title: Assessment of immunologic mechanisms for flare reactions to Synvisc.
abstract: Intraarticular injection of Synvisc for treatment of knee pain sometimes results in an acute local reaction (flare). We tested the hypothesis that the flare was a Type-1 hypersensitivity reaction as manifested by the presence of Synvisc antibodies in the synovial fluid and serum and by an increase in the concentration of the mast-cell enzyme tryptase in the synovial fluid. Our second objective was to determine whether the ratio of CD4+ to CD8+ lymphocytes in the synovial fluid was increased, as would be expected in a Type-4 hypersensitivity reaction. The study population was a prospective, consecutive series of 16 patients who had a flare, and 20 control patients. We found no differences in product-specific antibodies in the synovial fluid or serum between patients with flares and patients without flares. The mean tryptase level in the synovial fluid of patients with flares, 3.8 +/- 0.8 microg/L, was not different from the corresponding level in the control patients. The CD4+/CD8+ ratio in the synovial fluid was more than eight times greater in patients with flares. Flares that sometimes occur after treatment with Synvisc are probably not Type-1 (antibody-mediated) hypersensitivity reactions, but may be Type-4 (cell-mediated) hypersensitivity reactions.
authors.affiliation: Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71130-3932, USA. amarino@lsuhsc.edu
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Marino
authors.forename: David D
authors.initials: DD
authors.lastname: Waddell
authors.forename: Oleg V
authors.initials: OV
authors.lastname: Kolomytkin
authors.forename: Stephen
authors.initials: S
authors.lastname: Pruett
authors.forename: Kalia K
authors.initials: KK
authors.lastname: Sadasivan
authors.forename: James A
authors.initials: JA
authors.lastname: Albright
mesh_terms: D000368:Aged; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D006967:Hypersensitivity / Q000209:etiology*; D007249:Inflammation / Q000209:etiology; D007270:Injections, Intra-Articular; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D018709:Statistics, Nonparametric; D013582:Synovial Fluid / Q000166:cytology / Q000187:drug effects
chemical_list: C049816:hylan; D006820:Hyaluronic Acid