NOLTREX™ NOLTREX™ VET DAM™+
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NOLTREX™ IS A MEDICAL DEVICE FOR THE TREATMENT OF JOINT ARTHRITIS AND ARTHROSIS

NOLTREX ™ is a synthetic implant based on three-dimensional polyacrylamide cross-linked polymer with silver ions added. The device is used to replace the joint synovial fluid (a fluid that fills the joint cavity and performs the function of intra-articular lubricant). It is used to treat arthrosis, osteoarthrosis arthritis, osteoarthritis.

NOLTREX molecule

NOLTREX™ MOLECULAR WEIGHT > 10 000 000 Dalton.


Composition:
3-dimensional
polyacrylamide, %
4,0 ± 1,5
Purified water, %

96,0 ± 1,5
Silver ions, %

0,0001 - 0,0025

A disposable syringe of NOLTREX™ contains 2.5 ml of gel to be administered into the joint cavity.

Unlike other products commonly used in intra-articular injections, NOLTREX™ does not contain hyaluronic acid or other substances susceptible to degradation under the influence of enzymes contained in the human body, which ensures its long presence in the injection site.

NOLTREX ™ is a biocompatible material, that has neither immunogenic, nor antigenic properties, it does not cause allergic reaction due to its synthetic nature.

NOLTREX ™ is not a pharmacological medication from a group of antibiotics or antimicrobial drugs, so it cannot be used as a primary therapeutic agent for bacterial arthritis.

MECHANISM OF ACTION


NOLTREX

PROTECTION OF CARTILAGE

Intra-articularly injected NOLTREX™ covers the entire joint surfaces and the synovial lining with a uniform layer of lubricating gel. The hydrogel layer creates a shock-absorbing effect, cushions the mechanical load on the joint, which helps to preserve the integrity of cartilage/stop further destruction of the cartilage.


PHYSICAL SEPARATION OF FRICTIONING SURFACES

Due to synovial viscosupplementation the joint space widens, i.e. the contacting and frictioning surfaces of the affected joint are physically separated. Thus, due to the reduced friction a mechanical protection of articular cartilages is achieved; the irritant constantly present in the joint, typically leading to pain and inflammation, is eliminated.

NOLTREX

NOLTREX

SYNOVIAL VISCOSUPPLEMENTATION OF JOINTS

NOLTREX ™ has viscosity characteristics close to normal synovial (joint) fluid. When injected in the joint affected by osteoarthritis, NOLTREX ™ restores synovial fluid properties, normalizing physical properties of articular medium.


EFFECTIVENESS

Given the complexity and the irreversibility of the processes occurring in the joints of patients with osteoarthritis, the physician should make a choice of medicinal products solely on the basis of their effectiveness. This is necessary to achieve maximum stabilization of the pathological process and prevent secondary changes in the joint. The preservation of the joint functions and the maximum limitation of the disease impact on the patient’s life quality depend on the effectiveness of the drug.

NATURAL OR SYNTHETIC?

There is a misconception that the use of drugs based on hyaluronic acid is preferable, compared with fully synthetic drugs. Claims are often made that the preparations based on hyaluronic acid are similar in composition to the human synovial fluid. However, the trouble is that the resemblance is not absolute, which is exactly what reduces their effectiveness in terms of quality. The preparations manufactured from animal raw materials are easily detected by immune cells of the body (phagocytes), destroyed and removed from the body. Besides, the use of animal raw materials often provokes allergic reactions and inflammations in the joint. 1-4 Besides, the high speed of resorption accounts for a very short recommended interval between repeated injections.

The injections of NOLTREX ™ should be repeated not more often than every nine months - two years5. This is accounted for by the macromolecules of the cross-linked polymer, which are virtually invisible for phags and eliminated from the body very slowly, enabling to maximize the length of therapeutic effect. Due to synthetic origin of the preparation allergic reactions to it are absolutely impossible.

Thus, there is an obvious answer to the question of choice of the drug for the treatment of osteoarthritis. At the moment NOLTREX ™ is the absolute leader among the medications for the treatment of arthritis in terms of effectiveness and safety.

SAFETY

BIOCOMPATIBILITY

Inert macromolecules of NOLTREX ™ do not react with body tissues. Over the years, the researches of polyacrylamides, a group of substances on which NOLTREX™ material is based, have shown that they are highly biocompatible with human tissues, exceptionally hypoallergenic and do not have any adverse impact on the vital functions of the patient’s body.6-10

SIDE EFFECTS

Some patients mention an unusual feeling of “a clot” occurring while the preparation is being injected into the joint cavity, which is caused by the gelly-like dense consistency of NOLTREX™ and is easily decreased by means of a few repeated pendular movements of the limb, made by the physician after the procedure.

There have been reported rare cases of a Burning Sensation In Joints Following NOLTREX™ administration. In all cases the intensity of the pain syndrome was mild or moderate, the duration averaged 12-24 hours and never exceeded 3 days. The pain syndrome is stopped by taking analgesics (the course is prescribed individually by the physician in charge) or ends spontaneously without any medications.

No hypersensitivity reactions to the preparation have been reported so far.

Exposure of damaged (inflamed, injured, etc.) tissues provokes a pain syndrome in the form of a strong burning sensation inside the joint. Therefore, it is recommended to use the material not before the inflammation has been arrested.


  1. Goldberg V.M., Coutts R.D.. Pseudoseptic reactions to hylan viscosupplementation: diagnosis and treatment. Clin Orthop Relat Res. 2004; (419):130-7.
  2. Pullman-Mooar S. et al.. Are there distinctive inflammatory flares after hylan g-f 20 intraarticular injections? J Rheumatol. 2002; 29(12):2611-4.
  3. Leopold S.S. et al.. Increased frequency of acute local reaction to intra-articular Hylan GF-20 (synvisc) in patients receiving more than one course of treatment. J Bone Joint Surg Am. 2002; 84-A(9):1619-23.
  4. Chen A.L. et al.. Granulomatous inflammation after Hylan GF-20 viscosupplementation of the knee : a report of six cases. J Bone Joint Surg Am. 2002; 84-A(7):1142-7.
  5. Загородний Н.В., Зар В.В.. Эффективность и безопасность лечения остеоартроза коленного сустава Нолтрексом — полимером с перекрёстными связями. // Эффективная фармакотерапия. 2011, № 1, с. 58-65.
  6. Перова Н.М.. Изучение биологического эффекта материала-биополимера водосодержащего с ионами серебра «Аргиформ». Протокол серии доклинических исследований: Всероссийский научно-исследовательский и испытательный институт медицинской техники МЗ РФ. Москва, 2003.
  7. Christensen L.H. et al.. Long-term effects of polyacrylamide hydrogel on human breast tissue. Plast Reconstr Surg. 2003; 111(6):1883-90.
  8. Zarini E. et al.. Biocompatibility and tissue interactions of a new filler material for medical use. Plast Reconstr Surg. 2004; 114(4):934-42.
  9. Breiting V. et al.. A study on patients treated with polyacrylamide hydrogel injection for facial corrections. Aesthetic Plast Surg. 2004 Jan-Feb; 28(1):45-53. Epub 2004 May 3.
  10. Wolters M., Lampe H.. Prospective multicenter study for evaluation of safety, efficacy, and esthetic results of cross-linked polyacrylamide hydrogel in 81 patients. Dermatol Surg. 2009; 35 Suppl 1:338-43.

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