Abstract
Rheumatoid arthritis (RA) is a deforming, destructive arthritis of unknown etiology. Although the true cause of RA is unknown, pathophysiology of joint destruction has been extensively studied for the past few years. The most pertinent pathological features of affected joint are neo-vascularization, cell infiltration, and thickening of synovial membrane, which all lead to joint destruction by eliciting abnormal immune reactions.
The abnormal immune reactions include production of various cytokines from cells in synovial membrane, and upregulated expression of adhesions molecules. CD 44 is ubiquitously expressed on cells in synovial membrane and is considered to be adhesion molecule, since it binds to hyaluronic acid which is present abundantly in articular matrix. Thus adhesion molecules act not only for transmigration of lymphocytes into synovial membrane but also for perpetuation of rheumatoid inflammation by holding inflammatory cells in articular matrix.
Hyaluronic acid has been used for treatment in patients with osteoarthritis. Recently, the double bind multi-center clinical trial clearly showed that the significant efficacy of hyaluronic acid in patients with RA. The basic and clinical profile of hyaluronic acid as an alternative therapeutic adjunct in patients with RA is briefly reviewed.
