EFFICACY OF WEEKLY INTRA-ARTICULAR LOW-MOLECULAR SODIUM HYALURONATE INJECTION FOR THREE WEEKS IN THE TREATMENT OF OSTEOARTHRITIS: OPEN, RANDOMIZED CLINICAL TRIAL

Authors

  • Burin Sutthapakti Department of Orthopedic Surgery, Buddhachinaraj Phitsanulok Hospital
  • Witoon Tremtrakranpol Department of Orthopedic Surgery, Buddhachinaraj Phitsanulok Hospital
  • Wiboon Wanitcharoenporn Department of Orthopedic Surgery, Buddhachinaraj Phitsanulok Hospital

DOI:

https://doi.org/10.55374/jseamed.v2i2.10

Keywords:

Osteoarthritis knee, Hyaluronie acid, Viscosupplementation, visual analog scale, Thai short form 36 health survey score

Abstract

The primary objective of this study was to determine whether the three-weekly injectionsimprove knee pain and patients’ quality of life. The secondary objective was to assess patients’ compliance to treatment and risks related to the three-weekly injections of Hyalagan®.The authors conducted a single-blind randomized controlled trial. Osteoarthritisknee participants aged 50 years or older with Kellgren-Lawrence grade I to III or early osteoarthritis kneewere randomized to intra-articular injection of three-weekly doses (the intervention group; n = 50) or five-weekly doses of Hyalagan®(the control group; n = 50). The outcomes of the study were measured at baseline, 1, 2, 3, 4, 5, and 8 weeks post-treatment. The weight-bearing after 50 foot-walking and patients’ quality of life at the baseline measured by visual analog scale(VAS) and Thai short form 36 (SF-36) health survey score were not significantly different between the two groups (p = 0.430 and 0.239, respectively). The VAS was statistically lowerat the 1st and 2nd week in the three-weekly intra-articularinjections group(p = 0.009 and 0.005, respectively). The evaluation of overall changes in the SF-36 scores also revealed that patients in the three weekly injection group had a higher quality of life compared to the other group (p = 0.0001). The numbers of loss to follow-up in the intervention group were significantly lower than the control group (2 cases vs.7 cases, p < 0.05) . And no complication related to intra-articular injection was found in the two treatment groups.In conclusion, the results of this present study support the hypothesized superiority of managing pain associated with knee OA and increasing patients’ quality of life in thethree weekly injections over the conservative management of the five weekly injections. More importantly, the safety of the treatment has been warranted.

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References

Abatangelo G, O'Regan M. Hyaluronan. Biological role and function in articular joints. European Journal of Rheumatology and Inflammation. 1995;15(1):9-16.

Punzi L. The complexity of the mechanisms of action of hyaluronan in joint diseases. Clinical and experimental rheumatology. 2001;19(3):242.

Karna E, Miltyk W, Paka JA, Jarzbek K, Woczyski S. Hyaluronic acid counteracts interleukin-1induced inhibition of collagen biosynthesis in cultured human chondrocytes. Pharmacological Research. 2006;54(4):275-81. DOI: https://doi.org/10.1016/j.phrs.2006.06.002

Amiel D, Toyoguchi T, Kobayashi K, Bowden K, Amiel ME, Healey RM. Long-term effect of sodium hyaluronate (Hyalgan ®) on osteoarthritis progression in a rabbit model. Osteoarthritis and Cartilage. 2003;11(9):636-43. DOI: https://doi.org/10.1016/S1063-4584(03)00119-5

Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther. 2003;54-67.

Watterson JR, Esdaile JM. Viscosupplementation:therapeutic mechanisms and clinical potential in osteoarthritis of the knee. The Journal of the American Academy of Orthopaedic Surgeons. 2000;8(5):277. DOI: https://doi.org/10.5435/00124635-200009000-00001

Smith MM, Ghosh P. The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatology International. 1987;7(3):113-22. DOI: https://doi.org/10.1007/BF00270463

Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Annals of the Rheumatic Diseases. 1957;16(4):494. DOI: https://doi.org/10.1136/ard.16.4.494

Goldberg VM,Goldberg L. Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis. Journal of Pain Research. 2010; 3: 51–6. DOI: https://doi.org/10.2147/JPR.S4733

Rutjes AW, Juni P, Da Costa B, Trelle S, Nuesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee a systematic review and meta-analysis. Ann Intern Med. 2012;157(3):180-91 DOI: https://doi.org/10.7326/0003-4819-157-3-201208070-00473

Altman RD, Hochberg MC, Moskowitz RW, Schnitzer TJ. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis and rheumatism. 2000;43(9):1905. DOI: https://doi.org/10.1002/1529-0131(200009)43:9<1905::AID-ANR1>3.0.CO;2-P

Modawal A, Ferrer M, Choi HK, Castle JA. Hyaluronic acid injections relieve knee pain: this meta-analysis shows good therapeutic effect for between 5 and 12 weeks. Journal of Family Practice. 2005;54(9):758-68.

Altman RD, Moskowitz R. Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. The Journal of rheumatology. 1998;25(11):2203.

Munigangaiah S, O'Sullivan TA, Lenehan B. Simultaneous bilateral septic arthritis of the knee after intraarticular steroid injection: a clinical report. Journal of Natural Science, Biology and Medicine. 2014;5(2):485-7. DOI: https://doi.org/10.4103/0976-9668.136278

Wen DY. Intra-articular hyaluronic acid injections for knee osteoarthritis. American family physician. 2000;62(3):565.

Ziebland S. The short form 36 health status questionnaire: clues from the Oxford region's normative data about its usefulness in measuring health gain in population surveys. Journal of Epidemiology and Community Health. 1995;49(1):102. DOI: https://doi.org/10.1136/jech.49.1.102

Leurmarnkul W, Meetam P. Properties testing of the retranslated SF-36 (Thai Version). Thai J Pharm Sci. 2005;29:69-88.

Goldberg VM, Coutts RD. Pseudoseptic reactions to hylan viscosupplementation: diagnosis and treatment. Clinical Orthopaedics and Related Research. 2004;419:130-7. DOI: https://doi.org/10.1097/00003086-200402000-00021

Tahiri L, Benbouazza K, Amine B, Hajjaj-Hassouni N. Acute pseudoseptic arthritis after viscosupplementation of the knee: a case report. Clinical Rheumatology. 2007;26(11):1977-9. DOI: https://doi.org/10.1007/s10067-007-0598-x

Carrabba M, Paresce E, Angelini M, Re KA, Torchiana EEM, Perbellini A. The safety and efficacy of different dose schedules of hyaluronic acid in the treatment of painful osteoarthritis of the knee with joint effusion. European Journal of Rheumatology and Inflammation. 1995;15(1):25-31.

Stitik TP, Issac SM, Modi S, Nasir S, Kulinets I. Effectiveness of 3 weekly injections compared with 5 weekly injections of intraarticular sodium hyaluronate on pain relief of knee osteoarthritis or 3 weekly injections of other hyaluronan products: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2017;98(5):1042-50. DOI: https://doi.org/10.1016/j.apmr.2017.01.021

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Published

2018-12-26

How to Cite

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Sutthapakti B, Tremtrakranpol W, Wanitcharoenporn W. EFFICACY OF WEEKLY INTRA-ARTICULAR LOW-MOLECULAR SODIUM HYALURONATE INJECTION FOR THREE WEEKS IN THE TREATMENT OF OSTEOARTHRITIS: OPEN, RANDOMIZED CLINICAL TRIAL. J Southeast Asian Med Res [Internet]. 2018 Dec. 26 [cited 2024 Apr. 17];2(2):58-66. Available from: https://jseamed.org/index.php/jseamed/article/view/10

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