Document Detail

Interaction of intraarticular hyaluronan and albumin in the attenuation of fluid drainage from joints.
MedLine Citation:
PMID:  10817572     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: How is fluid volume regulated in joints? Fluid drainage rate is an important factor, both in normal joints and those with effusions. Hyaluronan and albumin, separately, are known to attenuate drainage, conserving synovial fluid volume in the presence of raised joint pressure. Hyaluronan and albumin normally coexist, however, in joint fluid. The objective was to determine their interactive effect on drainage. METHODS: The fluid escape rate from the joint cavity through synovium was measured at controlled intraarticular pressures using a rabbit knee model in vivo. One joint contained 4 mg/ml hyaluronan and the other contained 4 mg/ml hyaluronan plus 20 mg/ml albumin, as in normal synovial fluid. Hyaluronan-albumin interactions were assessed in vitro by viscometry and osmometry. RESULTS: Hyaluronan alone greatly attenuated fluid escape. Drainage rates plateaued at 4-5 microl/minute as pressure was raised, because the opposition to drainage increased with pressure. Addition of albumin to hyaluronan shifted the opposition-versus-pressure relation upward and further attenuated drainage by 22.5%, despite a small fall in the viscosity of the mixture. Osmometry showed a small synergistic interaction. Analysis of aspirates showed that < or =8% of albumin molecules in the draining fluid were reflected by the synovial lining (compared with 79% of hyaluronan molecules). CONCLUSION: Hyaluronan and albumin act together at normal concentrations to conserve synovial fluid in the presence of raised drainage pressures. Hyaluronan has the greater effect, acting osmotically by way of a concentration polarization boundary layer. Attenuation of this effect in arthritic effusions with low hyaluronan concentrations is one of several factors limiting fluid accumulation and, hence, the size of the effusion.
D Scott; P J Coleman; R M Mason; J R Levick
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  43     ISSN:  0004-3591     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-06-01     Completed Date:  2000-06-01     Revised Date:  2003-11-14    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1175-82     Citation Subset:  AIM; IM    
St George's Hospital Medical School, London, UK.
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MeSH Terms
Albumins / pharmacology*
Cartilage, Articular / chemistry
Drug Interactions
Hyaluronic Acid / pharmacology*
Knee Joint / surgery*
Synovial Fluid / chemistry*
Reg. No./Substance:
0/Albumins; 9004-61-9/Hyaluronic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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