Hyaluronic acid in human synovial effusions; A sensitive indicator of altered connective tissue cell function during inflammation

TUDIES OF HUMAN JOINT FLUID have S sought to relate hyaluronic acid conwntration and parameters of molecular weight to the various rheumatic diseases associated with synovial effusions. It is difficult to compare data in published studies largely because of: (1) a paucity of observations on individual normal joint fluids and (2) a lack of uniform methodology in meawrement of hyaluronic acid and performance of physical studies. In one of the most comprehensive studies, Sundblad examined 2 normal fluids and found the hyaluronic acid concentration to be 2.97 mg./ml. and the mean intrinsic viscosity (a parameter molecular weight) to be 39.3.l His study indicated that rheumatoid, degenerative, and traumatic arthritis all led to a significant decrease in concentration of hyaluronic acid. Intrinsic viscosity was decreased in rheumatoid arthritis. degenerative joint disease, and infectious arthritis but not in traumatic arthritis. These studies suggested that neither the size and duration of effusion, nor systemic parameters such as the erythrocyte sedimentation rate correlated with the degree of mucopolysaccharide abnormality. Hamerman and Schuster provided the first evidence suggesting that normal values for the hyaluronic acid (HA) content of joint fluids might vary with age.2 Their PRINCE AND MARGARET J. HAZELTON