Intraarticular Hyaluronic Acid Supplementation in the Horse: The Role of Molecular Weight

Osteoarthritis (OA) is a primary cause of lameness and loss of use in the equine industry. Treatment of affected joints is aimed at reducing synovial inflammation, halting the inflammatory cascade within the joint, minimizing articular cartilage breakdown, and reducing pain. Treatments of affected joints commonly used by equine practitioners include intraarticular hyaluronic acid (HA). Consideration of the average molecular weight (MW) and concentration of the HA product may dictate what product is selected. The purpose of this review is to briefly summarize for the practitioner the scientific data available evaluating the significance of hyaluronic acid molecular weight with regard to efficacy and duration of action in horses when administered intraarticularly. In summary, the beneficial effects of HA supplementation are attributable to the anti-inflammatory effects, improvement in viscoelastic properties of the synovial fluid, and interaction with the synovial membrane affecting pain transmission and joint metabolism. As this review shows, the importance of HA molecular weight with regard to efficacy of treating synovial inflammation and osteoarthritis has not been clearly demonstrated, and results are conflicting. Until there is a full understanding of the mechanism of action of HA within the joint, the veterinarian's choice of HA products will continue to be based on clinical preference. Additional studies directly comparing products of different HA average molecular weights and formulations in a controlled in vivo setting are needed to assess the importance of HA molecular weight in treating joint disease.