Hyaluronic acid is an essential component of synovial fluid and also of articular cartilage, which
is used as an intra-articular therapy for joint problems. High molecular weight hyaluronic acid, which is the form injected into joints, inhibits lymphocyte migration and phagocytosis and also reduces the permeability of the synovial membrane. Usually between 20 and 40 mg of the sodium salt of hyaluronic acid (10mg/ml) is injected into the joint, with an equivalent volume of synovia being removed. Reporting many studies of the effects of hyaluronic acid treatment in racing horses saw "frequently very good effects." These good effects were seen in horses that had previously been point fired, blistered, and sometimes treated with intra-articular corticosteroids. The remarkable thing in these studies was that in most cases, injecting 1 to 2 ml of hyaluronic acid was sufficient to cure the lameness. The only factors that appeared to predictably interfere with therapy were pronounced bony changes in the joint or prior treatment with corticosteroids.
The mode of action of hyaluronic acid is not clear, but it appears to persist in the joints for days after injection. One theory is that hyaluronic has good surface-protecting properties. Because of its high molecular weight and the large number of electrical charges carried by hyaluronic acid, diffusion of hyaluronic acid out from an intra-articular injection site and its detection is quite highly unlikely for performance horses.
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