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Chu B, Chen D, Ma S, Yang Y, Shang F, Lv W, Li Y. Novel poly(lactic-co-glycolic acid) nanoliposome-encapsulated diclofenac sodium and celecoxib enable long-lasting synergistic treatment of osteoarthritis. J Biomater Appl 2024; 39:221-234. [PMID: 38820587 DOI: 10.1177/08853282241258311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Diclofenac sodium (DS) and celecoxib (CEL) are primary anti-inflammatory agents used in the treatment of osteoarthritis (OA). Formulating these drugs into extended-release versions can effectively address the issue of multiple daily doses. In this study, we designed and synthesized a novel poly(lactic-co-glycolic acid) (PLGA) nanoliposome as a dual-drug delivery sustained-release formulation (PPLs-DS-CEL) to achieve long-lasting synergistic treatment of OA with both DS and CEL. METHODS PPLs-DS-CEL was synthesized by the reverse evaporation method and evaluated for its physicochemical properties, encapsulation efficiency, drug release kinetics and biological properties. A rat OA model was established to assess the therapeutic efficacy and biosafety of PPLs-DS-CEL. RESULTS The particle size of PPLs-DS-CEL was 218.36 ± 6.27 nm, with a potential of 32.56 ± 3.28 mv, indicating a homogeneous vesicle size. The encapsulation of DS and CEL by PPLs-DS-CEL was 95.18 ± 4.43% and 93.63 ± 5.11%, with drug loading of 9.56 ± 0.32% and 9.68 ± 0.34%, respectively. PPLs-DS-CEL exhibited low cytotoxicity and hemolysis, and was able to achieve long-lasting synergistic analgesic and anti-inflammatory therapeutic effects in OA through slow release of DS and CEL, demonstrating good biosafety properties. CONCLUSION This study developed a novel sustained-release nanoliposomes formulation capable of co-loading two drugs for the long-acting synergistic treatment of OA. It offers a new and effective therapeutic strategy for OA treatment in the clinic settings and presents a promising approach for drug delivery systems.
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Affiliation(s)
- Bo Chu
- Orthopaedics, Wuxi Xishan People's Hospital, Wuxi, China
| | - Dagui Chen
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Senlin Ma
- Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yong Yang
- Orthopaedics, Wuxi Xishan People's Hospital, Wuxi, China
| | - Fusheng Shang
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Wei Lv
- Orthopaedics, Wuxi Xishan People's Hospital, Wuxi, China
| | - Yinghua Li
- Institute of Translational Medicine, Shanghai University, Shanghai, China
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Yuan SC, Álvarez Z, Lee SR, Pavlović RZ, Yuan C, Singer E, Weigand SJ, Palmer LC, Stupp SI. Supramolecular Motion Enables Chondrogenic Bioactivity of a Cyclic Peptide Mimetic of Transforming Growth Factor-β1. J Am Chem Soc 2024; 146:21555-21567. [PMID: 39054767 DOI: 10.1021/jacs.4c05170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Transforming growth factor (TGF)-β1 is a multifunctional protein that is essential in many cellular processes that include fibrosis, inflammation, chondrogenesis, and cartilage repair. In particular, cartilage repair is important to avoid physical disability since this tissue does not have the inherent capacity to regenerate beyond full development. We report here on supramolecular coassemblies of two peptide amphiphile molecules, one containing a TGF-β1 mimetic peptide, and another which is one of two constitutional isomers lacking bioactivity. Using human articular chondrocytes, we investigated the bioactivity of the supramolecular copolymers of each isomer displaying either the previously reported linear form of the mimetic peptide or a novel cyclic analogue. Based on fluorescence depolarization and 1H NMR spin-lattice relaxation times, we found that coassemblies containing the cyclic compound and the most dynamic isomer exhibited the highest intracellular TGF-β1 signaling and gene expression of cartilage extracellular matrix components. We conclude that control of supramolecular motion is emerging as an important factor in the binding of synthetic molecules to receptors that can be tuned through chemical structure.
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Affiliation(s)
- Shelby C Yuan
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208, United States
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois 60611, United States
| | - Zaida Álvarez
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois 60611, United States
- Department of Medicine, Northwestern University, Chicago, Illinois 60611, United States
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), Barcelona 08028, Spain
| | - Sieun Ruth Lee
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois 60208, United States
| | - Radoslav Z Pavlović
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois 60611, United States
| | - Chunhua Yuan
- Campus Chemical Instrument Center, The Ohio State University, Columbus, Ohio 43210, United States
| | - Ethan Singer
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
| | - Steven J Weigand
- DuPont-Northwestern-Dow Collaborative Access Team Synchrotron Research Center, Northwestern University, Advanced Photon Source/Argonne National Laboratory 432-A004, Argonne, Illinois 60439, United States
| | - Liam C Palmer
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois 60611, United States
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
| | - Samuel I Stupp
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208, United States
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, Illinois 60611, United States
- Department of Medicine, Northwestern University, Chicago, Illinois 60611, United States
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois 60208, United States
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
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Arias-Vázquez PI. Intra-articular Injections for Treating Knee Osteoarthritis: A Classification According to Their Mechanism of Action. J Clin Rheumatol 2024; 30:168-174. [PMID: 38595298 DOI: 10.1097/rhu.0000000000002080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Pedro Iván Arias-Vázquez
- From the MD Rehabilitation Medicine, Sports Medicine, Department of Rehabilitation, Universidad Juárez Autónoma de Tabasco, Comalcalco, México
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Sconza C, Romano D, Scaturro D, Mauro GL, Leonardi G, Alito A, Respizzi S, Kon E, Di Matteo B. Safety and Efficacy of Hybrid Cooperative Complexes of Sodium Hyaluronate and Sodium Chondroitin for the Treatment of Patients with Symptomatic Knee Osteoarthritis. Rheumatol Ther 2024; 11:381-395. [PMID: 38345716 PMCID: PMC10920506 DOI: 10.1007/s40744-024-00643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/18/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) represents a widespread degenerative disease that causes pain and motor disability. Conservative treatments mainly focus on relieving symptoms, improving joint function, and trying to delay surgery. Safety and efficacy of hybrid cooperative complexes (2.4% sodium hyaluronate and 1.6% sodium chondroitin; HA-SC) for symptomatic KOA were investigated in a single-arm, prospective, pilot study. METHODS Patients with a visual analogue scale (VAS) pain score ≥ 4 and Kellgren-Lawrence Grade < 4 received a single intraarticular HA-SC injection. Patients with a VAS score change from baseline ≤ 1 received a second injection at day 30. Device-related adverse events (DR-AEs)/adverse events (AEs) were primary endpoints. Secondary endpoints included Western Ontario and McMaster Universities Osteoarthritis Index LK 3.1 (WOMAC LK 3.1), VAS, patient global assessment of disease status (PtGA), and patient proportion needing a second injection. RESULTS Of 83 patients with KOA (Kellgren-Lawrence Grade, 2-3), 34.9% had DR-AEs at day 7. No serious DR-AEs/AEs were reported. A significant (P < 0.0001) reduction over time in VAS pain score plus WOMAC pain, stiffness, physical function limitation, and total scores was reported. Median PtGA scores indicated a 'slight improvement' at most follow-up visits. Only 18.1% of patients required a second injection. CONCLUSIONS A single intraarticular HA-SC injection was safe, well-tolerated, and did not lead to major deterioration in terms of reducing knee pain, stiffness, and physical function limitation in patients with symptomatic KOA.
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Affiliation(s)
- Cristiano Sconza
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
| | - Dario Romano
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Dalila Scaturro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy
| | - Giulia Letizia Mauro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy
| | - Giulia Leonardi
- Department of Physical and Rehabilitation Medicine, University Hospital "G. Martino", Messina, Italy
| | - Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Stefano Respizzi
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Berardo Di Matteo
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
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Safali S, Ertaş ES, Özdemir A, Cataklı D. Evaluation of single and multiple hyaluronic acid injections at different concentrations with high molecular weight in the treatment of knee osteoarthritis. BMC Musculoskelet Disord 2024; 25:164. [PMID: 38383379 PMCID: PMC10880376 DOI: 10.1186/s12891-024-07200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Knee osteoarthritis is severe progressive and most commonly diagnosed articular disease and its incidence is increasing around the world depending on age. This pathologic condition which limits daily activity of patients can be characterized by degeneration of cartilage and inflammation. Although non-steroidal anti-inflammatory (NSAII) agents and other analgesics are routinely used treatment options, the potential effects of intraarticular injections including hyaluronic acid (HA) have also been demonstrated by various studies. However, few studies compare the efficacy of a single high molecular weight (HMW) high dose and a triple HMW low dose. This study aimed to compare the efficacy of single high molecular weight (HMW) high dose (2 mL / 60 mg) and triple HMW low dose (2 mL /30 mg) intra-articular injection of HA in knee osteoarthritis (OA) patients by evaluating function and pain parameters during 12 months. METHODS This is a single-center, retrospective clinical study that included and involved 128 patients. Group I (n=64) patients received triple 30 mg HA injections (SEMICAL®) with one-week intervals, while Group II (n=64) patients received a single 60 mg HA injection (SEMICAL®). Lequesne Index, WOMAC and VAS scores were recorded to assess pain and function during a 12-month period. RESULTS There was no significant difference in characteristics of patient demographics. Our finding indicate that WOMAC, VAS score, and Lequesne Index values during follow-up visits exhibited a decrease, signifying improvement in the clinical condition. Notably, scores were significantly more favorable with the 30 mg of HA injection compared to the 60 mg of HA injection. CONCLUSION This study suggests that the triple low-dose injection of HMW HA is more effective in improving WOMAC, VAS scores and Lequesne Index values than a single high-dose injection.
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Affiliation(s)
- Selim Safali
- Orthopaedics and Traumatology Department, Faculty of Medicine, Selcuk University, Konya, Turkey.
| | - Erkan Sabri Ertaş
- Orthopaedics and Traumatology Department, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Ali Özdemir
- Orthopaedics and Traumatology Department, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Deniz Cataklı
- Department of Pharmacology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Ohana N, Segal D, Kots E, Feldman V, Nyska M, Palmanovich E, Slevin O. A pilot study exploring the use of hyaluronic acid in treating insertional achilles tendinopathy. J Orthop Surg (Hong Kong) 2024; 32:10225536241242086. [PMID: 38589277 DOI: 10.1177/10225536241242086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
PURPOSE This study explores the use of ultrasound-guided Hyaluronic Acid (HA) injections for Insertional Achilles Tendinopathy (IAT). METHODS A cohort of 15 ankles diagnosed with IAT received three weekly ultrasound-guided HA injections. The Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire scored the severity of symptoms and functional impairment before treatment, and at one and six months post-treatment. RESULTS Significant improvement was observed in VISA-A scores post-treatment, rising from an average baseline of 34.8 ± 15.2 (11-63) to 53.6 ± 20.9 (15-77) after one month, and then to 50.7 ± 18.6 (20-75) after six months. No adverse reactions were noted, underscoring the safety of the intervention. CONCLUSION The pilot study presents HA injections as a potentially effective treatment for IAT, while interpretation of these findings must take into account the variability in results, indicating a range of patient responses. It encourages further research to confirm these findings and to explore HA's full potential in managing IAT, despite the limitations of a small sample size and lack of control group.
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Affiliation(s)
- Nissim Ohana
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar-Saba, Israel
- Faculty of medicine, Tel-Aviv University, Tel Aviv, Israel
| | - David Segal
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar-Saba, Israel
- Faculty of medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eugene Kots
- Faculty of medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Radiology, Musculoskeletal and Invasive Radiology unit, Meir Medical Center, Kfar-Saba, Israel
| | - Viktor Feldman
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar-Saba, Israel
- Faculty of medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Meir Nyska
- Faculty of medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ezequiel Palmanovich
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar-Saba, Israel
- Faculty of medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Omer Slevin
- Faculty of medicine, Tel-Aviv University, Tel Aviv, Israel
- Hand surgery unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Ranawat A, Guo K, Phillips M, Guo A, Niazi F, Bhandari M, Waterman B. Health Economic Assessments of Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review. Adv Ther 2024; 41:65-81. [PMID: 37899384 DOI: 10.1007/s12325-023-02691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Hyaluronic acid (HA) use to treat knee osteoarthritis (OA) has been extensively investigated in the literature. There are also multiple economic assessments comparing intra-articular HAs with oral anti-inflammatory medicines and other conservative measures (NSAIDs), as well as different types and formulations of HA. Owing to the broad landscape of evidence across this area, it is important to further understand the empirical data comparing HA products, as well as the health economic implications that exist between commercially available HAs. This systematic review aims to identify and summarize the available evidence comparing commercially available HA products in the USA, as well as the health economic evidence and socioeconomic outcomes associated with HA use for knee OA. METHODS A systematic literature review within the OVID Medline, Embase, HealthStar, and Cochrane EBM HTA databases was conducted. Articles were screened for eligibility, and a qualitative summary of the findings was provided based on specific themes: (1) trials comparing the safety and/or efficacy of two or more HA products in knee OA, (2) economic/cost analyses of HA use in knee OA, and (3) studies investigating healthcare resource utilization in patients treated with HA for knee OA. RESULTS The search strategy identified 398 studies, 27 of which were deemed eligible: 21 health economic analyses with US relevance and six head-to-head trials of HA products available in the USA, cumulatively assessing 5,782,156 patients with knee OA. The evidence demonstrates a clear distinction between high and low molecular weight HAs, as both efficacy and cost analyses provided favorable results for the high molecular weight options. In all but one cost analysis, HA use was a cost-effective option when compared to routine nonoperative care, captured in administrative databases, which typically included NSAID use and/or corticosteroids. HA saw benefits in delaying the need for total knee arthroplasty (TKA), decreasing the use of rescue medication, and limiting the need for additional corticosteroid injection. The included evidence highlights that the treatment's cost-effectiveness is improved when HA is utilized in earlier stages of the disease, as opposed to when HA is reserved for late stages of knee OA. Additionally, among HAs, Bio-HA and Hylan G-F 20 evidence made up the majority of available literature with beneficial efficacy and cost outcomes. Head-to-head evidence between them indicated similar pain outcomes; however, Bio-HA required less rescue with acetaminophen and had fewer joint effusions in this comparison. CONCLUSIONS The available efficacy and safety data as well as health economic analyses on the use of HA for knee OA management suggest that there are economic benefits of this treatment option. From a healthcare system perspective, the body of HA literature summarizes favorable costs profile, decreased opioid and corticosteroid use as rescue medication, and a delay to the need for TKA in patients who have HA included in their treatment regimen.
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Affiliation(s)
- Anil Ranawat
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Kaiwen Guo
- Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA.
| | - Mark Phillips
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Amy Guo
- Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA
| | - Faizan Niazi
- Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brian Waterman
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Ferkel E, Manjoo A, Martins D, Bhandari M, Sethi P, Nicholls M. Intra-articular Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review of Product Properties. Cartilage 2023; 14:424-432. [PMID: 37314014 PMCID: PMC10807741 DOI: 10.1177/19476035231154530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/30/2022] [Accepted: 12/30/2022] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION There are many intra-articular hyaluronic acid (IA-HA) products on the market that have known intrinsic differences in molecular size, source, and structure. The current review summarizes existing evidence describing and assessing these differences, while also identifying whether these differences have an impact on clinical outcomes. METHODS This systematic review summarized all literature that specifically addresses IA-HA product differences. Included studies summarized basic science and mechanism of action comparisons of IA-HA product differences, or systematic reviews that assess differences in clinical outcomes between IA-HA product differences. RESULTS A total of 20 investigations assessed basic science differences between IA-HA products, while 20 investigations provided assessments of the clinical outcome differences between IA-HA product characteristics. The published basic science literature provided a differentiation between low molecular weight (LMW) and high molecular weight (HMW) HA with regard to changes within the synovial fluid, driven by the interactions that these molecules have with receptors in the joint space. These differences in receptor interaction manifest within clinical outcomes, as meta-analyses comparing pain relief after IA-HA suggest that pain reduction is superior in patients who receive HMW HA as opposed to LMW HA. CONCLUSION This review highlights differences between IA-HA characteristics, and how important the molecular weight, derivation of the product, and structure are to variances in reported clinical outcomes to treat osteoarthritis (OA) of the knee. HMW IA-HAs have shown greater efficacy compared to the alternative of LMW products, while avian-derived and cross-linked products have potentially demonstrated an increase in inflammatory events over non-avian-derived, non-cross-linked HAs.
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Affiliation(s)
- Eric Ferkel
- Southern California Orthopedic Institute, Los Angeles, CA, USA
| | - Ajay Manjoo
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Sethi
- Orthopedic & Neurosurgical Specialists, ONS Foundation, Greenwich, CT, USA
| | - Mathew Nicholls
- Virginia Mason Orthopedics & Sports Medicine, Seattle, WA, USA
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Bernetti A, Agostini F, Paoloni M, Raele MV, Farì G, Megna M, Mangone M. Could Hyaluronic Acid Be Considered as a Senomorphic Agent in Knee Osteoarthritis? A Systematic Review. Biomedicines 2023; 11:2858. [PMID: 37893231 PMCID: PMC10604344 DOI: 10.3390/biomedicines11102858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is one of the most common causes of disability in elderly patients and tends to be a major burden on social and health care spending. Despite its severe socioeconomic impact, KOA remains, to date, an incurable disease. Due to its proper characteristics, KOA represents a favorable disease model for experimenting with senotherapeutics, a group of treatments that counteract the development of age-related disorders and chronic diseases. In recent years, the use of intra-articular hyaluronic acid (IAHA) in the treatment of diseases related to the wear and tear of the articular cartilage has been gaining popularity. Given its ability in joint lubrification, shock absorption, and cell signaling, our aim is to investigate, through the existing scientific literature, its potential role as a senomorphic agent, emphasizing its crucial function in KOA patients. Indeed, senomorphics are a particular group of senotherapeutics capable of modulating the functions and morphology of senescent cells to those of young cells or delaying the progression of young cells to senescent cells in tissues. METHODS A search in the scientific literature (PubMed, Cochrane Library, and Google Scholar) was carried out from 2019 to 2023, thus the last 5 years. RESULTS One hundred thirty-eight articles were found concerning the role of hyaluronic acid injections in KOA patients. In these studies, its therapeutic efficacy, its anti-inflammatory properties, and its low risk of side effects emerged. CONCLUSION IAHA injections are a valuable treatment option for KOA while they can provide pain relief, improve joint function, and slow the progression of joint degeneration. The inhibitory effect of HA on MMP13 and its action as a senomorphic agent suggests that it may have additional benefits beyond its lubricating and shock-absorbing properties. In order to clarify its mechanisms of action and to optimize its clinical use, further studies are definitely needed.
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Affiliation(s)
- Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy;
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy; (F.A.); (M.P.); (M.M.)
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy; (F.A.); (M.P.); (M.M.)
| | - Maria Vittoria Raele
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.V.R.); (M.M.)
| | - Giacomo Farì
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy;
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.V.R.); (M.M.)
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy; (F.A.); (M.P.); (M.M.)
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Zeng L, Zhou G, Yang W, Liu J. Guidelines for the diagnosis and treatment of knee osteoarthritis with integrative medicine based on traditional Chinese medicine. Front Med (Lausanne) 2023; 10:1260943. [PMID: 37915321 PMCID: PMC10617515 DOI: 10.3389/fmed.2023.1260943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Knee osteoarthritis (KOA) is a common geriatric disease in middle-aged and elderly people. Its main pathological characteristics are articular cartilage degeneration, changes in subchondral bone reactivity, osteophyte formation at joint edges, synovial disease, ligament relaxation or contracture, and joint capsular contracture. The prevalence rate of symptomatic KOA in middle-aged and elderly people in China is 8.1%, and this is increasing. The main clinical manifestations of this disease are pain and limited activity of the knee joint, which seriously affect the quality of life of patients and may cause disability, posing a huge burden on society and the economy. Although the pathogenesis of KOA is not clear, the treatment of KOA is diverse, and Chinese medicine, which mainly relies on plant-based natural products, has a relatively stable and reliable curative effect. This guideline aims to emphasize the evidence-based staging and stepped treatment of KOA and the therapeutic effect of integrative medicine based on traditional Chinese medicine on KOA. We make recommendations that include the adoption of manual therapy, acupuncture, external application of herbs, herbal plasters, exercise therapy, and other integrative medicine based on traditional Chinese medicine. Users of the above guidelines are most likely to include clinicians and health managers in healthcare settings.
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Affiliation(s)
- Lingfeng Zeng
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Guanghui Zhou
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weiyi Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Enginering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
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Peterson KS, Vacketta V, Kavanagh A. The Ankle Joint: Non-Operative Updates in Ankle Arthritis, Are Biologics Working? Clin Podiatr Med Surg 2023; 40:669-680. [PMID: 37716744 DOI: 10.1016/j.cpm.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
The vast majority of ankle arthritis is post-traumatic in nature, with rates of 60% to 80%. Symptoms include pain, decreased range of motion, and joint effusion. Diagnostic imaging is helpful in determining the degree of joint degeneration, with MRI and CT scan being the most sensitive. Conservative treatment modalities are targeted at reducing symptoms and improving function. Injectable therapy has gained popularity over the last few decades, with advancements in biologic treatments. Corticosteroids, hyaluronic acid, platelet-rich plasma, and amniotic tissue-derived products can be used to reduce inflammation in the joint, as well as prevent cartilage degeneration.
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Affiliation(s)
- Kyle S Peterson
- Suburban Orthopaedics, 1110 West Schick Road, Bartlett, IL 60103, USA.
| | - Vincent Vacketta
- Orthopedic Foot and Ankle Center Fellowship, 350 West Wilson Bridge Road, Suite. 200, Worthington, OH 43085, USA
| | - Amber Kavanagh
- Hinsdale Orthopaedics (IBJI) Foot and Ankle Fellowship, 951 Essington Road, Joliet, IL 60435, USA
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12
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Ossendorff R, Thimm D, Wirtz DC, Schildberg FA. Methods of Conservative Intra-Articular Treatment for Osteoarthritis of the Hip and Knee. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:575-581. [PMID: 37427991 PMCID: PMC10552632 DOI: 10.3238/arztebl.m2023.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Osteoarthritis is a degenerative joint disease that is becoming increasingly common as the population ages. Conservative treatment for hip or knee osteoarthritis has been limited to pain control. Intra-articular injections for targeted local treatment have been widely used in clinical practice for many years. METHODS This review is based on publications retrieved by a selective literature search, including recent meta-analyses, systematic reviews, randomized controlled trials (RCTs), and current guidelines. RESULTS In Germany, the 12-month prevalence of osteoarthritis in adults is 17.9%. Conservative treatments are intended to alleviate symptoms and do not affect the progression of the disease. Glucocorticoids can be used to relieve otherwise intractable pain in the short term, but their prolonged use increases the risk of cartilage loss and progression of osteoarthritis. According to multiple guidelines, there is only weak evidence for the use of hyaluronic acid. Evidence does exist that high-molecular-weight hyaluronic acid may lead to better outcomes than the low-molecular-weight form. RCTs have revealed no more than short-term clinical efficacy for a variety of specific therapeutic approaches, including the use of cytokine inhibitors. Other treatments, e.g., with platelet-enriched plasma, aspirates from bone marrow or adipose tissue, or expanded mesenchymal stromal cells (MSC), have not been found to have clinically relevant long-term effects. CONCLUSION In view of the scant available evidence, further standardized RCTs will be needed to give a more comprehensive picture of the efficacy of intra-articular treatments for hip and knee osteoarthritis.
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Affiliation(s)
- Robert Ossendorff
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn
| | - Dominik Thimm
- Pharmaceutical Institute, Pharmaceutical & Medical Chemistry, Rhenish Friedrich Wilhelm University of Bonn
| | - Dieter C. Wirtz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn
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13
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Tschopp M, Pfirrmann CW, Fucentese SF, Brunner F, Catanzaro S, Kühne N, Zwyssig I, Sutter R, Götschi T, Tanadini M, Rosskopf AB. A Randomized Trial of Intra-articular Injection Therapy for Knee Osteoarthritis. Invest Radiol 2023; 58:355-362. [PMID: 36728848 PMCID: PMC10090303 DOI: 10.1097/rli.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intra-articular injections are widely used for conservative treatment of knee osteoarthritis (OA). However, rigorous data are lacking regarding the comparative therapeutic effectiveness of these injections. PURPOSE The aim of this study was to compare clinical outcomes after intra-articular injections of glucocorticoid, hyaluronic acid, platelet-rich plasma (PRP), or placebo in patients with mild or moderate OA of the knee. MATERIALS AND METHODS In a double-blinded, placebo-controlled, single-center trial, we randomly assigned knees with early- to middle-stage knee OA (Kellgren-Lawrence grade 1-3) to an intra-articular injection with one of these substances: glucocorticoid, hyaluronic acid, PRP, or placebo. Primary outcome was pain reduction within 6 months after the injection, assessed with the numeric rating scale (NRS; range, 0-100). Secondary outcome parameters included WOMAC scores, Tegner Activity Scale, knee mobility, and adverse events. Finally, a linear mixed-effects model was calculated and corrected for possible patient and covariate effects. RESULTS One hundred twenty knees (30 knees per treatment group) in 95 patients (41 female) were included in the final analysis. The median age of patients was 60 years (interquartile range, 54.0-68.0). There was no evidence that the drug effects of primary and secondary outcome parameters differed over time. The median pain at baseline was 32.5 (interquartile range, 15.00-50.00) on NRS. The changes in pain level during the first 6 months compared with baseline were small (within ±5 points on NRS), whereas the intrapatient variability was large between -20 and +20 points. Secondary outcome parameters did not differ significantly among the groups. Kellgren-Lawrence grade did not have a statistically significant effect on pain reduction ( P = 0.61). CONCLUSIONS There is no evidence that knee injections with glucocorticoid, PRP, or hyaluronic acid have superior short- or long-term effects in patients with low pain level at baseline and early- to middle-stage knee OA when compared with placebo.
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Affiliation(s)
- Marcel Tschopp
- From the Department of Physical Medicine and Rheumatology, Balgrist University Hospital
| | | | - Sandro F. Fucentese
- University of Zurich, Faculty of Medicine
- Orthopedic Surgery, Balgrist University Hospital
| | - Florian Brunner
- From the Department of Physical Medicine and Rheumatology, Balgrist University Hospital
- University of Zurich, Faculty of Medicine
| | | | | | - Iwan Zwyssig
- Unit for Clinical and Applied Research, Balgrist Campus
| | - Reto Sutter
- University of Zurich, Faculty of Medicine
- Departments of Radiology
| | - Tobias Götschi
- Unit for Clinical and Applied Research, Balgrist Campus
- Institute for Biomechanics, Swiss Federal Institute of Technology
| | - Matteo Tanadini
- Zurich Data Scientists, c/o Impact Hub Zurich AG, Zurich, Switzerland
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14
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Via GG, Brueggeman DA, Lyons JG, Frommeyer TC, Froehle AW, Krishnamurthy AB. Funding has no effect on studies evaluating viscosupplementation for knee osteoarthritis: A systematic review of bibliometrics and conflicts of interest. J Orthop 2023; 39:18-29. [PMID: 37089621 PMCID: PMC10114245 DOI: 10.1016/j.jor.2023.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/11/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Background Viscosupplementation for knee osteoarthritis (OA) may raise concerns regarding conflicts of interest (COI). Evidence of inconclusive study results and publication bias in previous studies has led to concern that financial COI have influenced viscosupplementation outcomes. It is critical to ensure that clinical practice is guided by informed decision making and evidence-based medicine. Methods A systematic review was conducted following PRISMA guidelines. PubMed, MEDLINE, and Web of Science databases were searched for articles pertaining to hyaluronic acid (or similarly derived) injections to native knees with primary OA only. Bibliometric data, financial COI, and study outcomes were assessed. Results 67 studies met inclusion criteria for analysis, 53 of which (79.1%) presented Level I evidence, and 21 of which (31.3%) reported at least one author with COI. All studies reporting COI also disclosed industry funding. There were no relationships between reported COI and study outcomes (Χ 2 = 0.31, P = 0.577), levels of evidence (Χ 2 = 3.48, P = 0.176), or relative citation ratio (RCR) (S = 743, P = 0.591). Studies reporting COIs/industry funding tended to be published in journals with significantly higher impact factors (IF) (reporting COI: IF = 3.5 ± 2.0; no COI: IF = 1.8 ± 1.1; S = 950, P < 0.001). Study outcomes were not related to the probability of being published in an open access journal (Χ 2 = 0.01, P = 0.960), nor to level of evidence (Χ 2 = 2.67, P = 0.263), RCR (S = 618, P = 0.835), or IF (S = 563, P = 0.655). Conclusions Investigator COIs (and commercial funding of studies) have not significantly influenced the frequency of favorable outcomes or study level of evidence regarding contemporary viscosupplementation for the treatment of knee OA. Studies reporting COIs/industry funding tended to be published in journals with significantly higher impact factors. Results overwhelmingly supported using viscosupplementation to treat knee OA. Level of evidence Level V Systematic Review.
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Affiliation(s)
- Garrhett Glenn Via
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
| | - David Anthony Brueggeman
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
| | - Joseph Gabriel Lyons
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
| | - Timothy Charles Frommeyer
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
| | - Andrew William Froehle
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
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15
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Blicharski T, Łukasik P, Plebanski R, Żęgota Z, Szuścik M, Moster E, Pavelka K, Jeon S, Park SL. Efficacy and Safety of Intra-Articular Cross-Linked Sodium Hyaluronate for the Treatment of Knee Osteoarthritis: A Prospective, Active-Controlled, Randomized, Parallel-Group, Double-Blind, Multicenter Study. J Clin Med 2023; 12:jcm12082982. [PMID: 37109318 PMCID: PMC10145240 DOI: 10.3390/jcm12082982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
The safety and efficacy of Hyruan ONE (test product), an intra-articular cross-linked sodium hyaluronate injection, to treat mild-to-moderate knee osteoarthritis was compared with that of Durolane (comparator) in a prospective, active-controlled, parallel-group, double-blind (masked-observed), multicenter non-inferiority study. European patients (n = 284) were randomized 1:1 (test product:comparator) and received one injection of cross-linked hyaluronic acid (60 mg/3 mL). In total, 280 patients completed the study. The primary endpoint of mean change in Western Ontario and McMaster University (WOMAC)-Likert Pain sub-scores from baseline at week 13 revealed changes of -5.59 and -5.54 for the test and comparator groups, respectively, demonstrating non-inferiority of the test product (difference, -0.05 [95% confidence interval, -0.838 to 0.729]). Secondary endpoint results, which included changes in WOMAC-Likert Pain sub-score from baseline to 26 weeks post-injection and changes in WOMAC-Likert Total score and Physical Function and Stiffness sub-scores, changes in patients' and investigators' global assessments, use of rescue medication, and responder rates at 13 and 26 weeks post-injection were similar between the groups. Incidence of adverse events was also similar. In both groups, most treatment-emergent adverse events were mild/moderate. Hyruan ONE was non-inferior to the comparator at 13 weeks post-injection in European patients with mild-to-moderate knee osteoarthritis.
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Grants
- T.B., T.H., A.G., J.B., P.Ł., R.P., Z.Ż., M.S., E.M., K.P., and T.T. received a study grant from LG Chem, Ltd. S.J. and S.L.P. are full-time employees of LG Chem, Ltd LG Chem
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Affiliation(s)
- Tomasz Blicharski
- Clinic of Rehabilitation and Orthopedics, Medical University of Lublin, 20-090 Lublin, Poland
| | - Piotr Łukasik
- Trauma and Orthopedic Ward, NZOZ Medi-Spatz, 44-100 Gliwice, Poland
| | | | - Zbigniew Żęgota
- Specjalistyczny Osrodek Leczniczo Badawczy (Specialist Treatment and Research Center), 14-100 Ostroda, Poland
| | - Marek Szuścik
- Orthopedic Department, Rydygier's Hospital, 31-826 Krakow, Poland
| | - Erik Moster
- Rheumatic Center of Dr. Mostera, 61500 Brno, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, 12850 Prague, Czech Republic
| | - Seonhui Jeon
- Life Sciences, LG Chem, Ltd., Seoul 07336, Republic of Korea
| | - So La Park
- Life Sciences, LG Chem, Ltd., Seoul 07336, Republic of Korea
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16
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Belk JW, Lim JJ, Keeter C, McCulloch PC, Houck DA, McCarty EC, Frank RM, Kraeutler MJ. Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone-Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis. Arthroscopy 2023:S0749-8063(23)00220-7. [PMID: 36913992 DOI: 10.1016/j.arthro.2023.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/13/2023] [Accepted: 03/01/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE To systematically review the literature in order to compare the efficacy and safety of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and hyaluronic acid (HA) injections for the treatment of knee osteoarthritis (OA). METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify Level I studies that compared the clinical efficacy of at least 2 of the following 3 injection therapies: PRP, BMAC, and HA for knee OA. The search phrase used was knee AND osteoarthritis AND randomized AND ("platelet rich plasma" OR "bone marrow aspirate" OR "hyaluronic acid"). Patients were primarily assessed based on patient-reported outcome scores (PROs) including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) score. RESULTS Twenty-seven studies (all Level I) met inclusion criteria, including 1,042 patients undergoing intra-articular injection(s) with PRP (mean age 57.7 years, mean follow-up 13.5 months), 226 patients with BMAC (mean age 57.0 years, mean follow-up 17.5 months), and 1,128 patients with HA (mean age 59.0 years, mean follow-up 14.4 months). Non-network meta-analyses demonstrated significantly better post-injection WOMAC (p < 0.001), VAS (p < 0.01), and Subjective IKDC scores (p < 0.001) in PRP patients when compared to HA patients. Similarly, network meta-analyses demonstrated significantly better post-injection WOMAC (p < 0.001), VAS (p = 0.03), and Subjective IKDC (p < 0.001) scores in BMAC patients when compared to HA patients. There were no significant differences in post-injection outcome scores when comparing PRP to BMAC. CONCLUSION Patients undergoing treatment for knee OA with PRP or BMAC can be expected to experience improved clinical outcomes when compared to HA patients. LEVEL OF EVIDENCE I, Meta-Analysis of Level I studies.
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Affiliation(s)
- John W Belk
- University of Colorado School of Medicine, Aurora CO 80045
| | - Joseph J Lim
- University of Colorado Boulder, Boulder CO 80309
| | - Carson Keeter
- University of Colorado School of Medicine, Department of Orthopedics, Aurora CO 80045
| | - Patrick C McCulloch
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston TX 77030
| | - Darby A Houck
- University of Colorado School of Medicine, Aurora CO 80045
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Aurora CO 80045
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopedics, Aurora CO 80045
| | - Matthew J Kraeutler
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston TX 77030.
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17
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Lu KH, Lu PWA, Lin CW, Lu EWH, Yang SF. Different molecular weights of hyaluronan research in knee osteoarthritis: A state-of-the-art review. Matrix Biol 2023; 117:46-71. [PMID: 36849081 DOI: 10.1016/j.matbio.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
Osteoarthritis (OA), the most common form of arthritis, is characterized by progressive cartilage destruction, concomitant adaptive osteogenesis, and loss of joint function. The progression of OA with aging is associated with a decrease in native hyaluronan (HA, hyaluronate or hyaluronic acid) with a high molecular weight (HMW) in synovial fluid and a subsequent increase in lower MW HA and fragments. As HMW HA possesses numerous biochemical and biological properties, we review new molecular insights into the potential of HA to modify OA processes. Different MWs in the formulation of products appear to have varying effects on knee OA (KOA) pain relief, improved function, and postponing surgery. In addition to the safety profile, more evidence indicates that intraarticular (IA) HA administration may be an effective option to treat KOA, with a particular emphasis on the use of HA with fewer injections of higher MW, including potential applications of HA of very HMW. We also analyzed published systemic reviews and meta-analyses of IA HA in treating KOA in order to discuss their conclusions and consensus statements. According to its MW, HA may offer a simple way to refine therapeutic information in selective KOA.
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Affiliation(s)
- Ko-Hsiu Lu
- Department of Orthopedics, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | | | - Chiao-Wen Lin
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Eric Wun-Hao Lu
- Department of Mechanical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
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18
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Mao B, Pan Y, Zhang Z, Yu Z, Li J, Fu W. Efficacy and Safety of Hyaluronic Acid Intra-articular Injection after Arthroscopic Knee Surgery: A Systematic Review and Meta-analysis. Orthop Surg 2022; 15:16-27. [PMID: 36411508 PMCID: PMC9837239 DOI: 10.1111/os.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Hyaluronic acid (HA) intra-articular injection after arthroscopic knee surgery has been widely applied but its efficacy and safety remain controversial. The aim of this systematic review is to analyze the efficacy and safety of HA intra-articular injection after arthroscopic knee surgery, and to compare the efficacy of HA with different molecular weights. METHODS We conducted a systematic literature search in PubMed, Embase, Google scholar and the Cochrane library from inception to 16 September 2022 for English-written articles, in order to identify randomized controlled trials that evaluated the clinical efficacy and/or safety of HA intra-articular injection after arthroscopic knee surgery. Then we meta-analyzed the outcomes of patients given intra-articular HA injections postoperatively and control patients. We also evaluated the influence of HA with different molecular weights. In every calculation, sensitive analysis was performed. The visual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and adverse events were selected as the primary outcome measurements, while Lysholm, International Knee Documentation Committee (IKDC) and Tegner score were selected as the secondary outcome measurements. Publication bias of every outcome was evaluated using egger test. RESULTS Fifteen studies involving 951 knees were included and 12 of them were used to performed the meta-analysis. The results showed no significant difference between the HA group and control group according to VAS, whether assessed at less (P = 0.90) or more than 6 months (P = 0.55). Besides, there were no statistical differences between the HA group and control group according to subgroup analysis (Ps = 0.77, 0.91 and 0.81 in anterior cruciate ligament reconstruction, meniscectomy and overall groups, respectively). Compared to control group, the overall effect of WOMAC score showed no significant differences (P = 0.25), nor did in two subgroups (P = 0.37 and P = 0.22). Outcomes measured by Lysholm (P = 0.13), IKDC (P = 0.86) and Tegner (P = 0.42) scores showed no significant differences, either. The analysis of the risk of adverse events indicated no increase in HA groups (P = 0.06). We found no significant differences between high- and low-molecular-weight HA at 6 (P = 0.96) or 12 months (P = 0.93) postoperatively. Two studies failed to pass the sensitive analysis and the reasons were discussed detailly and acceptable publication bias was observed. CONCLUSIONS Although HA injection after arthroscopic knee surgery is safe, the available evidence does not support its efficacy in pain relief and functional recovery. Therefore, the application of HA injection after arthroscopic knee surgery is not recommended.
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Affiliation(s)
- BeiNi Mao
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina,Department of Orthopaedics SurgeryShenzhen Hospital, Southern Medical UniversityShenzhenChina
| | - YunLong Pan
- Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
| | - Zhong Zhang
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina,Department of Orthopaedics SurgeryNO. 3 People's Hospital of ChengduChengduChina
| | - ZePing Yu
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
| | - Jian Li
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
| | - WeiLi Fu
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
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19
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Huang HY, Hsu CW, Lin GC, Lin HS, Chou YJ, Liou IH, Sun SF. Comparing efficacy of a single intraarticular injection of platelet-rich plasma (PRP) combined with different hyaluronans for knee osteoarthritis: a randomized-controlled clinical trial. BMC Musculoskelet Disord 2022; 23:954. [PMID: 36329428 PMCID: PMC9635114 DOI: 10.1186/s12891-022-05906-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Intraarticular plasma-rich platelet (PRP) and hyaluronic acid (HA) have each been shown to be effective for treating knee osteoarthritis (OA). Evidence supporting the combination therapy is controversial. This study aimed to investigate the efficacy of a single intraarticular PRP injection combined with different HAs in patients with knee OA. METHODS In this prospective randomized-controlled trial, 99 patients with Kellgren-Lawrence grade 2 knee OA with average knee pain ≥ 30 mm on a 0-100 mm pain visual analog scale (VAS) were randomized into two groups. The PRP + Artz group received a single intraarticular HA (Artz, 2.5 ml, 10 mg/ml) followed by 3 ml PRP (n = 50). The PRP + HYAJOINT Plus group received a single intraarticular cross-linked HA (HYAJOINT Plus, 3 ml, 20 mg/ml) followed by 3 ml PRP (n = 49). All patients were evaluated before and at 1, 3 and 6 months after injections. The primary outcome was the VAS pain reduction from baseline at 6 months. Secondary outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance (SLS) test and patient satisfaction. RESULTS Ninety-five patients were analyzed by intention-to-treat analysis. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at 1, 3 and 6 months post intervention (p < 0.05). Between-group comparisons showed no significant differences at most follow-up time points, except better improvements in Lequesne index at 1 month (p = 0.003) and WOMAC-stiffness score at 6 months (p = 0.020) in the PRP + Artz group, and superiority in SLS at 1, 3 and 6 months in the PRP+ HYAJOINT Plus group (p < 0.001, p = 0.003 and p = 0.004). Additional Johnson-Neyman analyses showed that among the patients with baseline WOMAC-pain score > 8.5, WOMAC-function score > 21.7 and WOMAC-total score > 32.0, respectively, those treated with PRP + HYAJOINT Plus injections had better effects in WOMAC-pain, WOMAC-function and WOMAC-total scores than those treated with PRP + Artz at 3 months postinjection (p < 0.05). Both groups reported high satisfaction. No serious adverse events occurred during the study. CONCLUSIONS A single PRP injection combined with Artz or HYAJOINT Plus is effective and safe for 6 months in patients with knee OA. Both injection regimens are potential treatment options for knee OA. Further studies are needed to confirm these results. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT04931719), retrospectively. Date of registration 18/6/2021. NAME OF TRIAL REGISTRY Comparing efficacy of single PRP combined with different hyaluronans for knee osteoarthritis. LEVEL OF EVIDENCE Therapeutic Level 1.
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Affiliation(s)
- Hung-Ya Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No 386, Ta-Chung 1st Road, 813, Kaohsiung, Taiwan, Republic of China
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
| | - Chien-Wei Hsu
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Guan-Chyun Lin
- Department of Information Technology and Management, Fooyin University, Kaohsiung, Taiwan, Republic of China
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan
| | - Yi-Jiun Chou
- Department of Orthopedic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - I-Hsiu Liou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No 386, Ta-Chung 1st Road, 813, Kaohsiung, Taiwan, Republic of China
| | - Shu-Fen Sun
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No 386, Ta-Chung 1st Road, 813, Kaohsiung, Taiwan, Republic of China.
- National Yang-Ming University School of Medicine, Taipei, Taiwan.
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20
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Moon JY, Kim J, Lee JY, Ko Y, Park HJ, Jeon YH. Comparison of polynucleotide, sodium hyaluronate, and crosslinked sodium hyaluronate for the management of painful knee osteoarthritis: a multi-center, randomized, double-blind, parallel-group study. PAIN MEDICINE 2022; 24:496-506. [PMID: 36255262 DOI: 10.1093/pm/pnac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the clinical effectiveness of sodium polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid for the management of painful knee osteoarthritis. DESIGN Randomized, double-blind, parallel-group clinical trial. SETTING Multicenter study. SUBJECTS Patients with chronic painful knee osteoarthritis. METHODS Ninety patients were selected and randomized into polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid groups (30 per group). Intra-articular injections of the viscosupplement for each group were administered to the patients three times at one-week intervals. The primary outcome was differences in changes of weight-bearing pain scores at 16 weeks between the groups. The secondary outcomes were changes in the intensity of knee pain during weight-bearing, walking, and rest, and functional disability, quality of life, and adverse events during the 16-week follow-up period. RESULTS At 16 weeks, the polynucleotide group showed a higher reduction in pain score using a Visual Analog Scale score (0-100) than the classic hyaluronic acid (-17.6 [95% CI = -35.1 to -0.1]; P = 0.048) and crosslinked hyaluronic acid (-22.4 [95% CI = -41.5 to -3.3]; P = 0.016) groups. The polynucleotide and crosslinked hyaluronic acid groups showed an early-onset reduction in knee pain during weight-bearing, walking, and rest. All three groups showed reductions in functional disability and improved quality of life at 16 weeks without inter-group differences. No severe adverse events were reported throughout the study period. CONCLUSION Polynucleotide significantly relieves pain more and relieves pain faster in patients with knee osteoarthritis than classic and crosslinked hyaluronic acid, with improved health-related quality of life. CLINICAL TRIAL NUMBER AND REGISTRY URL Clinical Research Information Service (https://cris.nih.go.kr/cris/index.jsp; Identifier: KCT0005308).
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Affiliation(s)
- Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeongsoo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Heu Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Jeon
- Department of Anesthesiology and Pain Medicine, Kyugpook National University College of Medicine, Daegu, Republic of Korea
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21
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Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial. BMC Musculoskelet Disord 2022; 23:856. [PMID: 36096771 PMCID: PMC9464606 DOI: 10.1186/s12891-022-05787-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Intra articular (IA) injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) are of the new methods in the management of hip osteoarthritis (OA). The aim of this study was to compare the effectiveness of IA injections of PRP, HA and their combination in patients with hip OA. HA and PRP are two IA interventions that can be used in OA in the preoperative stages. Due to the different mechanisms of action, these two are proposed to have a synergistic effect by combining. Methods This is a randomized clinical trial with three parallel groups. In this study, patients with grade 2 and 3 hip OA were included, and were randomly divided into three injection groups: PRP, HA and PRP + HA. In either group, two injections with 2 weeks’ interval were performed into the hip joint under ultrasound guidance. Patients were assessed before the intervention, 2 months and 6 months after the second injection, using the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne questionnaires. Results One hundred five patients were enrolled randomly in HA, PRP and PRP + HA groups. All three groups showed significant improvement in WOMAC, VAS, and Lequesne at 2 months and 6 months compared with baseline. Comparison of the 3 groups demonstrated significant differences regarding WOMAC and Lequesne total scores and the activities of daily living (ADL) subscale of Lequesne (P = 0.041, 0.001 and 0.002, respectively), in which the observed improvement at 6th month was significantly higher in the PRP + HA and PRP groups compared to the HA group. Conclusion Although all 3 interventions were associated with improvement of pain and function in patients with hip OA, the therapeutic effects of PRP and PRP + HA injections lasted longer (6 months), and the effects of these two interventions on patients’ performance, disability, and ADL were superior to HA in the long run. Moreover, the addition of HA to PRP was not associated with a significant increase in the therapeutic results. Trial registration The study was registered at Iranian Registry of Clinical Trials (IRCT) website http://www.irct.ir/, a WHO Primary Register setup, with the registration number of IRCT20130523013442N30 on 29/11/2019.
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22
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Ko PY, Li CY, Li CL, Kuo LC, Su WR, Jou IM, Wu PT. Single Injection of Cross-Linked Hyaluronate in Knee Osteoarthritis: A 52-Week Double-Blind Randomized Controlled Trial. Pharmaceutics 2022; 14:pharmaceutics14091783. [PMID: 36145530 PMCID: PMC9504468 DOI: 10.3390/pharmaceutics14091783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/13/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: to compare the 52-week effectiveness and safety between HYAJOINT Plus (HJP) and Durolane in knee osteoarthritis (OA) treatment. Methods: consecutive patients received a single injection of 3 mL HJP or Durolane. The primary outcome was a visual analog scale (VAS) pain measurement at 26 weeks post-injection. Secondary outcomes included other clinical, satisfaction, and safety assessments for 52 weeks. Results: 142 patients were equally randomized. At week 26, the HJP group had less VAS pain than the Durolane group (18.1 ± 9.5 versus 24.4 ± 14.0, p = 0.001). Both groups showed improvement in their VAS pain and stiffness scores, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and total scores for 52 weeks after injection (p < 0.001). However, the HJP group showed lower VAS pain and stiffness scores, reduced WOMAC pain and stiffness scores, a shorter Timed “Up & Go” (TUG) time, and a higher satisfaction score than the Durolane group for 39 weeks (p < 0.05). Only mild and self-limited adverse events occurred (40.8%). Conclusion: While a single injection of either HJP or Durolane is safe and effective for at least 52 weeks, HJP provided superior improvement in terms of VAS pain and stiffness scores, WOMAC pain and stiffness scores, and satisfaction score within 39 weeks of treatment.
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Affiliation(s)
- Po-Yen Ko
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701401, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung 404328, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
| | - Chia-Lung Li
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Department of Orthopedics, Tainan Hospital, Ministry of Health and Welfare, Tainan 700043, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan 701401, Taiwan
| | - Wei-Ren Su
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan 701401, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, Kaohsiung 824005, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 824005, Taiwan
- GEG Orthopedic Clinic, Tainan 701002, Taiwan
| | - Po-Ting Wu
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701401, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan 701401, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
- Correspondence: ; Tel.: +886-6-276-6689
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23
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Kim KY, Kim GW. The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series. J Back Musculoskelet Rehabil 2022; 35:743-748. [PMID: 34744067 DOI: 10.3233/bmr-210043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA. OBJECTIVE We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations. CASE DESCRIPTION Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects. CONCLUSION The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.
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Affiliation(s)
- Kun Yung Kim
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Kola S, Kola I, Frroku E, Abazaj E. Diagnosis and Management of Osteoarthritis with Hyaluronic Acid. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Osteoarthritis (OA) of the genu joint is a degenerative disease of the genu joint, which due to functional limitations leads to deterioration of the quality of life of these patients. In many cases, surgical therapy prosthesis of articular surfaces represents the gold standard of treatment for these patients.
AIM: In this study, it is proposed to evaluate the effectiveness of hyaluronic acid (HA) injected under the direction of Echo (ultrasound) in the genu articulation accompanied by a rehabilitation program.
MATERIALS AND METHODS: Fifteen patients with knee OA were studied. According to the Kellgren-Lawrence radiological classification, Grade II-III arthrosis does not qualify for surgical treatment. Patients underwent intra-articular injection with HA, under ultrasound guidance, and after 6 days continued with rehabilitative treatment aimed at combating the patient’s analgesic posture, recovery of muscle traction participating in genu joint movement, decompression maneuvers, and decompaction in monopodial load. Patients were evaluated at the beginning and after 3 months.
RESULTS: In the evaluation of patients at the beginning and after 3 months, a reduction in> 60% of the pain was found, and the Western Ontario and McMaster University Osteoarthritis test in 40% of patients after the first intra-articular injection. No significant side effects were observed during infiltrative procedures.
CONCLUSIONS: This study confirms the effectiveness of the combined treatment of the rehabilitation program and intra-articular therapy under the guidance of Echos, in patients suffering from knee OA, significantly reducing pain and recovery of functional capacity.
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25
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Ashuro AA, Zhang SC, Wang T, Chu QS, Fu YS, Fan YG, Ye DQ. The Effect of protease inhibitors-based antiretroviral therapy on serum/plasma interleukin-6 levels among PLHIV: a systematic review and meta-analysis. J Med Virol 2022; 94:4669-4676. [PMID: 35665943 DOI: 10.1002/jmv.27912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/15/2022] [Accepted: 05/31/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Recommended treatment regimen for HIV infection includes protease inhibitors/ritonavir (PIs/r) combined with two nucleoside reverse transcriptase inhibitors (2NRTIs), that enable to achieve and maintain viral suppression, restore and preserve immune function. However, there were inconsistent findings on the levels of interleukin-6 levels (IL-6). METHODOLOGY Systematic review and meta-analysis were performed to quantify the pooled effects of PIs/r-based ART on serum/plasma IL-6 levels in PLHIV. PubMed, Web of Science, and Embase were searched from the earliest record to November 4, 2020. Data analysis was conducted on Stata version 16 and Review Manager 5.3. A random-effect model was used to compute a pooled effect size and weighted mean difference (WMD) was considered the summary effect size. Heterogeneity between studies was estimated by Cochrane's Q test (chi-square test) and I-square statistic and subgroup analysis were performed to explore the source of heterogeneity. RESULT Initial search identified 3098 records and five studies (seven trials) met inclusion criteria. The pooled mean difference in serum/plasma IL-6 levels from baseline to follow-up was 0.534 pg/ml (95% CI: -0.012, 1.08, P=0.05, I2 =76.4%). In subgroup analysis, there was a significant association between increased serum/plasma IL-6 levels, and age group ≥35 years old, baseline CD4+ counts <350 cell/mm3 , and mean viral load ≥ 4.5 log10 copies/ml. CONCLUSION We found that serum/plasma IL-6 levels increased after combined anti-retroviral therapy (cART) among treatment-naïve individuals who initiated a successful combination of PIs/r with 2NRTIs. This result also highlights the need to monitor serum/plasma IL-6 levels during antiviral therapy, which may aid in the effective future treatment of systemic inflammation and related disorders following elevated IL-6 levels. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Akililu Alemu Ashuro
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, China, 81 Meishan Road, Hefei, Anhui, 230032, PR China
| | - Si-Chen Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, China, 81 Meishan Road, Hefei, Anhui, 230032, PR China
| | - Ting Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, China, 81 Meishan Road, Hefei, Anhui, 230032, PR China
| | - Qin-Shu Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, China, 81 Meishan Road, Hefei, Anhui, 230032, PR China
| | - Yuan-Sheng Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, China, 81 Meishan Road, Hefei, Anhui, 230032, PR China
| | - Yin-Guang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, China, 81 Meishan Road, Hefei, Anhui, 230032, PR China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, PR China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, China, 81 Meishan Road, Hefei, Anhui, 230032, PR China
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26
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Ishijima M, Nakamura T, Shimizu K, Hayashi K, Kikuchi H, Soen S, Omori G, Yamashita T, Uchio Y, Chiba J, Ideno Y, Kubota M, Kaneko H, Kurosawa H, Kaneko K. Different changes in the biomarker C-terminal telopeptides of type II collagen (CTX-II) following intra-articular injection of high molecular weight hyaluronic acid and oral non-steroidal anti-inflammatory drugs in patients with knee osteoarthritis: a multi-center randomized controlled study. Osteoarthritis Cartilage 2022; 30:852-861. [PMID: 35331859 DOI: 10.1016/j.joca.2022.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We previously reported, based on a multicenter randomized-control study, that the efficacy of intra-articular injections of hyaluronic acid (IA-HA) was not inferior to that of oral non-steroidal anti-inflammatory drugs (NSAIDs) in patients with knee osteoarthritis (OA). However, the molecular effects on the pathophysiology of knee OA remain unclear. C-terminal telopeptides of type II collagen (CTX-II) is reported to primarily originate from the interface between articular cartilage and subchondral bone, which is a site of potential remodeling in OA. We performed a predefined sub-analysis of the previous study to compare the changes of urinary CTX-II (uCTX-II) in response to IA-HA to those in response to NSAID for knee OA. DESIGN A total of 200 knee OA patients were registered from 20 hospitals and randomized to receive IA-HA (2,700 kDa HA, 5 times at 1-week intervals) or NSAID (loxoprofen sodium, 180 mg/day) for 5 weeks. The uCTX-II levels were measured before and after treatment. RESULTS The uCTX-II levels were significantly increased by IA-HA treatment (337.7 ± 193.8 to 370.7 ± 234.8 ng/μmol Cr) and were significantly reduced by NSAID treatment (423.2 ± 257.6 to 370.3 ± 250.9 ng/μmol Cr). The %changes of uCTX-II induced by IA-HA (11.6 ± 29.5%) and NSAID (-9.0 ± 26.7%) was significantly different (between-group difference: 20.6, 95% confidence intervals: 10.6 to 30.6). CONCLUSIONS While both IA-HA and NSAID improved symptoms of knee OA, uCTX-II levels were increased by IA-HA and reduced by NSAIDs treatment, suggesting these treatments may improve symptoms of knee OA through different modes of action.
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Affiliation(s)
- M Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - T Nakamura
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Fukuoka, Japan.
| | - K Shimizu
- Department of Orthopaedic Surgery, Gifu University, School of Medicine, Gifu, Japan.
| | - K Hayashi
- Department of Laboratory Sciences, School of Health Sciences, Faculty of Medicine, Gunma University, Gunma, Japan.
| | - H Kikuchi
- Department of Orthopaedic Surgery, Kinki University Sakai Hospital, Osaka, Japan.
| | - S Soen
- Department of Orthopaedic Surgery and Rheumatology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan; Department of Laboratory Sciences, School of Health Sciences, Faculty of Medicine, Gunma University, Gunma, Japan.
| | - G Omori
- Center of Transdisciplinary Research, Institute for Research Promotion, Niigata University, Niigata, Japan.
| | - T Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan.
| | - Y Uchio
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University School of Medicine, Shimane, Japan.
| | - J Chiba
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.
| | - Y Ideno
- Center of Mathematics and Data Sciences, Gunma University, Maebashi, Japan.
| | - M Kubota
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - H Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - H Kurosawa
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - K Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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27
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Orthobiologics for the Management of Early Arthritis in the Middle-Aged Athlete. Sports Med Arthrosc Rev 2022; 30:e9-e16. [PMID: 35533063 DOI: 10.1097/jsa.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article is dedicated to the use of orthobiologic therapies in the management of early osteoarthritis in middle-aged athletes. Understanding a patient's presenting symptoms, physical examination, imaging results, and goals is of critical importance in applying orthobiologic therapies. The field of orthobiologics is expanding at a rapid pace, and the clinical studies examining the utility of each treatment lag behind the direct-to-consumer marketing that leads to these products being used. Here we provide a review of the available treatments, emerging treatments, and the current literature supporting or refuting their use. Currently studied orthobiologics include autologous and allogenic cell therapies, autologous blood products, hyaluronic acid, gene therapies, Wnt inhibitors, and a variety of systemic treatments.
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28
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Domżalski M, Migliore A. A Review of the Clinical Effectiveness and Safety of Hybrid Cooperative Complexes in Intra-articular Viscosupplementation. Rheumatol Ther 2022; 9:957-974. [PMID: 35501596 PMCID: PMC9314521 DOI: 10.1007/s40744-022-00450-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/07/2022] [Indexed: 10/28/2022] Open
Abstract
Viscosupplementation by intra-articular (i.a.) injection of the non-sulfated glycosaminoglycan (GAG) hyaluronic acid (HA) is a conservative therapy widely accepted in clinical practice for the management of osteoarthritis (OA) and joint diseases. The aim of viscosupplementation is to restore the rheological properties of the synovial fluid to relieve joint inflammation and pain and improve joint function through a chondroprotective effect. However, there is a range of hyaluronic acid products for OA that differ in preparation, molecular weight, rheological characteristics and concentration, and different i.a. formulations are more suited to particular patient populations and clinical situations, in part because of anatomical differences between joints. This paper focuses on innovative hybrid cooperative complexes of high and low molecular weight hyaluronic acid (HA-HL) and hyaluronic acid plus sodium chondroitin (HA-SC) that have been developed. Both products are formulated with pharmaceutical-grade, highly purified hyaluronic acid obtained with a multi-step biofermentation process, with properties that make them suitable across a range of degenerative joint diseases. They represent progress in building on the symptomatic and functional benefits of viscosupplementation in joint disease, with the additional beneficial effect of treating the patient with a high concentration of GAGs by a low number of injections. Here, we review the clinical evidence for the efficacy of a hybrid cooperative compound of HA-HL in various degenerative joint diseases, which suggests a synergistic effect of the different molecular weight hyaluronans that together more closely mimic the physiological composition of synovial fluid. Similarly, the evidence shows that HA-SC is safe, effective, and well tolerated in hip OA, with rapid and clinically significant improvements in pain symptoms and functionality. Such innovations in viscosupplementation expand the usefulness of the modality in the management of OA and other joint diseases, complemented by a lack of systemic or local side effects that allow the concurrent use of other drugs if needed.
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Affiliation(s)
- Marcin Domżalski
- Department of Orthopaedics and Trauma, Veteran's Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Alberto Migliore
- Unit of Rheumatology, S. Pietro Fatebenefratelli Hospital, Via Cassia 600, 00189, Rome, Italy.
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Di Francesco M, Fragassi A, Pannuzzo M, Ferreira M, Brahmachari S, Decuzzi P. Management of osteoarthritis: From drug molecules to nano/micromedicines. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2022; 14:e1780. [PMID: 35253405 PMCID: PMC9285805 DOI: 10.1002/wnan.1780] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/29/2021] [Accepted: 01/21/2022] [Indexed: 12/12/2022]
Abstract
With the change in lifestyle and aging of the population, osteoarthritis (OA) is emerging as a major medical burden globally. OA is a chronic inflammatory and degenerative disease initially manifesting with joint pain and eventually leading to permanent disability. To date, there are no drugs available for the definitive treatment of osteoarthritis and most therapies have been palliative in nature by alleviating symptoms rather than curing the disease. This coupled with the vague understanding of the early symptoms and methods of diagnosis so that the disease continues as a global problem and calls for concerted research efforts. A cascade of events regulates the onset and progression of osteoarthritis starting with the production of proinflammatory cytokines, including interleukin (IL)‐1β, IL‐6, tumor necrosis factor (TNF)‐α; catabolic enzymes, such as matrix metalloproteinases (MMPs)‐1, ‐3, and ‐13, culminating into cartilage breakdown, loss of lubrication, pain, and inability to load the joint. Although intra‐articular injections of small and macromolecules are often prescribed to alleviate symptoms, low residence times within the synovial cavity severely impair their efficacy. This review will briefly describe the factors dictating the onset and progression of the disease, present the current clinically approved methods for its treatment and diagnosis, and finally elaborate on the main challenges and opportunities for the application of nano/micromedicines in the treatment of osteoarthritis. Thus, future treatment regimens will benefit from simultaneous consideration of the mechanobiological, the inflammatory, and tissue degradation aspects of the disease. This article is categorized under:Nanotechnology Approaches to Biology > Nanoscale Systems in Biology Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement
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Affiliation(s)
- Martina Di Francesco
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Agnese Fragassi
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Chemistry and Industrial Chemistry, University of Genova, Genoa, Italy
| | - Martina Pannuzzo
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Miguel Ferreira
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Sayanti Brahmachari
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Paolo Decuzzi
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
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A Multicenter, Randomized, Double-Blinded, Parallel-Group, Placebo-Controlled Phase I/IIa Study to Evaluate the Efficacy and Safety of a Single Intra-Articular Injection of YYD302 in Patients with Knee Osteoarthritis. J Clin Med 2022; 11:jcm11061482. [PMID: 35329808 PMCID: PMC8953367 DOI: 10.3390/jcm11061482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 01/16/2023] Open
Abstract
This study was a phase I/IIa, multicenter, randomized, double-blinded, parallel, placebo-controlled clinical trial that aimed to assess the efficacy and safety of a single intra-articular injection of YYD302, a novel high-molecular-weight hyaluronic acid with divinyl sulfone cross-linking. Thirty adults with knee osteoarthritis were randomized to receive a single 2 mL intra-articular injection of YYD302 (test group 1), 3 mL of YYD302 (test group 2), or 3 mL of the placebo (placebo group). We compared the changes from the baseline in the weight-bearing pain of 100 mm using the Visual Analog Scale (VAS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Rheumatology-Osteoarthritis Research Society International (OMERACT-OASRSI) responder rates, and the use of rescue analgesics to assess the safety of this novel drug. A total of 26 subjects (10 in test group 1, 10 in test group 2, and 6 in the placebo group) were included in the full analysis set. At 12 weeks, only test groups 1 and 2 showed significant changes in the weight-bearing pain VAS scores (p = 0.0015 and p = 0.0085), symptoms, and average daily KOOS values compared to the baseline (p < 0.001, p = 0.0124, and p = 0.0018, p = 0.0426, respectively). While the rate and frequency of consuming the rescue drug continued to increase in the placebo group until 12 weeks, there was no change in the test groups. Our findings showed that YYD302, especially 2 mL of YYD302, reduced pain and improved knee joint function compared to the placebo.
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Fazeli MS, McIntyre L, Huang Y, Chevalier X. Intra-articular placebo effect in the treatment of knee osteoarthritis: a survey of the current clinical evidence. Ther Adv Musculoskelet Dis 2022; 14:1759720X211066689. [PMID: 35126683 PMCID: PMC8808023 DOI: 10.1177/1759720x211066689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/23/2021] [Indexed: 01/06/2023] Open
Abstract
Knee osteoarthritis (KOA) is a debilitating disease characterized by chronic pain, stiffness, and decreased mobility. Intra-articular injectable therapies show good clinical efficacy in improving symptoms; however, these therapies and their comparators (intra-articular saline) have been associated with a large underlying placebo effect. We aimed to describe the existing evidence on the challenges, hypotheses, and potential solutions to mitigate the intra-articular placebo effect in clinical trials in KOA. A targeted literature review was conducted by searching Embase, MEDLINE®, and CENTRAL using predefined study selection criteria. All eligible studies identified were extracted for relevant data, and results were narratively summarized. Forty-three studies were included following screening. Challenges associated with the intra-articular placebo effect included its ability to mask the comparative efficacy of active treatments in trials (n = 7 studies), long-lasting effects (up to 6 months; n = 3), and substantial variation of placebo effect sizes across populations (n = 3). Hypotheses for the mechanism of the placebo effect included aspiration of synovial fluid during administration (n = 6) and dilution of inflammatory mediators (n = 2). Factors affecting the placebo effect size were more invasive routes of administration (e.g., injection versus oral; n = 4) and patient expectations (n = 2). Proposed solutions included the suggestion for readers to weigh the relevance of clinical trial evidence against the presence of large underlying placebo effects (n = 9), discontinuation of intra-articular saline as an appropriate placebo (n = 5), and inclusion of 'no treatment' or sham injection as a control (n = 4). The intra-articular placebo effect is a well-documented occurrence in KOA clinical trials, and it is suggested that it be accounted for when designing randomized controlled trials. Awareness and understanding of the intra-articular placebo effect in KOA are required for fair interpretation of clinical trial evidence.
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Affiliation(s)
- Mir Sohail Fazeli
- Evidinno Outcomes Research Inc., 1750 Davie Street, Suites 601 & 602, Vancouver, BC V6G 1W3, Canada
| | | | - Yili Huang
- Northwell Health, New Hyde Park, NY, USA
| | - Xavier Chevalier
- Hôpital Henri Mondor, Université Paris XII, UPEC, Créteil, France
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Kemmochi M. Consecutive injections of leukocyte-rich platelet-rich plasma are effective in not only mild but also severe knee degeneration. J Orthop 2022; 29:31-37. [PMID: 35115742 PMCID: PMC8790296 DOI: 10.1016/j.jor.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION How can non-cultured platelet-rich plasma (PRP) therapy be the ultimate intervention in the treatment of total knee arthroplasty (TKA) -adaptive levels of knee osteoarthritis, as opposed to stem cell therapy that requires culture? METHODS An intra-articular injection of leukocyte-rich PRP (LR-PRP) was administered to 260 patients every 4 weeks for over four times (mean 5.8 times); they were followed up for a maximum of 24 months. The clinical evaluation used the Knee Injury and Osteoarthritis Outcome Score, visual analogue scale, and magnetic resonance imaging osteoarthritis knee score-body mass lesions to determine the therapeutic effect using the Outcome Measures in Rheumatology-Osteoarthritis Research Society International responder criteria for osteoarthritis. RESULTS Among those administered with LR-PRP, the responder rate was 72.0%, 78.1%, 78.1%, and 77.1% at 3, 6, 12, and 24 months, respectively. CONCLUSIONS Our manually prepared LR-PRP was effective following multiple consecutive injections, despite severe degeneration.
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Vincent P. Acide hyaluronique intra-articulaire dans la gonarthrose: résultats cliniques d'une famille de produits (ARTHRUM), avec méta-analyses comparatives. Curr Ther Res Clin Exp 2021; 95:100652. [PMID: 34868410 PMCID: PMC8626835 DOI: 10.1016/j.curtheres.2021.100652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction La viscosupplémentation est largement pratiquée, pour réduire la douleur dans l'arthrose (OA), par des injections intra articulaires (IA) d'acide hyaluronique (AH). En Europe, ces produits sont des dispositifs médicaux de classe III, pour lesquels la réglementation Medical Device Regulation (MDR) impose une évaluation clinique, basée sur des études spécifiques et/ou une revue bibliographique des dispositifs équivalents. L'objet de cet article est de présenter une revue comparative entre une famille de dispositifs (ARTHRUM, de LCA Pharmaceuticals, Chartres, France) et un groupe important de dispositifs AH IA présumés équivalents dont les résultats et ceux de leurs contrôles, ont fait l'objet de publications dans des journaux scientifiques. Méthodes Pour rejoindre les critères utilisés dans la plupart des études ARTHRUM, les sous-scores de l'indice Western Ontario and McMaster Universities ont été sélectionnés pour la douleur (WOMAC A), la raideur (WOMAC B) et la fonction (WOMAC C). Le critère principal était la variation du score WOMAC A depuis T0 (date d'inclusion) jusqu'à T6 (6 mois). Les autres critères WOMAC ont été évalués à T1, T3, T6 et complétés par les taux de répondeurs au traitement selon OMERACT-OARSI. Cinquante articles ont été sélectionnés, incluant des résultats portant sur plus de 12.000 patients. Ceux-ci ont été répartis en trois groupes: ARTHRUM, EQUIVALENTS et CONTROLES. Pour obtenir des comparaisons quantitatives, des méta-analyses furent réalisées pour chaque critère individuel. Les intervalles de confiance (CI) à 95% de chaque variation par rapport à l'inclusion, ont permis d'évaluer la pertinence clinique en se référant à un minimum validé dans la littérature de l'OA. L'investigation a été complétée par des comparaisons entre groupes et par l'évaluation de la tolérance. Résultats Pour les scores WOMAC A, B et C, l'intégralité de CI 95% était toujours supérieure à l'amélioration minimale cliniquement perceptible (MPCI), pour les groupes ARTHRUM et EQUIVALENTS, ce qui n'a pas été observé pour la totalité des critères, avec le groupe CONTROLES. Dans les comparaisons, les groupes ARTHRUM et EQUIVALENTS ont été significativement meilleurs que le groupe CONTROLES pour chaque critère. La taille de l'effet (ES) sur la douleur, pour les groupes ARTHRUM et EQUIVALENTS, a varié de 0,28 à 0,56 et de 0,23 to 0,27, respectivement. Globalement, ARTHRUM a toujours été évalué non-inférieur aux EQUIVALENTS, et parfois statistiquement et cliniquement supérieur. Conclusions La comparaison des études cliniques ARTHRUM, avec les études tirées de la recherche bibliographique, permet de conclure que l'efficacité clinique des dispositifs médicaux ARTHRUM, pour réduire la douleur et améliorer la fonction dans la gonarthrose, sur une période de six mois, est au moins aussi élevée que celle des dispositifs équivalents. Avec un bon profil de tolérance (taux plus faible d'effets indésirables, et aucun sévère), le rapport risque-bénéfice est en faveur de la viscosupplémentation avec ARTHRUM.
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Affiliation(s)
- Patrice Vincent
- Directeur R&D, LCA Pharmaceutical, 9 allée Prométhée, 28000 Chartres, France
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Miller LE, Bhattacharyya S, Parrish WR, Fredericson M, Bisson B, Altman RD. Safety of Intra-Articular Hyaluronic Acid for Knee Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Trials Involving More than 8,000 Patients. Cartilage 2021; 13:351S-363S. [PMID: 31735075 PMCID: PMC8808790 DOI: 10.1177/1947603519888783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to report the safety of intra-articular hyaluronic acid (IAHA) in patients with symptomatic knee osteoarthritis (OA). METHODS We identified randomized controlled trials reporting the safety of IAHA versus IA saline in adults with symptomatic knee OA. Main safety outcomes were adverse events (AEs), local AEs, serious adverse events (SAEs), study withdrawals, and AE-related study withdrawals. RESULTS A total of 35 randomized controlled trials with 38 group comparisons comprising 8,078 unique patients (IAHA: 4,295, IA saline: 3,783) were included in the meta-analysis. Comparing IAHA with IA saline over a median of 6 months follow-up, there were no differences in the risk of AEs (42.4% vs. 39.7%, risk ratio [RR] = 1.01, 95% CI = 0.96-1.07, P = 0.61), SAEs (1.8% vs. 1.2%, RR = 1.44, 95% CI = 0.91-2.26, P=0.12), study withdrawals (12.3% vs. 12.7%, RR = 0.99, 95% CI = 0.87-1.12, P = 0.83), or AE-related study withdrawals (2.7% vs. 2.1%, RR = 1.37, 95% CI = 0.97-1.93, P = 0.08). Local AEs, all of which were nonserious, were more common with IAHA vs. IA saline (14.5% vs. 11.7%, RR = 1.21, 95% CI = 1.07-1.36, P = 0.003) and typically resolved within days. CONCLUSION IAHA was shown to be safe for use in patients with symptomatic knee OA. Compared with IA saline, IAHA is associated with an increased risk of nonserious, transient local reactions. There was no evidence to suggest any additional safety risks of IAHA.
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Affiliation(s)
| | | | | | - Michael Fredericson
- Department of Orthopaedic Surgery,
Division of Physical Medicine and Rehabilitation, Stanford University Medical
School, Stanford, CA, USA
| | | | - Roy D. Altman
- Division of Rheumatology and Immunology,
David Geffen School of Medicine, University of California at Los Angeles, Los
Angeles, CA, USA
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Sdeek M, Sabry D, El-Sdeek H, Darweash A. Intra-articular injection of Platelet rich plasma versus Hyaluronic acid for moderate knee osteoarthritis. A prospective, double-blind randomized controlled trial on 189 patients with follow-up for three years. Acta Orthop Belg 2021; 87:729-734. [PMID: 35172440 DOI: 10.52628/87.4.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Platelet-rich plasma injections have been proposed as an option for Conservative management of knee Osteoarthritis to provide symptomatic relief and also to delay the need for surgical intervention. Although almost all the current literatures provide some evidence on the benefits of this technique compared with Visco- supplementation, no studies have been performed to compare their Clinical outcomes. The purpose is to compare the Clinical outcomes provided by intra- articular injection of either Platelet rich plasma or Hyaluronic acid to treat knee Osteoarthritis. Study Design: Randomized Controlled Trial 200 Patients with a history of Symptomatic knee Osteo- arthritis (Kellgren-Lawrence grade 2 or 3) were randomized to undergo 3 blinded intra-articular in- jections of either Platelet rich plasma or Hyaluronic acid. The Interval between successive injections was 2 weeks. Patients were evaluated prospectively before the injection and then at 2, 6, 12, 24, 30 and 36 months. Evaluation was based on International Knee Documentation Committee (IKDC), Visual analog scale, VOMAC Score and the re- injection rate; 189 patients reached the final evaluation. Both platelet rich plasma and Hyaluronic acid were effective in improving knee Symptoms and functional status over time and remained stable over time up to 18 months Post-injection (No re-injection has been performed to any patient incorporated in this study during the first 18 months). The performed re-injections have been significantly lower in the PRP group. Both platelet rich plasma and Hyaluronic acid were effective in improving knee Symptoms and functional status over time and remained stable over time up to 18 months Post-injection. The rate of the required re-injections has been significantly lower in platelet rich plasma group. platelet rich plasma provide longer duration of symptomatic relief, longer duration of functional status improvement and lesser number of needed re-injections than Hyaluronic acid when the patients have been followed through 36 months.
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Boissier P, Mainil-Varlet P, Mautone GR. Increasing Concentration of Sinovial: Effect on Cartilage Protection in a Rabbit ACLT Model. Cartilage 2021; 13:185S-195S. [PMID: 32070117 PMCID: PMC8804756 DOI: 10.1177/1947603520905363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to test the hypothesis that administration of increasing doses of Sinovial (hyaluronic acid [HA]), would exhibit a dose-dependent effect on the prevention of cartilage degradation, without local and systemic toxicity. METHODS Twenty-seven adult rabbits were subjected to anterior cruciate ligament transection (ACLT). Two Sinovial products containing HA concentrations of 1.6% and 2.4% were used as active treatment, and 0.9% saline was used as control and injected intra-articularly 7 days post ACLT. Radiographs were taken prior to surgery, at injection and sacrifice times. After euthanasia, 8 weeks postsurgery, knee joints were observed macroscopically using India ink staining with OARSI (Osteoarthritis Research Society International) scoring and histologically using modified Mankin scoring. The synovial membranes were analyzed using Cake classification. RESULTS No intraoperative complications were observed. One week postinjection, 4 animals in the HA 2.4% group developed subcutaneous nodules that disappeared spontaneously. No inflammation of the synovial membrane was ever observed. The control group exhibited the maximum uptake of India ink 2.22 ± 0.14. HA groups exhibited a dose-dependent (P = 0.02) reduction in India ink uptake: 1.75 ± 0.17 for HA 1.6% and 1.58 ± 0.14 for HA 2.4%. The most marked dose-dependent effect of this study was a reduction of modified Mankin score for HA groups, with the 2.4% treatment achieving a statistically significant improvement as compared with the control group (7.19 ± 0.85 for saline, 4.65 ± 0.66 for HA 1.6%, and 3.53 ± 0.59 for HA 2.4%; P = 0.005). CONCLUSIONS A dose-dependent protective effect on cartilage was observed after injection of both HA solutions.
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Mordin M, Parrish W, Masaquel C, Bisson B, Copley-Merriman C. Intra-articular Hyaluronic Acid for Osteoarthritis of the Knee in the United States: A Systematic Review of Economic Evaluations. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2021; 14:11795441211047284. [PMID: 34840501 PMCID: PMC8619730 DOI: 10.1177/11795441211047284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/30/2021] [Indexed: 01/02/2023]
Abstract
Background: The economic impact of intra-articular hyaluronic acid (IAHA) for the treatment of knee pain associated with osteoarthritis (OA) has been evaluated in the United States, but not systematically summarized. Objective: We reviewed the literature to determine the economic impact of IAHA for pain associated with knee OA in the United States. Methods: A literature review was performed in PubMed (including MEDLINE and MEDLINE In-Process), Embase, the Cochrane Database of Systematic Reviews, and National Health Service Economic Evaluation Database and was limited to English language human studies published from January 2000 to October 2020. Results: The literature search identified 215 unique abstracts; of these, 47 were selected for full-text review and 21 studies met the inclusion criteria. Intra-articular hyaluronic acid injections delayed progression to total knee arthroplasty (TKA), and repeated courses of treatment successfully delayed TKA by more than 5 years. Intra-articular hyaluronic acid was found to reduce the use of pain medications overall and reduce the number of patients receiving opioid prescriptions by 6% (P < .001). Several studies showed that IAHA is more cost-effective in treating pain associated with knee OA compared with conventional care with nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and corticosteroids, and several authors concluded that IAHA should be the dominant treatment strategy. Conclusions: Current studies suggest that IAHA may reduce the use of pain medications, such as NSAIDs and opioids, and impact time to TKA procedures, thus potentially decreasing overall treatment costs of knee OA over time. Furthermore, IAHA was determined to be cost-effective against NSAIDs, corticosteroids, analgesics, and conservative treatment. As the safety and efficacy of IAHA for knee OA have been well established, the findings from our literature review may be used to inform future economic evaluations.
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Affiliation(s)
- Margaret Mordin
- Market Access and Outcomes Strategy, RTI Health Solutions, Ann Arbor, MI, USA
| | - William Parrish
- Department of Medical Affairs, DePuy Synthes, Raynham, MA, USA
| | - Catherine Masaquel
- Market Access and Outcomes Strategy, RTI Health Solutions, Ann Arbor, MI, USA
| | - Brad Bisson
- Department of Medical Affairs, DePuy Synthes, Raynham, MA, USA
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Park YG, Ha CW, Yoo JH, Lee WS, Lee HJ, In Y, Bae KC, Shon OJ, Kim YM, Seon JK, Song SJ, Chang CB, Kim JM, Kim CW, Kim DH, Bae JH. Intra-Articular Injection of a Novel DVS Cross-Linked Hyaluronic Acid Manufactured by Biological Fermentation (YYD302) in Patients With Knee Osteoarthritis: A Double-Blind, Randomized, Multicenter, Noninferiority Study. Clin Ther 2021; 43:1843-1860. [PMID: 34736768 DOI: 10.1016/j.clinthera.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/31/2021] [Accepted: 09/02/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE This double-blind, randomized, Phase III clinical trial was conducted to assess the efficacy and safety of the novel divinyl sulfone cross-linked hyaluronate (YYD302) compared with the 1,4-butanediol diglycidyl ether cross-linked hyaluronate (Synovian) in patients with knee osteoarthritis. METHODS A total of 184 patients with osteoarthritis (Kellgren-Lawrence grade I-III) were randomized to 1 of 2 study groups (YYD302 group, n = 95; Synovian group, n = 89). A single injection of YYD302 or Synovian was given to both groups, and 182 participants completed the study (YYD302 group, n = 95; Synovian group, n = 87). The primary end point was the change in weight-bearing pain (WBP) at 12 weeks after the primary single injection. Secondary end points included the Knee Injury and Osteoarthritis Outcome Score; the Western Ontario and McMaster Universities Osteoarthritis Index score; the Patient Global Assessment and Investigator Global Assessment; the range of motion, swelling, and tenderness of the target knee; OMERACT-OARSI responder rate; WBP responder rate (the proportion of patients achieving at least 20 mm or 40% decrease in WBP); and rate of rescue medicine use and its total consumption at weeks 2, 4, and 12. Based on the efficacy results at week 12, the responders were administered an additional single injection of the same study drug at week 24, and safety and efficacy were additionally assessed at week 36. FINDINGS Mean changes of WBP at 12 weeks after the primary injection were -31.76 mm with YYD302 and -29.74 mm with Synovian, proving noninferiority of the YYD302 group to the Synovian group as the lower bound of the 95% CI (-4.3 to 8.3) was well above the predefined margin (-10 mm). At week 2, the Knee Injury and Osteoarthritis Outcome Score (total, pain, activities of daily living, and sports/recreation) and Western Ontario and McMaster Universities Osteoarthritis Index scores (total, stiffness) were significantly better in the YYD302 group than in the Synovian group. There were no significant differences between the groups in all other end points. Local overall adverse events (pain, heat, erythema, or swelling) at the injection site were observed in 48.4% of the YYD302 group and in 47.7% of the Synovian group. No serious reactions were reported. There was no statistically significant difference between the 2 groups regarding re-injected patients (YYD302 group, n = 54; Synovian group, n = 46) in any of the efficacy outcomes at week 36. IMPLICATIONS The results of this study support that YYD302 is comparable to Synovian in terms of the efficacy and safety of the intra-articular injection treatment for osteoarthritis of the knee joint. Furthermore, YYD302 provided faster improvements in some efficacy assessments compared with Synovian. ClinicalTrials.gov identifier: NCT03561779.
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Affiliation(s)
- Yong-Geun Park
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Chul-Won Ha
- Department of Orthopedic Surgery, Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Ju-Hyung Yoo
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Cheor Bae
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Young-Mo Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Hwasun, Republic of Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Dong-Hwi Kim
- Department of Orthopaedic Surgery, College of Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Ji-Hoon Bae
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Intra-articular Hymovis injection for managing hip OA in active sportsmen. A 24-month observational retrospective clinical investigation. J Clin Orthop Trauma 2021; 22:101594. [PMID: 34603955 PMCID: PMC8463867 DOI: 10.1016/j.jcot.2021.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hip Osteoarthitis (OA) risk is sport-specific and depends on frequency, intensity, and type of mechanic stress the hip is subjected to. This retrospective observational study aims to investigate the safety and performance of Hymovis (HYADD-4) injection, a hexadecyl (C-16) HA-derivative, when used to manage symptomatic hip OA in active middle-aged sportsmen over a 24-month observation period. METHODS The retrospective analysis included clinical records of active sportsmen, aged between 40 and 65 years, and suffering from symptomatic Kellgren-Lawrence grade II to III hip OA, treated with two (24 mg/3 ml) Hymovis injections, two weeks apart, every 3-4 months, for two years. When available, data on MRI examination were included in the analysis as well as Heidelberg Sports Activity Score (HAS) and Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaires. RESULTS Thirty patients (56.4 ± 7.3 years) were included in the study, sixteen cyclists and 14 tennis players. For all patients, HAS and most HAGOS scores improved significantly (p < 0.05) at the first control visit (4 months) and further improved over time. For all other scores an important clinical benefit was experienced by more than 50% of participants. No adverse events were recorded. CONCLUSION Treatment of hip OA in active sportsmen with Hymovis seems a safe and effective approach for the management of OA symptoms, by potentially protecting cartilage and subchondral bone from further damage.
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Vincent P. Intra-articular hyaluronic acid in knee osteoarthritis: clinical data for a product family (ARTHRUM), with comparative meta-analyses. Curr Ther Res Clin Exp 2021; 95:100637. [PMID: 34712370 PMCID: PMC8529397 DOI: 10.1016/j.curtheres.2021.100637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/29/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Viscosupplementation is widely practiced, to reduce pain in osteoarthritis (OA), using intra articular (IA) injections of hyaluronic acid (HA). In Europe, these products are class III medical devices, for which the Medical Device Regulation (MDR) requires clinical assessment, based on specific studies and/or a bibliographical review of equivalent devices. The purpose of this article is to present a comparative review between a family of devices (ARTHRUM, from LCA Pharmaceuticals, Chartres, France) and an extensive group of presumed equivalent IA HA devices or their controls, whose results have been published in Scientific journals. Methods To meet the criteria used in most ARTHRUM studies, the Western Ontario and McMaster Universities’ index sub-scores were selected for pain (WOMAC A), stiffness (WOMAC B) and function (WOMAC C). The main criterion was the variation of the WOMAC A score from T0 (date of inclusion) to T6 (6 months). The other WOMAC criteria were assessed at T1, T3, T6 and complemented by OMERACT-OARSI rates of responders to the treatment. Fifty articles were selected, containing treatment details on more than 12,000 patients. These were divided into three groups: ARTHRUM, EQUIVALENTS and CONTROLS. To get quantitative comparisons, meta-analyses were performed for each criterion individually. The 95% confidence interval of each difference from baseline, was used to assess the clinical relevance, with reference to a minimum validated in OA literature. Comparisons between groups and tolerance assessment completed the investigation. Results For the WOMAC A, B and C scores, the full 95% CI was always above the minimal perceptible clinical improvement (MPCI), in the ARTHRUM and EQUIVALENTS groups, but not for all criteria in the CONTROLS group. In the comparisons, both ARTHRUM and EQUIVALENTS groups were significantly better than the CONTROLS group for each criterion. The effect size (ES) on pain, for the ARTHRUM and EQUIVALENTS groups, varied from 0.28 to 0.56 and from 0.23 to 0.27, respectively. Overall, ARTHRUM was estimated always non-inferior to EQUIVALENTS, and sometimes statistically and clinically superior. Conclusions The comparison of ARTHRUM clinical studies, with studies selected through bibliographic research, leads to the conclusion that the clinical efficacy of the ARTHRUM medical devices, to reduce pain and improve the function in knee OA, during a six-month period, is at least as great as those of equivalent products. With good tolerance results (lowest rate of adverse events, and none of them serious), the risk benefit ratio favours using viscosupplementation with ARTHRUM.
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Key Words
- AE, adverse event
- CD, Cohen's D (effect size)
- CI, confidence interval (with probability %)
- CS, chondroitin sulfate
- ES, effect size
- GAG, glycosaminoglycan
- HA, hyaluronic acid (sodium hyaluronate)
- IA, intra-articular
- KL, Kellgren-Lawrence (radiological OA severity scale)
- MD, mean difference
- MDR, Medical Device Regulation
- MPCI, minimal perceptible clinical improvement
- MSC, mesenchymal cells
- Mw, molecular weight (average in weight)
- NSAID, non-steroidal anti-inflammatory drug
- OA, osteoarthritis
- OARSI, Osteoarthritis Research Society International
- OMERACT, Outcomes Measurements in Rheumatology (international network)
- PRP, platelet rich plasma
- SAE, serious adverse event
- SD, standard deviation
- SE, standard error
- SF, synovial fluid
- SSD, smallest detectable difference
- WOMAC, Western Ontario & Mac Master Universities (OA index)
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Affiliation(s)
- Patrice Vincent
- R&D manager, LCA Pharmaceutical, 9 allée Prométhée, 28000 Chartres, France
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Jalali Jivan S, Monzavi SM, Zargaran B, Hamidi Alamdari D, Tavakol Afshari J, Etemad-Rezaie A, Asadi Sakhmaresi T, Shariati-Sarabi Z. Comparative Analysis of the Effectiveness of Intra-Articular Injection of Platelet-Rich Plasma versus Hyaluronic Acid for Knee Osteoarthritis: Results of an Open-Label Trial. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:487-495. [PMID: 34692930 DOI: 10.22038/abjs.2021.52003.2569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/13/2021] [Indexed: 11/09/2022]
Abstract
Background Platelet-rich plasma (PRP), an autologous source of growth factors, and hyaluronic acid (HA) are among the minimally invasive treatments for knee osteoarthritis (OA). This trial was designed to compare the effectiveness of intra-articular injection of PRP with HA (as one of the standard treatments) on mild to moderate knee OA. Methods In this phase I open-label clinical trial, 10 patients underwent intra-articular PRP injection and 10 others received HA injection. At baseline (pre-injection) visit and 1, 3, 6, and 12 months post-injection, clinical assessments were performed using visual analogue scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Physical examinations of the knee, including crepitation and range of motion (ROM) were performed at each visit. The follow-up responses were compared with the baseline visit. Results The PRP treatment was ascertained to be safe and caused no adverse effects. Significant improvements in the majority of KOOS subscales and VAS were found throughout the entire 12-month follow-up, following the PRP injections. HA injection, however, caused only one month significant improvement in the majority of patient-reported outcomes. In the majority of visits, the extent of improvements in the scores of KOOS subscales, as well as the extent of reduction in VAS were significantly greater in PRP recipients, compared to HA recipients. The ROM in both groups slightly increased after interventions. The frequency of coarse crepitation, which was detected in 100% of the patients in both groups at the baseline visit, decreased significantly to fine crepitation at the first follow-up visit in 80% and 40% of the PRP and HA recipients, respectively. Conclusion Intra-articular injection of PRP or HA alleviates symptoms and pain and improves functionality and physical examinations in patients with knee OA. However, PRP therapy produces greater and longer-lasting improvements in most of the outcome parameters compared to HA.
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Affiliation(s)
- Sara Jalali Jivan
- Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Rheumatology Division, Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.,These authors contributed equally to this work
| | - Seyed Mostafa Monzavi
- Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,These authors contributed equally to this work
| | - Bita Zargaran
- Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daryoush Hamidi Alamdari
- Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Clinical Biochemistry, Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jalil Tavakol Afshari
- Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Etemad-Rezaie
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tayebeh Asadi Sakhmaresi
- Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zhaleh Shariati-Sarabi
- Center of Excellence for Stem Cell Research and Regenerative Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Bruyère O, Honvo G, Vidovic E, Cortet B. Assessment of the Response Profile to Hyaluronic Acid Plus Sorbitol Injection in Patients with Knee Osteoarthritis: Post-Hoc Analysis of a 6-Month Randomized Controlled Trial. Biomolecules 2021; 11:biom11101498. [PMID: 34680131 PMCID: PMC8533492 DOI: 10.3390/biom11101498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022] Open
Abstract
In a previous randomized trial, the non-inferiority of two hyaluronic acid injections (Synolis VA versus Synvisc-One) was assessed in patients with knee OA, with a response rate of 79% for Synolis VA. To assess whether a responder profile could be established for this treatment modality, we used the Synolis VA arm of a published 6-month prospective, multicenter, comparative, randomized, double-blinded trial. At baseline and during the study, pain and function were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Ninety-six subjects from the intention-to-treat trial were included in the analysis. The 6-month change of WOMAC Pain with Synolis VA was not associated with any baseline clinical data. However, the change in WOMAC Function was significantly associated with its baseline level, even after adjustment for potential confounding variables (p = 0.028), i.e., a poorer physical function at baseline was associated with a better response. In conclusion, in addition to the high absolute response rate to Synolis VA, the probability of success is even increased if administered in patients with more limited physical function at baseline. Further research with other potential confounding clinical variables is warranted in order to better applicate the concept of personalized medicine.
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Affiliation(s)
- Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium;
- Correspondence: ; Tel.: +32-4-366-25-81
| | - Germain Honvo
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium;
| | - Eduard Vidovic
- Aptissen SA Medical Department, 1228 Plan-les-Ouates, Switzerland;
| | - Bernard Cortet
- Department of Rheumatology and UR 4490, University Hospital of Lille, 59000 Lille, France;
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Abstract
Biopolymers are natural polymers sourced from plants and animals, which include a variety of polysaccharides and polypeptides. The inclusion of biopolymers into biomedical hydrogels is of great interest because of their inherent biochemical and biophysical properties, such as cellular adhesion, degradation, and viscoelasticity. The objective of this Review is to provide a detailed overview of the design and development of biopolymer hydrogels for biomedical applications, with an emphasis on biopolymer chemical modifications and cross-linking methods. First, the fundamentals of biopolymers and chemical conjugation methods to introduce cross-linking groups are described. Cross-linking methods to form biopolymer networks are then discussed in detail, including (i) covalent cross-linking (e.g., free radical chain polymerization, click cross-linking, cross-linking due to oxidation of phenolic groups), (ii) dynamic covalent cross-linking (e.g., Schiff base formation, disulfide formation, reversible Diels-Alder reactions), and (iii) physical cross-linking (e.g., guest-host interactions, hydrogen bonding, metal-ligand coordination, grafted biopolymers). Finally, recent advances in the use of chemically modified biopolymer hydrogels for the biofabrication of tissue scaffolds, therapeutic delivery, tissue adhesives and sealants, as well as the formation of interpenetrating network biopolymer hydrogels, are highlighted.
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Affiliation(s)
- Victoria G. Muir
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jason A. Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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Lv Z, Yang YX, Li J, Fei Y, Guo H, Sun Z, Lu J, Xu X, Jiang Q, Ikegawa S, Shi D. Molecular Classification of Knee Osteoarthritis. Front Cell Dev Biol 2021; 9:725568. [PMID: 34513847 PMCID: PMC8429960 DOI: 10.3389/fcell.2021.725568] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/09/2021] [Indexed: 01/15/2023] Open
Abstract
Knee osteoarthritis (KOA) is the most common form of joint degeneration with increasing prevalence and incidence in recent decades. KOA is a molecular disorder characterized by the interplay of numerous molecules, a considerable number of which can be detected in body fluids, including synovial fluid, urine, and blood. However, the current diagnosis and treatment of KOA mainly rely on clinical and imaging manifestations, neglecting its molecular pathophysiology. The mismatch between participants' molecular characteristics and drug therapeutic mechanisms might explain the failure of some disease-modifying drugs in clinical trials. Hence, according to the temporal alteration of representative molecules, we propose a novel molecular classification of KOA divided into pre-KOA, early KOA, progressive KOA, and end-stage KOA. Then, progressive KOA is furtherly divided into four subtypes as cartilage degradation-driven, bone remodeling-driven, inflammation-driven, and pain-driven subtype, based on the major pathophysiology in patient clusters. Multiple clinical findings of representatively investigated molecules in recent years will be reviewed and categorized. This molecular classification allows for the prediction of high-risk KOA individuals, the diagnosis of early KOA patients, the assessment of therapeutic efficacy, and in particular, the selection of homogenous patients who may benefit most from the appropriate therapeutic agents.
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Affiliation(s)
- Zhongyang Lv
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yannick Xiaofan Yang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiawei Li
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuxiang Fei
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hu Guo
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ziying Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun Lu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xingquan Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, RIKEN Center for Integrative Medical Science (IMS, RIKEN), Tokyo, Japan
| | - Dongquan Shi
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Kalashnikov O, Sulyma O, Osadchuk T, Zayets V, Nizalov T, Kozak R, Chernyak P. Use of hyaluronic acid preparations for treatment of osteoarthritis of major ligaments. PAIN MEDICINE 2021. [DOI: 10.31636/pmjua.v6i2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The authors of the article analyzed the experience of domestic and foreign experts in the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major ligaments.
Background and Objective. To analyze the literature sources in order to determine the effectiveness of the use of HA preparations in the treatment of osteoarthritis of major ligaments.
Materials and methods. Articles in specialized scientific journals and collections, Internet resource.
Results. The analysis of literature sources determined the important role of HA preparations in the supplying and functioning of the articular cartilage. Researchers are inclined to believe that the ideal HA preparation should be as close as possible to the physiological HA of the synovial fluid of the joint. The developed domestic drug Arthro-Patch fully corresponds to these parameters.
Conclusions. The use of modern injectable HA preparations is advisable at stages 1–3 of OA. Anti-inflammatory effect of HA preparations makes it possible to reduce the dose and time of administration of non-steroidal anti-inflammatory drugs and, as a consequence, reduce the risk of developing many adverse side effects of NSAIDs. The high level of safety of HA preparations, the absence of serious side effects during their long-term use determine their widespread use in the clinical practice of modern orthopedists.
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Johnston J, Brown K, Muir J, Sloniewsky MJ. Long-Term Outcomes of Single versus Multiple Courses of Viscosupplementation for Osteoarthritic Knee Pain: Real-World, Multi-Practice Experience Over a Six-Year Period. J Pain Res 2021; 14:2413-2421. [PMID: 34408486 PMCID: PMC8364370 DOI: 10.2147/jpr.s312418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/27/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Viscosupplementation (VS) is a safe and effective local treatment for osteoarthritis (OA) of the knee. While much research has been completed evaluating its efficacy, comparatively little research has been completed examining the effects of multiple, repeat courses of treatment versus a single course of treatment. METHODS We retrospectively reviewed real-world data from a large cohort of patients receiving treatment for OA of the knee at 16 rehabilitation clinics. Patients were grouped based on whether they received a single course of treatment or multiple courses. Outcomes for this study included pain (measured via the visual analog scale, VAS) and functional ability (measured via the Western Ontario and McMaster Universities Arthritis Index (WOMAC)). Pain and function scores were collected at baseline (prior to treatment administration) and one week following each course of treatment. RESULTS Patients receiving multiple courses of treatment saw greater improvements than those receiving a single course. For VAS, maximal improvement occurred after the fourth course (66% improvement: 1.7±1.2 vs 5.0±2.4 at baseline, p<0.0001). WOMAC scores saw maximal improvement up to the fourth course for all domains (pain: 74%: 2.5±3.3 vs 9.5±5.3, p<0.0001; stiffness: 61%: 1.3±1.0 vs 3.3±2.0, p<0.0001; function: 66%: 9.5±7.2 vs 28.3±14.1, p<0.0001). When scores from multiple courses were averaged, improvements were maintained through the fourth course for VAS (3.4±2.8) and all WOMAC domains (pain: 6.1±5.0; stiffness: 3.0±2.2; function: 23.4±17.3). DISCUSSION Our results indicate that multiple courses of treatment are associated with greater improvements than a single course of VS, and that these improvements continue through four courses of treatment.
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Zhao D, Pan JK, Yang WY, Han YH, Zeng LF, Liang GH, Liu J. Intra-Articular Injections of Platelet-Rich Plasma, Adipose Mesenchymal Stem Cells, and Bone Marrow Mesenchymal Stem Cells Associated With Better Outcomes Than Hyaluronic Acid and Saline in Knee Osteoarthritis: A Systematic Review and Network Meta-analysis. Arthroscopy 2021; 37:2298-2314.e10. [PMID: 33713757 DOI: 10.1016/j.arthro.2021.02.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a network meta-analysis to evaluate clinical efficacy and treatment-related adverse events (AEs) of intra-articular hyaluronic acid (HA), leukocyte-poor platelet-rich plasma (LP-PRP), leukocyte-rich platelet-rich plasma (LR-PRP), bone marrow mesenchymal stem cells (BM-MSCs), adipose mesenchymal stem cells (AD-MSCs), and saline (placebo) during 6 and 12 months of follow-up. METHODS Six databases were searched for randomized controlled trials. Outcome assessment included the visual analog scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscore, WOMAC score, International Knee Documentation Committee (IKDC) subjective score, and treatment-related AEs. Main inclusion criteria were at least one of the aforementioned outcome measurements, a minimum follow-up period of 5 months, and >80% patient follow-up. Treatments combined with the use of other operations or drugs were excluded. RESULTS Forty-three studies meeting the eligibility criteria were included. At 6 months, VAS scores and WOMAC pain subscores showed that AD-MSCs were the best treatment option (surface under the cumulative ranking curve [SUCRA] = 96.7%, SUCRA = 85.3%, respectively). According to WOMAC scores and subjective IKDC scores, LP-PRP was the most effective treatment (SUCRA = 86.0%, SUCRA = 80.5%, respectively). At 12 months, only AD-MSCs were associated with improved VAS scores compared with the placebo (weighted mean difference [WMD] = -20.93, 95% credibility interval [CrI], -41.71 to -0.78). Both LP-PRP and AD-MSCs were more beneficial than the placebo for improving WOMAC pain subscores (WMD = -30.08; 95% CrI, -53.59 to -6.25; WMD = -34.85; 95% CrI, -68.03 to -4.86, respectively). For WOMAC scores, LP-PRP and LR-PRP were significantly associated with improved WOMAC scores compared with the placebo after sensitivity analysis was performed (WMD = -35.26; 95% CrI, -64.99 to -6.01; WMD = -38.69; 95% CrI, -76.21 to -2.76). LP-PRP exhibited relatively better efficacy in improving subjective IKDC scores than the placebo (WMD = 13.67; 95% CrI, 4.05-23.39). Regarding safety, all treatments except for LP-PRP (relative risk = 1.83; 95% CrI, 0.89-4.64) increased treatment-related AEs compared with the placebo. CONCLUSIONS Based on the results of current research findings, during 6 months of follow-up, AD-MSCs relieved pain the best; LP-PRP was most effective for functional improvement. During the 12-month follow-up, both AD-MSCs and LP-PRP showed potential clinical pain relief effects; functional improvement was achieved with LP-PRP. Unfortunately, AD-MSC/LP-PRP functional comparisons were only based on WOMAC scores due to missing IKDC scores. BM-MSCs seem to have potentially beneficial effects, but the wide credibility interval makes it impossible to draw a well-supported conclusion. HA viscosupplementation clinical efficacy was lower than that of biological agents during follow-up, which may be related to the properties of the drugs. Considering the evaluation of treatment-related AEs, LP-PRP is the most advisable choice; although the AEs of these treatments are not serious, they may affect treatment compliance and satisfaction. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
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Affiliation(s)
- Di Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-Ke Pan
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Yi Yang
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Hong Han
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling-Feng Zeng
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Gui-Hong Liang
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jun Liu
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
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Yeap SS, Abu Amin SR, Baharuddin H, Koh KC, Lee JK, Lee VKM, Mohamad Yahaya NH, Tai CC, Tan MP. A Malaysian Delphi consensus on managing knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:514. [PMID: 34088302 PMCID: PMC8178929 DOI: 10.1186/s12891-021-04381-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/18/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The 2013 Malaysian Clinical Practice Guidelines on the Management of Osteoarthritis (OA) recommend a linear step-up approach to manage knee OA. However, patients with knee OA often require a multimodal approach to address OA-related pain symptoms and functional limitations. This consensus aimed to provide doctors with an updated set of evidence-based, clinical experience-guided recommendations to manage knee OA. METHODS A multi-speciality expert panel consisting of nine Malaysian physicians from different healthcare settings who manage a diverse OA patient population was convened. Using a combination of the ADAPTE process and modified Delphi method, the panel reviewed current evidence on the management of knee OA and synthesised a set of nine recommendations on the management of knee OA, supported by an algorithm that summarises the consensus' core messages. RESULTS A multimodal intervention strategy is the mainstay of OA management and the choice of any single or multimodal intervention may vary over the course of the disease. Overall, a non-pharmacological core treatment set of patient education, weight loss and exercise is recommended for all patients. When pharmacotherapy is indicated, symptomatic slow-acting drugs for osteoarthritis are recommended at the early stage of disease, and they can be paired with physical therapy as background treatment. Concurrent advanced pharmacotherapy that includes non-steroidal anti-inflammatory drugs, intraarticular injections and short-term weak opioids can be considered if patients do not respond sufficiently to background treatment. Patients with severe symptomatic knee OA should be considered for knee replacement surgery. Management should begin with specific treatments with the least systemic exposure or toxicity, and the choice of treatment should be determined as a shared decision between patients and their team of healthcare providers. CONCLUSIONS This consensus presents nine recommendations that advocate an algorithmic approach in the management of patients living with knee OA. They are applicable to patients receiving treatment from primary to tertiary care providers in Malaysia as well as other countries.
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Affiliation(s)
- Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, No. 1, Jalan SS12/1A, 47500, Subang Jaya, Selangor, Malaysia.
| | | | - Hazlyna Baharuddin
- Department of Internal Medicine, Universiti Teknologi MARA, Kampus Sungai Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Kar Chai Koh
- Poliklinik Kepong Baru, Jalan Ambong Kiri Satu, Kepong Baru, 52100, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Joon Kiong Lee
- Department of Orthopaedic Surgery, Beacon Hospital, Jalan Templer, Section 51, 46050, Petaling Jaya, Selangor, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nor Hamdan Mohamad Yahaya
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Cheh Chin Tai
- Department of Orthopaedic Surgery, Ara Damansara Medical Centre, Jalan Lapangan Terbang Subang, Seksyen U2, 40150, Shah Alam, Selangor, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
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Pradelli L, Sinigaglia T, Migliore A, Checchia GA, Franceschi F, Frediani B, Iannone F, Romanini E. Non-Surgical Treatment of Knee Osteoarthritis: Multidisciplinary Italian Consensus on Best Practice. Ther Clin Risk Manag 2021; 17:507-530. [PMID: 34093017 PMCID: PMC8170371 DOI: 10.2147/tcrm.s288196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of this document is to provide a set of indications on the national best practice management of knee osteoarthritis based on an analysis of the existing literature and the contribution of experts in the field. During the first phase of the project, in agreement with the multidisciplinary panel of experts, the main guidelines on the topic were selected. Each guideline was assessed through the AGREEII system to identify their strong/weak points and a summary of the recommendations contained in the various documents was drawn up. The panel drew up a list of therapeutic options to be included in the document and some of these topics were selected for in-depth analysis and review. The search strategy for the required literature reviews was constructed using the PICOS approach. The results obtained from the literature reviews, the in-depth analyses conducted by the members of the scientific societies involved and the analysis of the existing guidelines enabled an initial draft of the consensus document to be elaborated. This document was examined at the consensus conference held on 28 May 2019, in the presence of a multidisciplinary group consisting of members of the various scientific societies involved. Single recommendations were discussed in work groups with a view to combining the indications given by the literature examined with the experience of the specialists involved. The recommendations discussed were then put to the vote in a plenary assembly. The final document contains 26 practice recommendations which leading specialists involved in the management of knee OA in Italy agree upon.
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Affiliation(s)
| | | | | | | | | | | | | | - Emilio Romanini
- RomaPro Center for Hip and Knee Arthroplasty, polo Sanitario San Feliciano, Rome, Italy
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Pavelka K, Horváth R, Hurnáková J, Saracino L, Giordan N, Procházková L, Moster E, Dokoupilová E. Clinical effectiveness and safety of intra-articular injection of HYALGO in the management of knee osteoarthritis symptoms: A multicenter prospective study. J Clin Orthop Trauma 2021; 19:75-80. [PMID: 34099970 PMCID: PMC8165427 DOI: 10.1016/j.jcot.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/29/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The reduced concentration of hyaluronic acid in the synovial fluid, leading to impairment of joint function and painful symptomatology during knee osteoarthritis (OA), can be restored by using injectable formulations of hyaluronic acid (HA) and chondroitin sulfate (CS), variable for relative composition, HA/CS molecular modifications, and injection protocols. The present study aims to assess the safety and performance of the intra-articular (IA) viscosupplementing agent HYALGO, a formulation combining 40 mg/mL HA (>1700 kDa) and 40 mg/mL CS, in the treatment of patients suffering from knee OA. METHODS 74 patients affected by knee lesions classified as grade II and III according to Kellgren and Lawrence classification were prospectively recruited and treated with three HYALGO injections (2 mL) given one week apart. Visual analogue scale (VAS) pain changes were monitored at each injection and over-time at 6, 14, and 26 weeks of follow-up. Secondary endpoints were: Western Ontario McMaster University Osteoarthritis index (WOMAC), Patient's Global Assessment (PGA) score, Clinical Observer Global Assessment (COGA) score, Outcome Measures in Rheumatology Committee (OMERACT) and Osteoarthritis Research Society International (OARSI) responders rates. Patients were also assessed for changes in their ultrasound joint scores according to the criteria of the OMERACT US Task Force Group. RESULTS Pain reduction was statistically significant starting from the first IA injection. Mean pain reduction from baseline to week 26 was -90.6%. At 26 weeks, WOMAC Pain was reduced by -62.7%, WOMAC Stiffness by -47.2%, WOMAC Physical Function by -54.1%; Total WOMAC by -53.8%. The VAS PGA change from baseline was -48.0 [mm] and VAS COGA -41.0 [mm]. Responders at week 26 were 78.4%. Ultrasound parameters (joint effusion, synovial thickness, and popliteal cysts) improved or remained stable from baseline to week 6. CONCLUSIONS Three injections of HYALGO were safe and effective to manage symptomatic knee OA, with a beneficial effect that increased progressively over time, peaking 6 months after injection.
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Affiliation(s)
- Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic,Corresponding author. Institute of Rheumatology, Na Slupi 4, Prague 2, 12850, Czech Republic.
| | - Rudolf Horváth
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic
| | - Jana Hurnáková
- Institute of Rheumatology, Prague, Czech Republic,Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic
| | | | | | | | - Erik Moster
- Revmacentrum MUDr. Mostera, s.r.o, Brno – Židenice, Czech Republic
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