There are a lot of drugs for intra-articular injections on the market, and all of them, according to the manufacturers, have almost magical properties. Each of them effectively treats arthrosis - relieves pain and restores mobility. Only the effects of one of the synovial fluid prostheses for some reason disappear after six months, while the other lasts many times longer. In this article we will analyze Gialurom, Ostenil, Intraject and Noltrex according to objective criteria and comments from their developers.
Not all liquid endoprostheses are equally effective
Comparison of the characteristics of liquid endoprostheses "Hialurom", "Ostenil", "Intraject" and "Noltrex"
| "Hyalur" | "Ostenil" | "Intraject" | "Noltrex" | |
| Compound | Sodium hyaluronate 1.5%, sodium chloride, water | Sodium hyaluronate 1%, sodium chloride, sodium monohydrogenphosphate, sodium dihydrogenphosphate, water | Unstabilized hyaluronic acid 1%, water | Three-dimensional polyacrylamide 4.5%, silver ions, water |
| Molecular mass | 2,400,000 Yes | 1,000,000 Yes | 2,200,000 Yes | More than 10,000,000 Yes |
| Volume | 2 ml (also available in 3 ml dosage) | 2 ml (there is also a dosage of 1 ml for small joints) | 2 ml | 2.5 ml |
| Contraindications | Infected wounds, joint abrasions, joint infections, systemic bleeding disorders | Pronounced sensitivity to any component of the drug | Autoimmune diseases, pathological bleeding, infections and inflammation in the joint, skin damage at the injection site | Inflammation of the skin at the injection site, inflammation of the joint, period 1 week after arthroscopy |
| Side effects | Local secondary effects - redness, swelling, feeling of warmth | Local secondary effects - redness, swelling, feeling of warmth | Local phenomena - pain, redness, joint swelling, intra-articular exudation, rarely - septic arthritis | Mild to moderate burning sensation in the joint, redness and swelling of the joint - very rare |
| Possibility of allergic reactions | Rarely | Very low | Extremely rare - itching, rash, urticaria, cases of anaphylactic reactions to the drug have been reported | Very low |
| Duration of effect after course | From 6 months | 6-12 months | 6-12 months | 6-24 months |
| Number of injections per course | At least 3 | 3-5 | 3-5 | 1-4 |
| Cost for 1 package (valid for the 1st quarter of 2019) | From 5000 rub. | From 3500 rub. | From 5700 rub. | 3100 rub. |
| Cost of treatment | At least 15,000 rubles. | 10-18 thousand rubles. | From 18 thousand rubles. | From 3,100 to 12,500 rubles. |
| Does it help with late stages of osteoarthritis? | No | slightly | No | Yes |
| Manufacturer country | Romania | Germany | Russia | Russia |
Intraject hyaluform synovial solution for intra-articular injection 1.8% 2ml 1 pc. syringe
Description of the dosage form
INTRAJECT hyaluform 1–8% (synovial) is a colorless, transparent, viscous, pyrogen-free gel, which is supplied in a glass syringe.
Characteristic
It is a colorless, transparent, viscous, pyrogen-free gel supplied in a glass syringe. This is a unique form of highly purified hyaluronic acid obtained through bacterial fermentation. The material does not contain animal proteins and does not require preliminary allergy testing. Hyaluronic acid is a natural glycosaminoglycan of the intercellular matrix, which has the greatest hygroscopicity of all known natural mucopolysaccharides.
Directions for use and doses
Before administering Intraject hyaluform 1.8% (synovial), it is necessary to thoroughly treat the injection areas with an appropriate antiseptic and allow the skin to dry.
The drug is intended for intra-articular injection; the mode of administration depends on the severity of degenerative or traumatic changes in the joint and is determined by the attending physician. Administration into the intravascular or extra-articular space, as well as into the tissue of the synovium or joint capsule is unacceptable.
It must first be warmed to room temperature, and therefore the syringe should be removed from the refrigerator at least 20 minutes in advance. before use.
The recommended course of treatment with Intraject hyaluform 1.8% (synovial) for patients with moderate to moderate severity of osteoarthritis is 3-5 injections of 2.0 ml (needles - from 19 to 21 G) into the synovial space of the joint with a week interval between each . The maximum recommended course duration is 6 weeks. If necessary, repeated courses of treatment may be prescribed after 6-12 months. It is possible to treat several joints simultaneously.
Indications for use Intraject hyaluform synovial solution for intra-articular injection 1.8% 2ml 1 pc. syringe
For temporary replacement and replenishment of synovial fluid; relief of pain and stiffness caused by degenerative-dystrophic (osteoarthritis or osteoarthritis) and traumatic changes in the knee, hip and other synovial joints; treatment of patients who lead an active lifestyle and regularly load the damaged joint.
Contraindications
Hypersensitivity or allergy to the components of the material. Having a history of autoimmune diseases or undergoing autoimmune therapy. Pathological bleeding (endogenous or caused by the use of anticoagulants). Infectious (septic) inflammatory process in the joint or periarticular tissues, intra-articular effusion, general infectious disease. Presence of signs of active skin disease or skin infection in the immediate vicinity of the injection site. Pregnancy and lactation. Children under 18 years of age.
Side effects Intraject hyaluform synovial solution for intra-articular injection 1.8% 2ml 1 pc. syringe
In rare cases, local secondary phenomena are possible: pain, a feeling of warmth, redness, swelling of the joint, the appearance of intra-articular exudation, and extremely rarely allergic reactions. Side effects may appear immediately or over time. These phenomena are short-term and disappear spontaneously. If these symptoms persist for more than one week, the patient should consult a doctor. In exceptional cases, septic arthritis may occur.
"Hyalur"
Hyalurome is a Romanian drug, a viscous sterile liquid for intra-articular injections for arthrosis and deforming osteoarthritis. The package contains a disposable glass syringe in transparent film, with a sterile needle and a protective cap. The manufacturer recommends using it for arthrosis and arthritis, as well as for osteochondrosis - for faster restoration of articular intervertebral tissue. In addition, indications include deficiency of synovial fluid, diagnostic arthroscopy and other surgical interventions on the joint.
Note!
For the treatment of arthrosis of small joints, the manufacturer recommends administering not 2, but 1 ml. "Gialurom" comes in a 2 ml package. According to the instructions, it is forbidden to use leftover medication - each syringe is intended for one injection. This means that if only one small joint is to be treated, half the contents of the syringe will not be useful.
During administration, patients report pain. Local reactions persist for 1-3 days. During this period, it is necessary to provide complete rest to the joint, and also apply cooling compresses if necessary.
After the administration of "Hyalurom" you need complete rest for up to three days.
Benefits, results
Main advantages of HYALUFORM Deep Booster:
- deep penetration of moisture into the dermis,
- accelerated effect of biomodeling,
- improvement of the structure of the dermis due to stimulation of fibroblasts,
- the possibility of effective rejuvenation of complex, problem areas,
- minimum number of injections.
The drug is administered painlessly, and there are no bruises or other marks left after the injections.
The action begins almost instantly:
- active fibroblasts produce new collagen,
- skin regeneration accelerates,
- the skin becomes smoother, more even, elastic,
- The feeling of tightness and dryness disappears.
Along with the moisturizing effect, the drug strengthens the structure of connective tissue fibers of subcutaneous fat and has a restructuring effect.
In addition, an antioxidant effect is achieved. Hyaluronic acid molecules capture and neutralize free radicals, preventing oxidation processes and slowing down skin aging.
Hyaluronic acid molecules are freely integrated into the dermal tissue, protect the intercellular matrix from damage and maintain the barrier function of the skin.
The effect of the drug lasts for 1 year, after which its molecules are broken down and naturally eliminated from the body.
"Ostenil"
"Ostenil" is a sterile solution of sodium hyaluronate, a highly purified biopolymer. No animal proteins are used in production, which completely eliminates allergic reactions to protein. A viscoelastic implant is indicated for degenerative and traumatic changes in the joints. It restores the lubricating, filtering and shock-absorbing properties of synovial fluid.
According to research results, the severity of pain after completing a course of Ostenil injections is reduced by an average of 55% after 3 months. The clinical effect develops after the first manipulation and persists for a period of at least six months. Is 55% enough to lead a normal lifestyle? The question is rhetorical.
Note!
The results of a study conducted by leading rheumatologists at the Institute of Rheumatology of the Russian Academy of Medical Sciences and several rheumatology centers are thought-provoking. A course of treatment with Ostenil consisting of three or five injections led to significant improvement only among 65-70% with gonarthrosis. Efficiency remained throughout the year in only 45-50% of subjects. The only good news is that the treatment did not produce serious adverse reactions, which means the drug is safe. How great its benefits are - the numbers speak for themselves.
And one more interesting point. In the instructions for the drug, the manufacturer recommends that doctors prescribe analgesics or anti-inflammatory drugs to patients during the first few days of treatment for osteoarthritis. It can be assumed that the pain syndrome after the introduction of a liquid endoprosthesis will be more noticeable than we would like.
Full course of treatment with Ostenil - 5 injections, or 5 weeks, or about 18,000 rubles
Intraject, 2.2%, solution for intra-articular administration, 2 ml, 1 pc.
INTRAJECT® is a sterile, colorless, transparent, homogeneous, viscous gel without mechanical impurities, obtained by bacterial fermentation. INTRAJECT® does not contain animal proteins and does not require a preliminary allergy test. Hyaluronic acid is a natural glycosaminoglycan of the intercellular matrix, which has the greatest hygroscopicity of all known natural mucopolysaccharides. Mechanism of action.
Hyaluronic acid is a natural polysaccharide belonging to the class of glycosaminoglycans, which is part of all tissues of the body and is the most important structural element of synovial fluid. Hyaluronic acid is unmodified.
INTRAJECT® product contains:
- sodium salt of hyaluronic acid and water, the molecules of which form hydrogen bonds due to the presence
- in the structure of molecules of hydroxyl groups (OH-groups), as well as the presence of a large number of oxygen and nitrogen atoms in the hyaluronic acid molecule. Due to the formation of hydrogen bonds with water molecules, hyaluronic acid has a high ability to bind and retain water, acquiring a jelly-like structure.
Macromolecules of hyaluronic acid, thanks to the same mechanisms, form intramolecular and intermolecular interactions, giving a fairly stable three-dimensional structure.
The INTRAJECT® product has an ordered gel structure, which is capable of retaining molecules of hyaluronic acid and water inside the synovial bursa, ensuring the stability of the INTRAJECT® product, which guarantees the prolonged action of the product.
The viscoelastic properties of hyaluronic acid, which is part of the synovial fluid, provide lubrication and shock absorption of the articular surfaces. Synovial fluid in joints with degenerative diseases (osteoarthritis) or traumatic changes in the joints has lower viscosity and elasticity than in healthy joints. Hyaluronic acid, which is part of INTRAJECT®, has a molecular weight of 2.2 million daltons, close to natural human hyaluronic acid, and has a positive effect after administration for the diagnosis of osteoarthritis (osteoarthritis). Intra-articular administration of INTRAJECT® restores the physiological and rheological properties of the synovial fluid of a joint affected by osteoarthritis. As a result, pain and discomfort are reduced and mobility in the joint is improved.
Biodegradation of a medical device in the patient’s body.
Complete biodegradation in the body occurs after 6 months. During movements, hyaluronates enter the lymphatic system of the joint capsule, enter the general bloodstream, and are ultimately absorbed by the liver, where they are degraded to water and carbon dioxide. INTRAJECT® does not have a metabolic effect on the body. Once administered, INTRAJECT® cannot be removed or replaced.
"Intraject"
“Intraject” is another liquid endoprosthesis, now made in Russia, for the treatment of moderate and moderate osteoarthritis. The manufacturer positions it as a means for the regeneration of cartilage tissue. Clinical studies have confirmed positive dynamics in the severity of pain in patients with grade 2-3 gonarthrosis, an improvement in general condition and an increase in the thickness of hyaline cartilage.
By and large, the drug "Intraject" is not much different from the previous ones, with the exception of a shorter shelf life (two years instead of three) and some other points.
The instructions indicate such a rare but dangerous complication as septic arthritis . The latter is accompanied by a local inflammatory reaction, increased body temperature and severe joint pain. Despite the fact that the manufacturer emphasizes “including those not related to the use of Intraject,” such references are still alarming and make us think that such cases have been recorded.
Another limitation specified in the instructions is incompatibility with quaternary ammonium salts, primarily benzalkonium chloride. This means that when using this drug it is prohibited to use antiseptics of this composition, which is a good idea for the patient to make sure of before administering a liquid endoprosthesis in a clinical setting.
In the instructions for Intraject we read: there have been cases of anaphylactic reactions to the drug
Indications:
HYALUFORM (Hyaluform) Deep Booster is intended for middle age.
Main indications:
- signs of photoaging,
- dryness, flaking of the skin,
- wrinkles on the face, hands, neck,
- folds, creases in the skin,
- ptosis, decreased skin tone and turgor,
- deterioration of complexion,
- stretch marks, post-acne.
In complex programs, Deep Booster is used for revitalization after chemical peelings, laser resurfacing, and other hardware procedures.
To achieve maximum, prolonged and lasting results of moisturizing and revitalization, a course of 2 – 3 procedures is recommended.
"Noltrex"
Noltrex is another endoprosthesis, a synovial fluid substitute, made in Russia. Of all the above-mentioned drugs, it is of synthetic origin, which gives it undeniable advantages. The components of the endoprosthesis, which do not include hyaluronic acid, as in other medications, are not broken down by enzymes in the human body, so the gel remains inside the joint for a long time and provides a long-lasting effect.
It is thanks to its synthetic nature that Noltrex is a completely hypoallergenic drug and is perfectly compatible with the tissues of the human body. Another feature of it is its record molecular weight, more than 10 million Da, thanks to which it is not removed from the joint for a very long time.
"Noltrex" is an inexpensive but very effective synthetic endoprosthesis with long-lasting action
HYALUFORM Deep Booster
This drug contains stabilized, high-molecular pure hyaluronic acid at a concentration of 25 mg/ml (2.5%) without impurities or additives.
Thanks to the high content of hyaluronic acid Deep Booster:
- creates a prolonged effect of moisturizing all layers of the dermis (including the deepest),
- combines the effects of biorevitalization, hydrolifting and 3-D skin remodeling:
- reduces the severity of folds, creases, wrinkles (including nasolabial, labiomental folds),
- increases skin elasticity,
- smoothes the relief,
- improves complexion.
A little about the price
Let's highlight:
- To keep osteoarthritis of the hip or knee under control with the help of the German drug “ Ostenil ” (costing only 3,500 rubles per injection!), you will have to fork out 10-18 thousand rubles every six months. That is, you will need from 20 to 36 thousand rubles , since the effect lasts on average only for 6-8 months.
- Treatment with Romanian “ Hyalurom ” will cost 15 thousand rubles per course - that is, about 30 thousand rubles per year .
- The Russian “ Intraject ” itself cannot be called cheap. A course of treatment with the drug costs 5,800 rubles. the injection will also cost at least 18 thousand rubles, and it will also probably have to be repeated twice a year, which means this amount is doubled - 36 thousand rubles.
- With Noltrex , which, according to some patients, costs not so little (from 3,100 rubles), you can save money. Even if the course consists of 4 injections, it will cost a little more than 12 thousand rubles . The effect will last for at least a year, meaning no additional investment is required.
Of course, it is “more prestigious” to treat arthrosis with an advanced German or popular Romanian drug. Many patients are skeptical about Russian developments, and this is still a tribute to the past. Today, some domestic medicines are not only not inferior to imported ones, but upon closer examination they even surpass them. See for yourself.
Advantages of Noltrex over the drugs Hyalurom, Ostenil and Intraject
- Due to its higher molecular weight, Noltrex lasts longer - up to two years (usually from a year to one and a half). It is impossible to get such a result from Hyalurom, Ostenil or Intraject.
- For a full course, sometimes 1-3 injections are enough, while preparations based on sodium hyaluronate must be administered at least 3 times, and in some cases 4-5.
- The cost of treating arthrosis of the knee, hip or elbow with Noltrex is significantly lower than with any other drug (about 12 thousand rubles for 4 injections, although two or three injections are often enough).
When choosing a drug for intra-articular injections, many are still guided by insignificant criteria. For some, the country of origin is a priority, for others, the cost of one injection is a priority. In fact, it is much more important to analyze the treatment regimen as a whole - with a future perspective, calculate the cost of treatment for the year, and study effectiveness statistics. The example of the comparison of popular liquid endoprostheses described above clearly shows the value of this particular approach.
