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Target of this paper is to focus on the current knowledge about viscosupplementation in the management of osteoarthritis. The molecular structure and the effects of hyaluronic acid derivates on mechanical, biochemical and cellular level are described. Since the exogenously introduced hyaluronic acid derivates stay on average only 10 to 20 hour in the synovial fluid and yet its effect continues over months, an additional effect is postulated: modulation of the activity of the different cells in the development and progression of the osteoarthritis (synoviocytes, chondrocytes, inflammatory cells), probably by direct effect on their specific receptors. These receptors play an important role in the migration, adhesion and activation of inflammatory cells, as well as maturation and differentiation of the chondrocytes for synthesizing the cartilage matrix. In experimental studies in vitro and in vivo an analgetic and anti-inflammatory effect of hyaluronic acid derivates was proven. These results were confirmed in clinical studies. An amelioration of symptoms was shown and a delay of disease progression seems possible. This therapy is well tolerated and complications are few. Further studies to determine the optimal dosage and product (low or high-molecular preparation), the possible combination with other therapies in ideal sequence and the effect in the different subtypes of population are needed.

Unlabelled: We measured basal and TRH-stimulated TSH values with a 3rd generation assay in patients under suppressive thyroxine (T4) therapy for thyroid carcinoma or goiter and in patients with overt hyperthyroidism. All hyperthyroid patients had undetectable basal TSH levels (< 0.01 mU/l). In patients on suppressive T4 treatment basal TSH values were undetectable in 37.5% (= group A) and measurable in the intermediate range of 0.01-0.05 mU/l in 62.5% (= group B). After TRH administration there was no TSH increase in the hyperthyroid patients (< 0.01 mU/l in 100%). T4-treated patients of group A showed no relevant TSH stimulation in 58% (peak < or = 0.05 mU/l = total TSH suppression). An increase of > 0.05 mU/l could be measured in 42% of group A and 100% of group B (= subtotal TSH suppression). Many of these TSH values measured by a 3rd generation assay are in the undetectable range for most of the commercially available 2nd generation assays (< 0.10 mU/l)., Conclusion: TSH assay of the 3rd generation decisively improves the diagnosis of hyperthyroidism and probably also borderline hyperthyroidism. Against the background of increased risk of osteoporosis and cardiac function disorders as a result of suppressive T4 treatment, our results suggest the following practical therapeutic guidelines: total TSH suppression with the risk of iatrogenic hyperthyroidism should be confined to high risk patients (eg with metastatic thyroid cancer). Where the risk is low, however (thyroid cancer with favourable prognosis, goiter, goiter prophylaxis), only subtotal TSH suppression is indicated.