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Hyaluronic acid for joint pain: treatment options and risks

Hyaluronic acid

Hyaluronic acid for joint pain: treatment options and risks

Used as lip filler, as ingredient in moisturizers and creams for wounds and burns, but also in eye surgeries as replacement for eye fluids, hyaluronic acid (HA) is a substance that’s naturally found inside the human body, being present in the highest concentrations in the eyes and in the synovial fluid of the joints.

This fluid acts as a cushion and lubricates the joints, retaining water and providing nutrients for the tissues forming them. Also, the synovial fluid contributes to the removal of waste from tissues that don’t have a direct blood supply, preventing the accumulation of debris in cartilages and other similar cells.

Besides these roles, the fluid inside joints works as a shock absorber, and prevents the bones that form the joint from touching each other. The health of joints depends on the presence and composition of this liquid, and in lots of cases, symptoms like joint pain, inflammation, swelling or stiffness are caused by problems with the synovial fluid.

How hyaluronic acid influences joint health

The cartilage is immersed in synovial fluid, which is rich in hyaluronic acid, and being an avascular tissue, it depends on this fluid for receiving nutrients and eliminating waste. When the amount of hyaluronic acid in the joint decreases, nutrients can’t be moved into the cells effectively and debris is likely to accumulate.

The joint cartilage, a smooth and translucent tissue found on the end of the bones that form the joints, prevents the friction between them, absorbs shocks and reduces the impact on bones during movement. The health of this cartilage is strongly linked with the amount of hyaluronic acid, which makes up the backbone structure of cartilage.

HA lubricates the structure and makes the joint cartilage a smooth and friction-free substance, and without an adequate amount of hyaluronic acid, cartilage is likely to fall apart and deteriorate. Unfortunately, the production of this substance decreases with age.

The average human has approximately 15 grams of hyaluronic acid inside the body, and 1/3 of this amount is degraded and synthesized on a daily basis, but with age the production is slowed down and breakdown happens faster. As a result, the synovial fluid becomes thinner and more watery and its functioning is impaired.

This leads to the wearing away of the cartilage and causes symptoms of osteoarthritis, like joint pain and swelling, stiffness and limited range of motion. In severe osteoarthritis, the amount of hyaluronic acid in synovial fluid can decrease by 75%, so it comes as no surprise that this substance is of such importance for joint health.

But what if we could replace the hyaluronic acid in joints, when the production decreases? Would that make any difference, would it solve joint pain and osteoarthritis problems?

Hyaluronic acid administration: options, risks and advantages

Hyaluronic acid injections became available as treatment for osteoarthritis in the 1990s, the procedure – called viscosupplementation – consisting in injecting HA into the swollen and painful joint.

In most patients, 3 to 5 weekly injections were necessary for providing relief, the therapy being considered safe but being somehow painful and unpleasant for the sufferer. Moreover, the injections have to be administered by a physician, so it’s a supplementary cost, and the risk of introducing an infection in the joint is present.

The injections themselves are expensive, and having to go to your physician three times a week for such procedures, which may or may not be covered by health insurance, is also not pleasant. For these reasons, scientists looked for alternative ways to deliver hyaluronic acid to the joints, and came up with a less invasive, more affordable and safer solution: HA supplements.

Oral HA supplements don’t require a prescription, and are sold as dietary supplements, this pain-free alternative to injections being more convenient and equally effective. This is why medical organizations currently recommend using hyaluronic acid supplements instead of injections, but there’s one aspect to keep in mind: to actually get results, you must choose high-quality products that closely mimic the composition and properties of your body’s hyaluronic acid.

Oral forms of hyaluronic acid generally come from three sources: low-purity animal extractions which are mixed with collagen, HA obtained through fermentation from bacteria, or extracted from avian cartilage. First option isn’t exactly the best, because they don’t provide the optimum concentration of HA, and taking too large amounts of these supplements may not be safe.

The second alternative, HA derived from bacterial fermentation, is less functional as well, and leaves out some of the components found in the hyaluronic acid produced by the human organism. The best option therefore is to get supplements obtained from avian extracts, which are the preferred choice for studies as well.

Concentrated extractions have been widely used in large human studies and found to be safe. Thanks to their composition, these oral HA supplements stimulate the body to produce more of its own natural hyaluronic acid and relieve symptoms of arthritis, these being some of the greatest advantages of avian-derived HA.



  1. Toshiyuki Tashiro, Satoshi Seino et al. – Oral Administration of Polymer Hyaluronic Acid Alleviates Symptoms of Knee Osteoarthritis: A Double-Blind, Placebo-Controlled Study over a 12-Month Period, ScientificWorldJournal, 2012: 167928,
  2. Hyaluronic Acid for Treatment of Osteoarthritis of the Knee,
  3. Muneaki Ishijima1, Toshitaka Nakamura et al. – Intra-articular hyaluronic acid injection versus oral non-steroidal anti-inflammatory drug for the treatment of knee osteoarthritis: a multi-center, randomized, open-label, non-inferiority trial, Arthritis research & therapy, 2014, 16: R18,

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