Hyaluronic Acid (Durolane)

Hyaluronic Acid Glycosaminoglycan

Poly d-glucuronic acid-n-acetyl-d-glucosamine

Hyaluronate

Synthesis of Hyaluronic Acid

Enzyme : Hyaluronic Acid Synthase

Mechanism of action of Viscosupplementation

1. Restoration of the elastoviscous properties of synovial fluid 2. Anti-inflamatory & antinociceptive properties

Greatest advantages with HA

Ability to delay surgeryTreatment given as an out-patient setting No drug medication (no regime of medicine) It works among majority of patients HA reduces NSAIDs consumptions

* Datamonitor 2002 (interviews)

Greatest disadvantages with HA Number of injections

Risk involved with several injections

* Datamonitor 2002 (interviews)

NASHA Technology Combination of modern biotechnological techniques &carefully controlled stabilisation process

NASHA Technology Non-Animal Produced by bacterial fermentation. Elimination of: animal-related allergic reaction. risk of transfer of diseases from animals. Stabilized: Long duration single injection treatment. Minimal tissue disturbance. Patent protection until 2015.

NASHA Technology High purity Mildest form of stabilisation : binds to receptors as effectively as unmodified HA Low degree of molecular cross-linking (