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Dima A, Dragosloveanu M, Romila AR, Cristea A, Marinică G, Dănilă AT, Mandici A, Cojocariu D, Vlad RA, Ciurba A, Bîrsan M. Can Hyaluronic Acid Combined with Chondroitin Sulfate in Viscosupplementation of Knee Osteoarthritis Improve Pain Symptoms and Mobility? Biomolecules 2024; 14:832. [PMID: 39062546 PMCID: PMC11274506 DOI: 10.3390/biom14070832] [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: 06/03/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The objective of the present study was to assess the effect of intra-articular Hyaluronic acid (HA) and Chondroitin sulfate (CS) supplementation (Hialurom® Hondro (HH)) on pain symptoms and joint mobility. In total, 60 mg/mL sodium hyaluronate and 90 mg/mL CS were administered to 21 patients (17 females and 4 males) respecting the in-force requirements, excluding patients with some specific comorbidities. In addition to the clinical study (where the pain intensity (severity) and joint mobility were assessed), rheological characterization was conducted evaluating the following parameters: elastic modulus (G'), loss modulus (G″) oscillatory frequency (fc) at 0.5 Hz and 2.5 Hz, crossover frequency (fc), relaxation time (λ) where it was noticed that the addition of chondroitin sulfate (CS) to sodium hyaluronate (SH) significantly enhances and improves the viscoelastic properties, particularly at higher shear frequencies. A significant decrease in pain intensity felt by the subjects was found, from 7.48 (according to Wong-Baker scale)-pain close to 8 (the patient is unable to perform most activities), to more reduced values of 5.86-at 6 weeks after injection, 4.81-at 3 months after injection, and 5.24-at 6 months after injection, improvements in symptoms was fast and durable. Data related to the evolution of joint mobility show that at 6 weeks after injection, the mobility of joints increased by 17.8% and at 6 months by 35.61%. No serious adverse events were reported with undesired effects so that they would impose additional measures. Better resistance to enzymatic degradation and free radicals could be expected from the synergic combination of sodium hyaluronate and chondroitin sodium sulfate, this having a special importance for the patients, granting them the ability to perform more ample movements and reducing dependency on attendants, thus increasing quality of life.
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Affiliation(s)
- Augustin Dima
- Department of Medical Rehabilitation-Orthopedics and Traumatology, National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 2 Sf. Dumitru Street, Sector 3, 030167 Bucharest, Romania; (A.D.); (A.C.)
| | - Magda Dragosloveanu
- Department of Rehabilitation, University of Medicine and Pharmacy “Carol Davila”, 8 Eroii Sanitari Street, Sector 5, 050474 Bucharest, Romania;
| | - Andreea Ramona Romila
- Department of Rehabilitation, Physical Medicine and Balneology II, National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 2 Sf. Dumitru Street, Sector 3, 030167 Bucharest, Romania;
| | - Alexandru Cristea
- Department of Medical Rehabilitation-Orthopedics and Traumatology, National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 2 Sf. Dumitru Street, Sector 3, 030167 Bucharest, Romania; (A.D.); (A.C.)
| | - Georgiana Marinică
- Medical and Pharmacovigilance Department, Rompharm Company SRL, 1A Eroilor Street, 075100 Otopeni, Romania (A.M.); (D.C.)
| | - Alexandru-Tiberiu Dănilă
- Medical and Pharmacovigilance Department, Rompharm Company SRL, 1A Eroilor Street, 075100 Otopeni, Romania (A.M.); (D.C.)
- Department Pharmaceutical Sciences II, Faculty of Pharmacy, Grigore T Popa University of Medicine and Pharmacy Iasi, 16 Universitatii Street, 700115 Iasi, Romania
| | - Alexandru Mandici
- Medical and Pharmacovigilance Department, Rompharm Company SRL, 1A Eroilor Street, 075100 Otopeni, Romania (A.M.); (D.C.)
- Department Pharmaceutical Sciences II, Faculty of Pharmacy, Grigore T Popa University of Medicine and Pharmacy Iasi, 16 Universitatii Street, 700115 Iasi, Romania
| | - Daniel Cojocariu
- Medical and Pharmacovigilance Department, Rompharm Company SRL, 1A Eroilor Street, 075100 Otopeni, Romania (A.M.); (D.C.)
- Department Pharmaceutical Sciences II, Faculty of Pharmacy, Grigore T Popa University of Medicine and Pharmacy Iasi, 16 Universitatii Street, 700115 Iasi, Romania
| | - Robert-Alexandru Vlad
- Department of Pharmaceutical Technology and Cosmetology, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania (M.B.)
| | - Adriana Ciurba
- Department of Pharmaceutical Technology and Cosmetology, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania (M.B.)
| | - Magdalena Bîrsan
- Department of Pharmaceutical Technology and Cosmetology, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania (M.B.)
- Department of Pharmaceutical Industry and Pharmaceutical Biotechnologies, Grigore T Popa University of Medicine and Pharmacy Iasi, 16 Universitatii Street, 700115 Iasi, Romania
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Langworthy M, Lascarides P, Ngai W, Steele K, Huang Y. Three once-weekly intra-articular injections of Hylan G-F 20 significantly improve pain relief compared with placebo in patients with chronic idiopathic knee osteoarthritis: a single-centre, evaluator-blinded and patient-blinded, randomized controlled trial. Drugs Context 2024; 13:2023-11-3. [PMID: 38601838 PMCID: PMC11006243 DOI: 10.7573/dic.2023-11-3] [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: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Background Clinical trials on the use of viscosupplementation with hyaluronic acid (HA) in patients with knee osteoarthritis (KOA) are inconsistent, making it challenging to determine its value in clinical practice. One issue is the availability of various HA products on the market; differences in their chemical features can impact patient outcomes. Herein, we assess the efficacy and safety of three once-weekly intra-articular (IA) injections of Hylan G-F 20, a high-molecular-weight and highly crosslinked HA product, in patients with KOA. We hypothesized that Hylan G-F 20 would provide significant pain relief with no increased safety risk compared with IA saline (placebo). Methods This was a 26-week, patient-blinded and evaluator-blinded, single-centre, randomized placebo- controlled trial. Men or women ≥18 years of age with Larsen grade II or III KOA were included. Patients received IA injections of either Hylan G-F 20 or placebo once a week for 3 weeks. The primary endpoints were the week 12 and 26 visits. Primary efficacy outcomes included visual analogue scale (VAS) pain scores, patient activity level and an overall assessment of clinical condition. Secondary outcomes included adverse events (AEs) that emerged during treatment. The primary analysis included the intention-to-treat population. An alpha level of 0.05 was used in the statistical analysis. Results Thirty patients were included in the intention-to-treat population (15 per group). All efficacy outcomes were statistically significant in favour of Hylan G-F 20, except night pain and inactivity stiffness, for both patient- assessed (all p=0.0001 at week 12) and evaluator-assessed (all p=0.0001 at week 12 and p=0.0004-0.0180 at week 26) measurements. There was also a greater proportion of symptom-free patients and those with a >50% improvement in their VAS scores, except night pain, in the Hylan G-F 20 group (p=0.001-0.003 in patient-assessed scores and p<0.0001 to 0.002 in evaluator-assessed scores at week 12). Two patients, one in each group, experienced an AE; no sequelae occurred, and no special treatment was required for either AE. No patients withdrew from the study prematurely due to an AE. Conclusion In patients with chronic idiopathic KOA, Hylan G-F 20 provides significant improvements in pain relief compared with placebo with no added safety concerns.
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Affiliation(s)
| | - Peter Lascarides
- Northwell Health, Northern Westchester Hospital, Mt Kisco, NY, USA
| | | | | | - Yili Huang
- Zucker School of Medicine at Hofstra/Northwell, Northwell Phelps Hospital, Sleepy Hollow, NY, USA
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Rasmussen S, Petersen KK, Aboo C, Andersen JS, Skjoldemose E, Jørgensen NK, Stensballe A, Arendt-Nielsen L. Intra-articular injection of gold micro-particles with hyaluronic acid for painful knee osteoarthritis. BMC Musculoskelet Disord 2024; 25:211. [PMID: 38475764 PMCID: PMC10935980 DOI: 10.1186/s12891-024-07321-4] [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: 11/12/2022] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Recently, in an open pilot study, we found up to two years, a potential pain-relieving effect of intra-articular gold micro-particles using the patient's synovial fluid for patients with knee osteoarthritis (KOA). During the study the excluded group of patients, due to multisite pain, co-morbidities, and other exclusion criteria., received intra-articular gold micro-particles using hyaluronic acid,. We aimed to identify if pre-treatment characteristics influence the global outcome two years after intra-articular treatment for painful KOA with gold microparticles using hyaluronic acid. METHODS Using hyaluronic acid as the carrier, 136 patients with KOA received intraarticular injections with 20 mg gold microparticles (72.000 particles, 20-40 μm in diameter). In the analysis, we included the Global Rating of Change Scale, Pain Detect Questionnaire (PDQ), Body Mass Index (BMI), and Kellgren & Lawrence score at the inclusion, Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) sub-scores for pain, stiffness, and function at inclusion and two years. RESULTS On the Global Rating Change Scale, 69.1% of patients reported a positive effect, 28.7% no effect, and 2.2% worse. PDQ and the three WOMAC subscores all improved at two years of follow-up. PDQ ≥ 13 (P = 0.028), BMI (P = 0.022) and Kellgren & Lawrence grade 4 (P = 0.028) at inclusion reduced the effect with a minor odds ratio compared to the baseline effect of treatment (P = 0.025). WOMAC subscores at inclusion did not influence the outcome (P > 0.5). CONCLUSIONS Severe osteoarthritis, obesity, and neuropathic pain, reduced the effect of intra-articular gold microparticles for knee OA. TRIAL REGISTRATION The study followed the principles of the Declaration of Helsinki and was approved by the local ethics committee of the North Denmark Region by 27/07/2016 (N-20,160,045). The regional data protection agency approved the project by 06/07/2016 (2008-58-0028, ID 2016 - 116) and registered in ClinicalTrial.Gov by 04/01/2018 (NCT03389906).
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Affiliation(s)
- Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, 249 Selma Lagerløfs Vej, Gistrup, 9260, Denmark.
- Department of Orthopedic Surgery, Sport and Arthroscopy, Aalborg University Hospital, Aalborg, Denmark.
| | - Kristian Kjaer Petersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Christopher Aboo
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Emilie Skjoldemose
- Department of Clinical Medicine, Aalborg University, 249 Selma Lagerløfs Vej, Gistrup, 9260, Denmark
| | - Nia Kristine Jørgensen
- Department of Clinical Medicine, Aalborg University, 249 Selma Lagerløfs Vej, Gistrup, 9260, Denmark
| | - Allan Stensballe
- Department of Clinical Medicine, Aalborg University, 249 Selma Lagerløfs Vej, Gistrup, 9260, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Onu I, Gherghel R, Nacu I, Cojocaru FD, Verestiuc L, Matei DV, Cascaval D, Serban IL, Iordan DA, Tucaliuc A, Galaction AI. Can Combining Hyaluronic Acid and Physiotherapy in Knee Osteoarthritis Improve the Physicochemical Properties of Synovial Fluid? Biomedicines 2024; 12:449. [PMID: 38398051 PMCID: PMC10886650 DOI: 10.3390/biomedicines12020449] [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: 01/25/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Known as the degenerative disease of the knee with the highest prevalence, knee osteoarthritis (KOA) is characterized by a gradual destructive mechanism that, in severe cases, can provoke the need for total knee substitution. As the disease progresses, various enzymatic, immunological, and inflammatory processes abnormally degrade hyaluronic acid (HA), SF's main component, and affect the concentrations of specific proteins, with the final results seriously endangering synovial fluid (SF)'s rheological and tribological features and characteristics. No effective treatments have been found to stop the progression of KOA, but the injection of HA-based viscoelastic gels has been considered (alone or combined with physiotherapy (PT)) as an alternative to symptomatic therapies. In order to evaluate the effect of viscosupplementation and PT on the characteristics of SF, SF aspirated from groups treated for KOA (HA Kombihylan® and groups that received Kombihylan® and complex PT) was analyzed and compared from analytical, spectrophotometrical, and rheological perspectives. In the patients treated with PT, the SF extracted 6 weeks after viscosupplementation had a superior elastic modulus (G') and viscous moduli (G″), as well as a homogeneous distribution of proteins and polysaccharides. The viscosupplementation fluid improved the bioadhesive properties of the SF, and the use of the viscosupplementation fluid in conjunction with PT was found to be favorable for the distribution of macromolecules and phospholipids, contributing to the lubrication process and the treatment of OA-affected joints.
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Affiliation(s)
- Ilie Onu
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700454 Iasi, Romania; (I.O.); (I.N.); (F.-D.C.); (L.V.); (D.-V.M.); (A.-I.G.)
- Department of Physiotherapy, Micromedica Clinic, 610119 Piatra Neamt, Romania
| | - Robert Gherghel
- Department of Physiotherapy, Micromedica Clinic, 610119 Piatra Neamt, Romania
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Isabella Nacu
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700454 Iasi, Romania; (I.O.); (I.N.); (F.-D.C.); (L.V.); (D.-V.M.); (A.-I.G.)
- Petru Poni Institute of Macromolecular Chemistry, 41-A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Florina-Daniela Cojocaru
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700454 Iasi, Romania; (I.O.); (I.N.); (F.-D.C.); (L.V.); (D.-V.M.); (A.-I.G.)
| | - Liliana Verestiuc
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700454 Iasi, Romania; (I.O.); (I.N.); (F.-D.C.); (L.V.); (D.-V.M.); (A.-I.G.)
| | - Daniela-Viorelia Matei
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700454 Iasi, Romania; (I.O.); (I.N.); (F.-D.C.); (L.V.); (D.-V.M.); (A.-I.G.)
| | - Dan Cascaval
- Department of Organic, Biochemical and Food Engineering, Faculty of Chemical Engineering and Environmental Protection “Cristofor Simionescu”, Technical University “Gheorghe Asachi”, 700050 Iasi, Romania; (D.C.); (A.T.)
| | - Ionela Lacramioara Serban
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Daniel Andrei Iordan
- Department of Individual Sports and Kinetotherapy, Faculty of Physical Education and Sport, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
- Center of Physical Therapy and Rehabilitation, “Dunărea de Jos” University of Galati, 800008 Galati, Romania
| | - Alexandra Tucaliuc
- Department of Organic, Biochemical and Food Engineering, Faculty of Chemical Engineering and Environmental Protection “Cristofor Simionescu”, Technical University “Gheorghe Asachi”, 700050 Iasi, Romania; (D.C.); (A.T.)
| | - Anca-Irina Galaction
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700454 Iasi, Romania; (I.O.); (I.N.); (F.-D.C.); (L.V.); (D.-V.M.); (A.-I.G.)
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Farì G, Mancini R, Dell’Anna L, Ricci V, Della Tommasa S, Bianchi FP, Ladisa I, De Serio C, Fiore S, Donati D, Ranieri M, Bernetti A, Megna M. Medial or Lateral, That Is the Question: A Retrospective Study to Compare Two Injection Techniques in the Treatment of Knee Osteoarthritis Pain with Hyaluronic Acid. J Clin Med 2024; 13:1141. [PMID: 38398454 PMCID: PMC10889499 DOI: 10.3390/jcm13041141] [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: 01/30/2024] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Mild-to-moderate knee osteoarthritis (KOA) can be successfully treated using intra-articular hyaluronic acid (IA-HA). The medial infrapatellar (MIP) approach and lateral infrapatellar (LIP) approach are two of the most used techniques for performing IA-HA, but it is still not clear which one is preferable. Objectives: The study aims to find the best knee injection technique between MIP and LIP approaches. Methods: In total, 161 patients were enrolled, divided into two groups (MIP or LIP). Each technique was performed once a week for three weeks. Patients were evaluated using the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Roles and Maudsley Score (RMS) at T0 (before the first injection), T1 (one week after the third injection) and T2 (six months after). Results: NRS, KOOS and RMS showed a statistically significant improvement in both groups at all the detection times, without significant differences. No differences were detected between the groups in terms of systemic effect effusions, while the MIP group presented a mildly higher number of bruises in comparison with the LIP group (p = 0.034). Conclusions: Both the IA-HA techniques are equally effective in measured outcomes. The MIP approach seems to produce some local and transient side effects. So, the choice of the LIP or MIP approach depends on the operator's skill and experience.
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Affiliation(s)
- Giacomo Farì
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University, 70121 Bari, Italy (M.R.)
- Department of Biological and Environmental Science and Technologies, University of Salento, 73100 Lecce, Italy
| | - Rachele Mancini
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University, 70121 Bari, Italy (M.R.)
| | - Laura Dell’Anna
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University, 70121 Bari, Italy (M.R.)
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, 20121 Milano, Italy
| | | | | | - Ilaria Ladisa
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University, 70121 Bari, Italy (M.R.)
| | - Carlo De Serio
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University, 70121 Bari, Italy (M.R.)
| | - Silvia Fiore
- School of Specialization in Rheumatology, Fondazione Polclinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Danilo Donati
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University, 70121 Bari, Italy (M.R.)
| | - Andrea Bernetti
- Department of Biological and Environmental Science and Technologies, University of Salento, 73100 Lecce, Italy
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience, Aldo Moro University, 70121 Bari, Italy (M.R.)
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Fuqua A, Premkumar A, Jayaram P, Wagner C. Complications and opioid-prescribing patterns following genicular nerve radiofrequency ablation versus intra-articular injection: a matched cohort study. Reg Anesth Pain Med 2024:rapm-2023-105053. [PMID: 38302251 DOI: 10.1136/rapm-2023-105053] [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: 09/28/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Genicular nerve radiofrequency ablation (GNRFA) is an emerging procedure used to relieve pain from severe knee osteoarthritis. While there have been rare reports of significant complications, their incidence has not been well established. The objective of this study was to examine complication rates at 30 and 90 days post treatment as well as characterize opioid-prescribing patterns before and after treatment. METHODS A large national database was queried to identify patients undergoing GNRFA from 2015 to 2022 and matched to control cohorts composed of patients receiving either intra-articular corticosteroid (CSI) or hyaluronic acid injection (HAI) of the knee. Complication rates at 30 and 90 days were analyzed. Opioid utilization was assessed in the 6 months before and after treatment. RESULTS Rates of infection (0.1%, CI 0.02% to 0.5% vs 0.2%, CI 0.05% to 0.6%), septic arthritis (<0.1%, CI 0.003% to 0.4% vs 0.1%, CI 0.02% to 0.5%), deep vein thrombosis (2.0%, CI 1.3% to 2.7% vs 1.6%, CI 1.0% to 2.2%), pulmonary embolism (1.2%, CI 0.6% to 1.7% vs 1.3%, CI 1.1% to 2.5%), bleeding (<0.1%, CI 0.003% to 0.4% vs 0%, CI 0% to 0.3%), seroma (<0.1%, CI 0.003% to 0.4% vs 0.2%, CI 0.05% to 0.6%), nerve injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%) and thermal injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%) were not different between CSI and GNRFA cohorts at 30 days. Rate of swelling was significantly greater in the GNRFA cohort (9.4%, CI 7.6% to 10.4% vs 6.4%, CI 4.8% to 7.2%, p=0.003) at 30 days. At 90 days, rates of septic arthritis (0.1%, CI 0.02% to 0.5% vs 0.3%, CI 0.08% to 0.7%), deep vein thrombosis (3.1%, CI 2.1% to 3.8% vs 3.1%, CI 2.2% to 3.9%), pulmonary embolism (1.5%, CI 0.9% to 2.1% vs 1.8%, CI 1.2% to 2.5%), and nerve injury (0%, CI 0% to 0.3% vs <0.1%, CI 0.003% to 0.4%) were not significantly different.Between HAI versus GNRFA cohorts, no significant differences were seen in rates of infection (0.3%, CI 0.08% to 0.07% vs 0.7%, CI 0.3% to 1.2%), septic arthritis (0.2%, CI 0.05% to 0.6% vs 0.4%, CI 0.2% to 0.9%), deep vein thrombosis (2.0%, CI 1.3% to 2.7% vs 1.9%, CI 1.2% to 2.7%), pulmonary embolism (1.5%, CI 0.9% to 2.2% vs 1.7%, CI 1.1% to 2.5%), bleeding (0.1%, CI 0.02% to 0.5% vs 0.2%, CI 0.05% to 0.6%), seroma (<0.1%, CI 0.03% to 0.4% vs 0%, CI 0% to 0.3%), nerve injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%), swelling (14.0%, CI 11.6% to 15.1% vs 12.0%, CI 10.3% to 13.6%), and thermal injury (<0.1%, CI 0.03% to 0.4% vs <0.01%, CI 0.3% to 0.4%) at 30 days. Rates of infection (0.7%, CI 0.3% to 1.2% vs 1.4%, CI 0.9% to 2.1%), septic arthritis (0.3%, CI 0.1% to 0.8% vs 0.5%, CI 0.2% to 1.1%), deep vein thrombosis (3.6%, CI 2.6% to 4.4% vs 3.1%, CI 2.2% to 4.0%), pulmonary embolism (2.3%, CI 1.5% to 3.0% vs 2.1%, CI 1.4% to 3.0%) and nerve injury (0%, CI 0% to 0.3% vs 0.1%, CI 0.02% to 0.5%) were not significantly different at 90 days.There were no significant differences in level of pretreatment opioid utilization although overall consumption in mean daily morphine equivalents was greater in the GNRFA cohort. Opioid utilization significantly increased in the first 30 days after ablation in patients with no prior opioid use compared to controls. In patients with some and chronic prior opioid use, opioid requirements were generally decreased in all treatment groups at 6 months with no clearly superior treatment in reducing opioid consumption. CONCLUSION Our study demonstrated that GNRFA possesses a safety profile similar to that of intra-articular injections although significant adverse events such as venous thromboembolism and septic arthritis may occur rarely. Although opioid utilization generally increased in the 30 days after ablation compared with intra-articular injection, similar reduction in opioid consumption at 6 months was seen in patients with prior opioid use in the ablation and control cohorts.
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Affiliation(s)
- Andrew Fuqua
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Prathap Jayaram
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Casey Wagner
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, 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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8
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Rodriguez-Merchan EC. The role of intraarticular injections of hyaluronic acid in joint pain relief in hemophilic arthropathy. Expert Rev Hematol 2023; 16:811-817. [PMID: 37837349 DOI: 10.1080/17474086.2023.2271660] [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: 07/19/2023] [Accepted: 10/12/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Chronic pain in hemophilic patients is due to joint degeneration associated with hemophilic arthropathy. In addition to appropriate hematological treatment (primary prophylaxis), pharmacologic management and Physical Medicine and Rehabilitation should be indicated. When such measures are not sufficient, intraarticular injections (IAIs) of hyaluronic acid (HyA) may be considered. AREAS COVERED In order to determine whether IAIs of HyA are effective in terms of pain relief in individuals with painful moderate hemophilic arthropathy, a PubMed and Cochrane Library search using 'hemophilia hyaluronic acid' as keywords was performed on 18 July 2023. EXPERT OPINION In a study of individuals with hemophilic arthropathy (elbows, knees and ankles), 91% of them improved pain after a mean follow-up of 6 years. In another study of individuals with knee arthropathy, after a 7-year follow-up 82% reported an improvement in pain. As for hemophilic ankle arthropathy, in a study 67% of patients showed relief of joint pain at 6-month follow-up. Although the literature on the subject is very heterogeneous and difficult to interpret, it appears that IAIs of HyA can relieve the joint pain of painful moderate hemophilic arthropathy for months. Moreover, the IAIs can be repeated every 6-12 months.
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9
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Huang Y, Lascarides P, Ngai W, Steele K, Hummer CD. Three Weekly Intra-Articular Injections of Hylan G-F 20 vs Arthrocentesis in Patients with Chronic Idiopathic Knee Osteoarthritis: A Multicenter, Evaluator- and Patient-Blinded, Randomized Controlled Trial. CURRENT THERAPEUTIC RESEARCH 2023; 99:100707. [PMID: 37408828 PMCID: PMC10319210 DOI: 10.1016/j.curtheres.2023.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/22/2023] [Indexed: 07/07/2023]
Abstract
Background Knee osteoarthritis is a leading cause of disability worldwide. Symptoms can vary over time, leading to episodes of worsened symptoms known as flares. Intra-articular injection of hyaluronic acid has demonstrated long-term symptomatic relief in the broader knee osteoarthritis population, although its use in the flare population has not been extensively examined. Objective To assess the efficacy and safety of 3 once-weekly intra-articular injections of hylan G-F 20 (as single and repeat courses) in patients with chronic knee osteoarthritis, including a subpopulation that experienced flare. Methods Prospective randomized controlled, evaluator- and patient-blinded, multicenter trial with 2 phases: hylan G-F 20 vs arthrocentesis only (control) and 2 courses vs single-course hylan G-F 20. Primary outcomes were visual analog scale (0-100 mm) pain scores. Secondary outcomes included safety and synovial fluid analysis. Results Ninety-four patients (104 knees) were enrolled in Phase I, with 31 knees representing flare patients. Seventy-six patients (82 knees) were enrolled in Phase II. Long-term follow-up was 26 to 34 weeks. In flare patients, hylan G-F 20 showed significantly more improvement than the controls for all primary outcomes except pain at night (P = 0.063). Both 1 and 2 courses of hylan G-F 20 showed significant improvements from baseline for primary outcomes with no differences in efficacy between groups in the intention-to-treat population at the end of Phase II. Two courses of hylan G-F 20 showed better improvement in pain with motion (P = 0.0471) at long-term follow-up. No general side effects were reported, and local reactions (pain/swelling of the injected joint) resolved within 1 to 2 weeks. Hylan G-F 20 was also associated with reduced effusion volume and protein concentration. Conclusions Hylan G-F 20 significantly improves pain scores vs arthrocentesis in flare patients with no safety concerns. A repeat course of hylan G-F 20 was found to be well tolerated and efficacious.
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Affiliation(s)
- Yili Huang
- Zucker School of Medicine at Hofstra/Northwell, Northwell Phelps Hospital, Sleepy Hollow, New York
| | - Peter Lascarides
- Northwell Health, Northern Westchester Hospital, Mount Kisco, New York
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10
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Conrozier T, Diraçoglù D, Monfort J, Chevalier X, Bard H, Baron D, Jerosch J, Migliore A, Richette P, Henrotin Y. EUROVISCO Good Practice Recommendations for a First Viscosupplementation in Patients with Knee Osteoarthritis. Cartilage 2023; 14:125-135. [PMID: 36443990 PMCID: PMC10416196 DOI: 10.1177/19476035221138958] [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: 11/30/2022] Open
Abstract
RATIONALE Viscosupplementation (VS) with hyaluronic acid is widely used in the management of knee osteoarthritis. There is no clear recommendation on the decision-making to achieve VS. DESIGN Based on extensive research of the literature and expert opinion, the members of the EUROVISCO (European Viscosupplementation Consensus Group) task force were asked to give their degree of agreement with 60 issues, using a Delphi method. RESULTS The expert panel achieved unanimous agreement in favor of the following statements: It is recommended to assess pain on a visual or 10-point numeric scale before considering VS. VS can be considered for patients with pain scores between 3 and 8. A standard x-ray must be obtained before the decision of VS. If the x-ray is normal, osteoarthritis must be confirmed by MRI or computed tomography (CT) arthrogram before considering VS. The aims of VS are relieving pain, improving function, and reducing non-steroidal anti-inflammatory drug (NSAID) consumption. The use of VS must not be considered for treating an osteoarthritis flare. VS can be envisaged as a first-line pharmacological treatment in patients having a contra-indication to NSAIDs or analgesics. VS can be considered in patients with contra-indications to arthroplasty. In the case of severe comorbidities (diabetes, hypertension, gastrointestinal disorders, renal failure), VS can avoid the use of potentially dangerous treatments. VS can be considered in patients receiving antiplatelet agents, vitamin K antagonists, and direct factor Xa or thrombin inhibitors. Five other statements obtained a high level of consensus. CONCLUSION These recommendations, illustrated in a decision algorithm, have been established to help practitioners in the decision-making of knee VS.
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Affiliation(s)
- Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Demirhan Diraçoglù
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jordi Monfort
- Servei de Reumatología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Xavier Chevalier
- Department of Rheumatology, Henri Mondor Hospital, Paris XII University, Creteil, France
| | - Hervé Bard
- Rheumatology, Cabinet Médical Vaudoyer, Paris, France
| | - Dominique Baron
- Centre de Réadaptation Fonctionnelle de Lannion-Trestel, Trévou-Tréguignec, France
| | - Jörg Jerosch
- Department of Orthopedic, Johanna Etienne Hospital, Neuss, Germany
| | - Alberto Migliore
- U.O.S. of Rheumatology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Pascal Richette
- Université Paris Cité, UFR Médicale, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Paris, France
| | - Yves Henrotin
- MusculoSKeletal Innovative Research Lab, Université de Liège, CHU Sart Tilman, Liège, Belgium
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11
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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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12
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Jerosch J. [Conservative treatment options for arthritis of the ankle : What is possible, what is effective?]. Unfallchirurg 2022; 125:175-182. [PMID: 35041020 DOI: 10.1007/s00113-021-01122-3] [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] [Accepted: 12/03/2021] [Indexed: 11/26/2022]
Abstract
In this article the causes of arthritis in the region of the ankle are introduced and the conservative treatment options are described and discussed more extensively. The risks of treatment with nonopioid analgesics (NOPA) are presented in detail. The topical use of nonsteroidal anti-inflammatory drugs (NSAID) should always be considered in the clinical routine. If contraindications for oral NSAIDs are present, intra-articular treatment is a meaningful option. The best evidence is currently available for viscosupplementation but the study situation for the use of platelet-rich plasma (PRP) is still not sufficiently comprehensive and there are only a few case reports on the use of mesenchymal stem cells..
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Affiliation(s)
- Jörg Jerosch
- Medizinisches Wissenschafts- und Gutachten-Institut Meerbusch (WGI) Meerbusch, Grabenstr. 11, 40667, Meerbusch, Deutschland.
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13
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Talesa G, Manfreda F, Pace V, Ceccarini P, Antinolfi P, Rinonapoli G, Caraffa A. The treatment of knee cartilage lesions: state of the art. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022099. [PMID: 36043984 PMCID: PMC9534246 DOI: 10.23750/abm.v93i4.11740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/11/2022] [Indexed: 11/11/2022]
Abstract
The management and repair of knee cartilage lesions currently represents a challenge for the orthopaedic surgeon. Identifiable causes are the characteristics of the involved tissues themselves and the presence of poor vascularization, which is responsible for overall reduced repair capacity. The literature reports three types of cartilage lesions' treatment modalities: chondroprotection, chondroreparation and chondrogeneration. The preference for one or the other therapeutic option depends on the pattern of the lesion and the clinical conditions of the patient. Each treatment technique is distinguished by the quality of the restorative tissue that is generated. In particular, the chondrorigeneration represents the last frontier of regenerative medicine, as it aims at the complete restoration of natural cartilage. However, the most recent literature documents good results only in the short and medium terms. In recent years the optimization of chondroregeneration outcomes is based on the modification of the scaffolds and the search for new chondrocyte sources, in order to guarantee satisfactory long-term results.
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Lee HS, Oh KJ, Moon YW, In Y, Lee HJ, Kwon SY. Intra-articular Injection of Type I Atelocollagen to Alleviate Knee Pain: A Double-Blind, Randomized Controlled Trial. Cartilage 2021; 13:342S-350S. [PMID: 31370668 PMCID: PMC8808911 DOI: 10.1177/1947603519865304] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Collagen disruption is one of the underlying causes of knee pain in patients with osteoarthritis and/or diverse cartilage defects. Atelocollagen is a type of collagen that lacks telopeptides and thus has reduced antigenicity. The intra-articular injection of type I atelocollagen supplements collagen levels in the disrupted articular cartilage. This randomized controlled trial evaluated the effects of the intra-articular injection of atelocollagen for the management of knee pain. DESIGN Two hundred patients with osteoarthritis, chondromalacia, or other cartilage defects were randomly assigned to receive a 3-mL intra-articular injection of atelocollagen (BioCollagen group) or saline (Placebo group). Clinical improvement was evaluated over a 24-week period using the 100-mm visual analogue scale (VAS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the 36-item Short-Form Health Survey (SF-36). RESULTS VAS scores were significantly better in the BioCollagen group as compared with the Placebo group at 24 weeks. More patients in the BioCollagen group reported exceeding 20% and 40% VAS improvements. The WOMAC and SF-36 scores were also significantly improved from baseline after the intra-articular injection of atelocollagen; although, the differences between the BioCollagen and Placebo groups were not significant. There were no unexpected or severe adverse events reported for either group. CONCLUSIONS The results show that an intra-articular injection of atelocollagen effectively alleviates knee pain, as intended. Therefore, the intra-articular injection of atelocollagen can be considered an alternative solution to controlling knee pain due to osteoarthritis and diverse cartilage defects.
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Affiliation(s)
- Hwa Sung Lee
- Department of Orthopedic Surgery,
Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Republic of Korea
| | - Kwang Jun Oh
- Department of Orthopedic Surgery, Konkuk
University Medical Center, School of Medicine, Konkuk University, Seoul, Republic of
Korea
| | - Young Wan Moon
- Department of Orthopedic Surgery,
Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic
of Korea
| | - Yong In
- Department of Orthopedic Surgery, Seoul
St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Republic of Korea
| | - Han Jun Lee
- Department of Orthopedic Surgery,
Chung-Ang University Hospital, School of Medicine, Chung-Ang University, Seoul,
Republic of Korea
| | - Soon Yong Kwon
- Department of Orthopedic Surgery,
Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Republic of Korea,Soon Yong Kwon, Department of Orthopedic
Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic
University of Korea, 10, 63-ro Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.
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15
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Webner D, Huang Y, Hummer CD. Intraarticular Hyaluronic Acid Preparations for Knee Osteoarthritis: Are Some Better Than Others? Cartilage 2021; 13:1619S-1636S. [PMID: 34044600 PMCID: PMC8808930 DOI: 10.1177/19476035211017320] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This literature review summarizes evidence on the safety and efficacy of intraarticular hyaluronic acid (IAHA) preparations approved in the United States for the treatment of osteoarthritis of the knee. DESIGN A systematic literature search was performed in PubMed, Ovid MEDLINE, and SCOPUS databases. Only studies in which clinical outcomes of individual IAHA preparations alone could be assessed when compared to placebo, no treatment, other standard knee osteoarthritis treatments, and IAHA head-to-head studies were selected. RESULTS One hundred nine articles meeting our inclusion criteria were identified, including 59 randomized and 50 observational studies. Hylan G-F 20 has been the most extensively studied preparation, with consistent results confirming efficacy in placebo-controlled studies. Efficacy is also consistently reported for Supartz, Monovisc, and Euflexxa, but not for Hyalgan, Orthovisc, and Durolane. In the head-to-head trials, high-molecular-weight (MW) Hylan G-F 20 was consistently superior to low MW sodium hyaluronate preparations (Hyalgan, Supartz) up to 20 weeks, whereas one study reported that Durolane was noninferior to Supartz. Head-to-head trials comparing high versus medium MW preparations all used Hylan G-F 20 as the high MW preparation. Of the IAHA preparations with strong evidence of efficacy in placebo-controlled studies, Euflexxa was found to be noninferior to Hylan G-F 20. There are no direct comparisons to Monovisc. One additional IAHA preparation (ie, Synovial), which has not been assessed in placebo-controlled studies, was also noninferior to Hylan G-F 20. CONCLUSION IAHA efficacy varies widely across preparations. High-quality studies are required to assess and compare the safety and efficacy of IAHA preparations.
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Affiliation(s)
- David Webner
- Crozer-Keystone Health System,
Springfield, PA, USA,David Webner, Crozer-Keystone Health
System, 196 W. Sproul Road, Suite 110, Springfield, PA 19064, USA.
| | - Yili Huang
- Northwell Health, Zucker School of
Medicine at Hofstra/Northwell, Hempstead, NY, USA
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16
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Cen X, Pan X, Zhang B, Liu C, Huang X, Zhao Z. Hyaluronan injection versus oral glucosamine and diclofenac in the treatment of temporomandibular joint osteoarthritis. Clin Oral Investig 2021; 26:2703-2710. [PMID: 34705118 DOI: 10.1007/s00784-021-04241-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study was aimed to compare the effects of 4 biweekly hyaluronan (HA) injection with glucosamine and diclofenac oral administration on TMJ OA patients. MATERIALS AND METHODS This retrospective cohort study included TMJ OA patients who had the treatment of 4 biweekly HA injection (group HA) or oral glucosamine hydrochloride for 3 months and diclofenac sodium for 2 weeks (group G/D), and had complete data at first-visit, 3 months, 6 months, and 12 months. Clinical signs and symptoms were scored by anamnestic dysfunction index (Ai) and clinical dysfunction index (Di), and condylar bone changes were evaluated by CBCT scoring system. RESULTS We included 22 patients in group HA and 20 patients in group G/D. After HA injection, Ai was decreased from 4.3 to 1.6(CI [- 4.0, - 1.4]) at 3-month follow-up, which was smaller than that in group G/D significantly. Di in group HA was declined significantly from 8.1 at first-visit to 3.6 at 3-month follow-up, while Di in group G/D scarcely changed until at 6- and 12-month follow-up. Neither HA injection nor oral glucosamine/diclofenac showed positive effect on the bone of TMJs during follow-ups with statistical significance. CONCLUSIONS HA injection alleviated signs and symptoms of TMJ OA rapidly and presented superior clinical effects over oral glucosamine with diclofenac. However, both treatments did not limit the bone destruction of TMJs significantly. CLINICAL RELEVANCE This cohort study provides knowledge on the symptom relief and bone changes of TMJ OA patients when treated with HA injection or glucosamine and diclofenac oral administration.
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Affiliation(s)
- Xiao Cen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Xuefeng Pan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Bo Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Chenlu Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Xinqi Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
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17
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Hayashi K, Bourgeois A, Lopez D, Caserto BG, Berthelsen E, Krotscheck U, Reesink HL, Kim SY, Putnam D. Intra-Articular Administration of a Synthetic Lubricin in Canine Stifles. Vet Comp Orthop Traumatol 2021; 35:90-95. [PMID: 34598303 DOI: 10.1055/s-0041-1736189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the functional, systemic, synovial and articular changes after intra-articular administration of a synthetic lubricin within healthy canine stifles. STUDY DESIGN A prospective randomized blinded placebo-controlled study composed of 10 dogs equally divided into either a treatment group (intra-articular synthetic lubricin injection, n = 5) or control group (saline, n = 5). Clinical (orthopaedic examination, gait observation, gait analysis), biochemical (complete blood count and biochemistry profile) and local tissue outcomes (joint fluid analysis, joint capsule and articular cartilage histopathology) were evaluated over a time period of 3 months. RESULTS No significant differences between the treatment group and control group were identified with regard to baseline patient parameters. No clinically significant orthopaedic examination abnormalities, gait abnormalities, biochemical alterations, joint fluid alterations or histopathological alterations were identified over the course of the study. CONCLUSION The synthetic lubricin studied herein is both biocompatible and safe for a single administration within the canine stifle joint. Further research is necessary to evaluate the clinical efficacy of the synthetic lubricin in canine osteoarthritic joints.
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Affiliation(s)
- Kei Hayashi
- College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Alexandria Bourgeois
- College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Daniel Lopez
- College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | | | - Erin Berthelsen
- College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Ursula Krotscheck
- College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Heidi L Reesink
- College of Veterinary Medicine, Cornell University, Ithaca, New York, United States
| | - Sun Young Kim
- Purdue University College of Veterinary Medicine, West Lafayette, Indiana, United States
| | - David Putnam
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States.,Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York, United States
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18
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Bączkowicz D, Skiba G, Szmajda M, Vařeka I, Falkowski K, Laudner K. Effects of Viscosupplementation on Quality of Knee Joint Arthrokinematic Motion Analyzed by Vibroarthrography. Cartilage 2021; 12:438-447. [PMID: 31072141 PMCID: PMC8461162 DOI: 10.1177/1947603519847737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the influence of viscosupplementation on osteoarthritic knee arthrokinematics analyzed by VAG. It is considered that intra-articular hyaluronic acid injection may improve the function of synovial joints by recovery of friction-reducing properties of articular environment. DESIGN Thirty-five patients with knee osteoarthritis (grade II according to the Kellgren-Lawrence system) and 50 asymptomatic subjects were enrolled in the study. Patients were analyzed at 3 time points: 1 day before and 2 weeks and 4 weeks after single injection of 1.5% cross-linked hyaluronate. Control subjects were tested once. The vibroarthrographic signals were collected during knee flexion/extension motion using an accelerator and described by variation of mean square (VMS), mean range (R5), and power spectral density for frequency of 50 to 250 Hz (P1), and 250 to 450 Hz (P2). RESULTS Patients before viscosupplementation were characterized by about 2-fold higher values of vibroarthrographic parameters than controls. Two weeks after the procedure, the values of R5, P1, and P2 significantly decreased, in comparison to pre-injection. At 4 weeks post-injection, we noted a significant increase in R5, P1, and P2 values, when compared to 2 weeks post-injection. Finally, at 4 weeks post-injection, the level of VMS, R5, and P2 parameters did not differ from values obtained at pre-injection. CONCLUSIONS We showed that viscosupplementation may be effective in providing arthrokinematics improvement, but with a relatively short period of duration. This phenomenon is observed as decreased vibroacoustic emission, which reflects a more smooth movement in the joint.
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Affiliation(s)
- Dawid Bączkowicz
- Institute of Physiotherapy, Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland,Dawid Bączkowicz, Institute of Physiotherapy, Faculty of Physical Education and Physiotherapy, Opole University of Technology, 76 Prószkowska Street, Opole 45-758, Poland.
| | | | - Mirosław Szmajda
- Institute of Automatic Control, Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, Opole, Poland
| | - Ivan Vařeka
- Department of Rehabilitation, Faculty Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Krzysztof Falkowski
- Department of Trauma and Orthopaedic Surgery, University Clinical Hospital in Opole, Opole, Poland
| | - Kevin Laudner
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
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19
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Alnasser S, AlHussain F, Asiri H, Almutairi A, Alsanawi H, Altamimi AAR, Asiri YA, Almohammed OA, AlRuthia Y. Orthopedic Surgeons' Views of Hyaluronic Acid Formulations in the Management of Knee Osteoarthritis: A Questionnaire-Based Cross-Sectional Study. ACTA ACUST UNITED AC 2021; 57:medicina57090990. [PMID: 34577913 PMCID: PMC8469390 DOI: 10.3390/medicina57090990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Multiple hyaluronic acid (HA) products were approved and marketed to manage osteoarthritis (OA). Although these products are widely prescribed by orthopedic surgeons to manage OA, especially knee OA, the therapeutic value of these products is highly uncertain. Few studies with significant limitations in their designs have indicated positive outcomes among OA patients treated with HA; however, their results were inconclusive. Thus, we aimed to explore the therapeutic value of different HA products in alleviating knee OA pain and improving patients’ physical function from the orthopedic surgeons’ perspective. Materials and Methods: This was a questionnaire-based cross-sectional study in which practicing orthopedic surgeons in two countries (e.g., Saudi Arabia and Jordan) were invited to participate. The 10-item, newly developed questionnaire inquired about the respondents’ sociodemographic characteristics (e.g., age, gender, country, years of experience), and their opinions regarding the efficacy of HA products in the management of OA (e.g., efficacy in improving mobility and alleviating pain). Results: Out of the 200 orthopedic surgeons who were invited to participate, 122 (61%) filled out the questionnaire. Most of the respondents were from Saudi Arabia (58%), aged 35 to 55 years (68%), had at least 10 years of experience (69%), and male (98%). About 80% of the respondents reported prescribing HA, such as Hyalgan®, Orthovisc®, Hyalubrix®, and Crespine Gel®. About 66% of the respondents believed that HA was moderately to highly effective in managing knee OA, and 34% believed that HA was either ineffective or mildly effective. Pain at the site of injection (44.3%) and rash or local skin reactions (22.1%) were the most commonly reported adverse events. Conclusions: The variations in the formulation of different HA brands (e.g., molecular weight and cross-linking) did not seem to offer any therapeutic advantage. HA might have value in the management of knee OA; however, its value is highly uncertain and necessitates more well-designed studies to further examine its therapeutic value.
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Affiliation(s)
- Shahd Alnasser
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (S.A.); (H.A.); (A.A.); (Y.A.A.); (O.A.A.)
| | - Fatima AlHussain
- Department of Pharmacoeconomics and Drug Pricing, Saudi Food and Drug, Authority, P.O. Box 84983, Riyadh 11681, Saudi Arabia;
| | - Hassan Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (S.A.); (H.A.); (A.A.); (Y.A.A.); (O.A.A.)
| | - Abdullah Almutairi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (S.A.); (H.A.); (A.A.); (Y.A.A.); (O.A.A.)
| | - Hisham Alsanawi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, P.O. Box 3145, Riyadh 12372, Saudi Arabia;
| | - Anas AR Altamimi
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, P.O. Box 921113, Amman 11192, Jordan;
| | - Yousif A. Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (S.A.); (H.A.); (A.A.); (Y.A.A.); (O.A.A.)
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (S.A.); (H.A.); (A.A.); (Y.A.A.); (O.A.A.)
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (S.A.); (H.A.); (A.A.); (Y.A.A.); (O.A.A.)
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
- Correspondence: ; Tel.: +966-114-677-483; Fax: +966-114-677-480
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20
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Phillips M, Bhandari M, Grant J, Bedi A, Trojian T, Johnson A, Schemitsch E. A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective. Orthop J Sports Med 2021; 9:23259671211030272. [PMID: 34485586 PMCID: PMC8414628 DOI: 10.1177/23259671211030272] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/01/2021] [Indexed: 12/31/2022] Open
Abstract
Background: There are many clinical practice guidelines (CPGs) for the prevention,
diagnosis, and treatment of knee osteoarthritis (OA). They differ by region,
considering local health care systems, along with cultural and economic
factors. Currently, there are conflicting CPG recommendations across the
various publications, which makes it difficult for clinicians to fully
understand the optimal treatment decisions for knee OA management. Purpose: To summarize the current published CPG recommendations for the role of
injections in the nonoperative management of knee OA, specifically with the
use of intra-articular hyaluronic acid (IA-HA), intra-articular
corticosteroids (IA-CS), and platelet-rich plasma (PRP). Study Design: Systematic review. Methods: A comprehensive search identified all nonoperative knee OA CPGs within the
ECRI (formerly Emergency Care Research Institute) Guidelines Trust database,
the Guidelines International Network database, Google Scholar, and the Trip
(formerly Turning Research Into Practice) database. Guideline
recommendations were categorized into strong, conditional, or uncertain
recommendations for or against the use of IA-HA, IA-CS, or PRP. Guideline
recommendations were summarized and depicted graphically to identify trends
in recommendations over time. Results: The search strategy identified 27 CPGs that provided recommendations. There
were 20 recommendations in favor of IA-HA use, 21 recommendations in favor
of IA-CS use, and 9 recommendations that were uncertain or unable to make a
formal recommendation for or against PRP use based on current evidence. Most
recommendations considered IA-HA and IA-CS use for symptom relief when other
nonoperative options are ineffective. IA-CS were noted to provide fast and
short-acting symptom relief for acute episodes of disease exacerbation,
while IA-HA may demonstrate a relatively delayed but prolonged effect in
comparison. The CPGs concluded that PRP recommendations currently lack
evidence to definitively recommend for or against use. Conclusion: Available CPGs provide recommendations on injectables for knee OA treatment.
General guidance from a global perspective concluded that IA-CS and IA-HA
are favored for different needed responses and can be utilized within the
knee OA treatment paradigm, while PRP currently has insufficient evidence to
make a conclusive recommendation for or against its use.
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Affiliation(s)
- Mark Phillips
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - John Grant
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas Trojian
- Department of Family Medicine, WellSpan Health, York, Pennsylvania, USA
| | - Aaron Johnson
- Department of Orthopaedics, University of Maryland, College Park, Maryland, USA
| | - Emil Schemitsch
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
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21
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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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22
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Andreani L, Giuntoli M, Addevico F, Aringhieri G, Cosottini M, Marchetti S. The effect of viscosupplementation on early-stage knee osteoarthritis: Clinical evaluation and assessment of cartilage in vivo with 7 T MRI. J Clin Orthop Trauma 2021; 19:53-61. [PMID: 34046300 PMCID: PMC8144354 DOI: 10.1016/j.jcot.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/31/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Viscosupplementation is a well-known strategy for managing early stages knee Osteoarthritis. However, despite its effectiveness in reducing symptoms, it has not yet been found to have an effect on joint cartilage. The aim of this study is to evaluate the clinical efficacy of a new product with gel-like behaviour and its in vivo effects on joint cartilage. METHODS 20 patients were treated by 2 consecutive injections of hyaluronan derivative Hymovis® at one-week interval. Clinical evaluation was performed before the treatment and at each time point during the follow-up using WOMAC and VAS. A 7 T magnet was used for cartilage evaluation at each MRI time point: T2 Relaxation Time (RT), T2∗ RT and cartilage parameters were evaluated before the first injection, after 45 days and at 6 months follow-up. Statistical analysis was obtained for each reported data. RESULTS We report significantly reduction in symptoms with an increase in knee and global activity functions. The T2 RT for lateral tibial compartment and T2∗ RT for Patello-Femoral compartment significantly decreased. A T2 RT reduction was observed in all knee compartments except for the medial tibial one, while a T2∗ RT reduction was observed in all knee compartments. We report an increase in cartilage volume and thickness in most of patients with a reduction of cartilage defects in 9 patients, but we didn't find MRI signals clearly referable to cartilage regeneration. CONCLUSIONS MRI results have confirmed the possibility to employ 7T magnets to evaluate early changes in cartilage structure in vivo. HA VS has provided good clinical outcomes and an improvement in the global assessment of the knee joint, but it doesn't seem to significantly modify the cartilage over the time.
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Affiliation(s)
- Lorenzo Andreani
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Michele Giuntoli
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy,Corresponding author.
| | - Francesco Addevico
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Giacomo Aringhieri
- Radiology Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Mirco Cosottini
- Neuroradiology Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Stefano Marchetti
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
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23
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Jargin SV. Chondroprotectives used for the treatment of knee osteoarthritis: A comment. Int J Rheum Dis 2021; 24:459-461. [PMID: 33502114 DOI: 10.1111/1756-185x.14071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Sergei V Jargin
- Peoples' Friendship University of Russia, Moscow, Russian Federation
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24
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Alyami AH, Alswat MM, Omer IA, Ahmed MEH, Alshammari SH, Alsaggaf KW, Amoudi JH, Aljafari DA. General population knowledge about osteoarthritis and its related risk factors in Jeddah Saudi Arabia. Saudi Med J 2021; 41:516-523. [PMID: 32373919 PMCID: PMC7253844 DOI: 10.15537/smj.2020.5.25061] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: To identify the knowledge gap and misconceptions about osteoarthritis (OA) and its risk factors among the general population of Jeddah, Saudi Arabia. Methods: This is a cross-sectional study conducted Jeddah, Saudi Arabia, between 11-13 April, 2019. The study was approved by King Abdullah International Medical Research Center. A representative sample of the public in well-known mall was asked to complete the questionnaire to assess their knowledge regarding OA. The questionnaire consisted of 3 parts: 1) demographic data, 2) general knowledge regarding OA, and 3) a quiz of 20 questions. A descriptive analysis was carried out with t-test and F-test-based method. Results: The study had 1238 respondents. Approximately 55% of them were females, with 51.8% between the ages of 18 to 29. Approximately 62% held a bachelor’s degree and 63% had a family member or a friend afflicted with OA. Relatives and friends were the main source of information regarding OA. Only 37% correctly identified the mechanism behind OA. The mean score for the 20-item quiz was 9.84. No significant differences were found when comparing scores of males and females or those of age groups. However, significant differences in scores were identified between respondents of varying educational levels (p<0.001), participants’ knowledge of the mechanism leading to OA (p<0.001), information sources (p<0.001), and knowing someone with it (p<0.001). Conclusion: The results of our study suggest a low level of knowledge regarding OA among Jeddah population. Many misconceptions regarding OA were identified, so more information be brought to the public.
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Affiliation(s)
- Ali H Alyami
- Orthopedic Division, Department of Surgery, Ministry of the National Guard-Health Affairs, Jeddah, Kingdom of Saudi Arabia. E-mail.
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25
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Shi X, Zhang H, Hu Y, Li X, Yin S, Xing R, Zhang N, Mao J, Wang P. Mechanism of Salviae Miltiorrhizae Radix et Rhizoma in the Treatment of Knee Osteoarthritis Based on Network Pharmacology. Nat Prod Commun 2020. [DOI: 10.1177/1934578x20983130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The molecular mechanism of Salviae Miltiorrhizae Radix et Rhizoma (SMRR) in the treatment of knee osteoarthritis (KOA) was analyzed based on network pharmacology. Methods Active components and potential targets of SMRR were obtained from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform. KOA targets were obtained from the OMIM, DisGeNET, DrugBank, PharmGKB, and GeneCards Databases. The potential targets of SMRR in the treatment of KOA were identified by the Venn diagram. A protein-protein interaction network was generated with the STRING database. Visualization of the interactions in a potential pharmacodynamic component-target network was accomplished with Cytoscape software. The Database for Annotation, Visualization, and Integrated Discovery database and R software were used for Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway annotation analyses of common targets. Molecular docking of the potential leading components, as determined by efficacy with the core target molecules, was performed with Discovery Studio. Results Fifty-seven potential pharmacodynamic components and 58 potential targets of SMRR in the treatment of KOA were found. Bioinformatics analyses showed that the interleukin (IL)-17, hypoxia-inducible factor-1 (HIF-1), and tumor necrosis factor (TNF) signaling pathways, as well as the advanced glycation end product-receptor for advanced glycation end product signaling pathway in cases of diabetic complications, are related to the molecular mechanism of SMRR in the treatment of KOA. Molecular docking results showed that luteolin, tanshinone IIA, cryptotanshinone, and other components of SMRR had a strong affinity for MYC, signal transducer and activator of transcription 3, caspase-3 (CASP3), JUN, cyclin D1, prostaglandin endoperoxide synthase 2 (PTGS2), epidermal growth factor receptor (EGFR), mitogen-activated protein kinase 1 (MAPK1), protein kinase B, vascular endothelial growth factor A, and other targets. Conclusion SMRR indirectly regulates IL-17, HIF-1, TNF, and other signal transduction pathways by regulating the expression of proteins, including PTGS2, MAPK1, EGFR, and CASP3, thus playing a role in promoting chondrocyte proliferation, improving microcirculation, eliminating free radicals, and inhibiting inflammatory factors.
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Affiliation(s)
- Xiaoqing Shi
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, P. R. China
| | - Haosheng Zhang
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, P. R. China
| | - Yue Hu
- Department of Integrated Traditional Chinese and Western Medicine, Jinling Hospital, Nanjing, P. R. China
| | - Xiaochen Li
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, P. R. China
| | - Songjiang Yin
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, P. R. China
| | - Runlin Xing
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, P. R. China
| | - Nongshan Zhang
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, P. R. China
| | - Jun Mao
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, P. R. China
| | - Peimin Wang
- Department of Orthopaedics and Traumatology, The First Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, P. R. China
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26
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Berríos-Hernández M, Casas-Fernández L, Blanco-Rodríguez J, Suárez-Peñaranda JM. Dermal embolization associated with peroneal mononeuropathy: an unusual complication after hyaluronic acid intra-articular injections. Int J Dermatol 2020; 60:636-638. [PMID: 33615439 DOI: 10.1111/ijd.15347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mario Berríos-Hernández
- Department of Pathology, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Luis Casas-Fernández
- Department of Dermatology, Hospital da Barbanza-EOXI Santiago, Santiago de Compostela, Spain
| | - Jorge Blanco-Rodríguez
- Department of Rheumatology, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - José M Suárez-Peñaranda
- Department of Pathology, Clinical University Hospital of Santiago, Santiago de Compostela, Spain.,Department of Forensic Sciences and Pathology, University of Santiago de Compostela, Spain
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27
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Chevalier X, Sheehan B, Whittington C, Pourrahmat MM, Duarte L, Ngai W, de Campos GC. Efficacy and Safety of Hylan G-F 20 Versus Intra-Articular Corticosteroids in People with Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2020; 13:1179544120967370. [PMID: 33281462 PMCID: PMC7691947 DOI: 10.1177/1179544120967370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022]
Abstract
Background: Direct injection of corticosteroids into the joint is a standard treatment
for knee osteoarthritis (OA). However, the treatment is somewhat
controversial with regard to the benefit of both single and repeated
injections; evidence that they are beneficial comes from small studies that
show only modest improvements. The aim of this study was to estimate the
short- and long-term clinical efficacy and safety of hylan G-F 20 versus
intra-articular corticosteroids (IACS) for the treatment of pain in knee OA
using Bayesian network meta-analysis. Methods: Based on a pre-specified protocol, MEDLINE, Embase, and CENTRAL were searched
from inception to June 2018 to identify randomized controlled trials. The
Cochrane Collaboration’s tool for assessing risk of bias in randomized
trials was used to assess the included studies. Hylan G-F 20 and IACS were
compared using Bayesian network meta-analysis. Efficacy was evaluated at 1,
3, and 6 months, and at the final follow-up for safety outcomes. A pain
hierarchy was used to select 1 pain outcome per study. Results: Forty-two trials were included for analysis. The network meta-analysis of
pain showed that hylan G-F 20 may be equivalent to IACS in the short-term,
but by 6 months the benefit relative to IACS was statistically significant,
standardized mean difference (95% credible interval): –0.13 (–0.26, –0.01).
There were no statistical differences in adverse events. Conclusions: Hylan G-F 20 may perform better in relieving pain at 6 months post-injection
compared to IACS. Both agents were relatively well tolerated, with no clear
differences in safety.
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Affiliation(s)
- Xavier Chevalier
- Department of Rheumatology, Hôpital Henri-Mondor, Paris University XII (UPEC), Créteil, France
| | - Brendan Sheehan
- Division of Orthopaedic Surgery, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Craig Whittington
- Doctor Evidence, Santa Monica, CA, USA.,Sanofi, Global Medical, Bridgewater, NJ, USA
| | | | | | - Wilson Ngai
- Sanofi, Global Medical, Bridgewater, NJ, USA
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Sedrak P, Hache P, Horner NS, Ayeni OR, Adili A, Khan M. Differential characteristics and management of pseudoseptic arthritis following hyaluronic acid injection is a rare complication: a systematic review. J ISAKOS 2020; 6:94-101. [PMID: 33832983 DOI: 10.1136/jisakos-2020-000438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/05/2020] [Accepted: 09/19/2020] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Acute pseudoseptic arthritis is a rare complication of hyaluronic acid (HA) injections that is not well documented in the literature. Practitioners initially suspect the symptoms of this complication to represent septic arthritis, cautiously prescribing antibiotics. This review identifies that time to presentation of symptoms postinjection, negative cell cultures and lack of crystallisation could be used as differentials to suspect pseudoseptic arthritis and to prescribe anti-inflammatory drugs while closely monitoring change of symptoms. OBJECTIVE The purpose of this study was to describe the presentation, diagnosis and treatment of pseudoseptic arthritis. EVIDENCE REVIEW A systematic review of the literature was conducted for studies reporting the use of HA injections for osteoarthritis resulting in pseudoseptic arthritis using the electronic databases MEDLINE, Embase and PubMed. Pertinent data were abstracted from the search yield. A unique case of a pseudoseptic reaction is also presented. FINDINGS A total of 11 studies (28 cases), all of level IV and V evidence were included in this review. Reported cases of pseudoseptic arthritis in the literature present with severe joint pain (100%), effusion (100%), inability to weight-bear, functional impairment, and occasionally fever (22.2%). C reactive protein and erythrocyte sedimentation rate are generally elevated (71.4% and 85.7%, respectively), and leucocytosis above 10 000 was less common (50%). All reported cases in the literature identified aseptic growth on arthrocentesis, despite four cases (15.4%) reporting synovial leucocyte counts above 50 000. The presented case is the highest reported leucocyte count at 1 74 960 cells/mm3. CONCLUSIONS AND RELEVANCE Acute pseudoseptic arthritis is rare, but a number of cases have been reported in the literature. A high degree of suspicion for pseudoseptic arthritis may be maintained in patients who present under 72 hours following HA injection. Initial antibiotic treatment, along with anti-inflammatory medications until cultures are confirmed to be negative at 5 days, is a cautious approach. However, the strength of this conclusion is limited by the few reported cases. Ultimately, this review is intended to inform practitioners of the symptoms, diagnosis and treatment of this complication, such that it could be safely differentiated from septic arthritis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Phelopater Sedrak
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Philip Hache
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Nolan S Horner
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Anthony Adili
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
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29
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Influence of stuck-needle technique on joint function and related inflammatory markers in patients with knee osteoarthritis: A randomized controlled trial. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2020. [DOI: 10.1016/j.wjam.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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30
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Gazendam A, Ekhtiari S, Bozzo A, Phillips M, Bhandari M. Intra-articular saline injection is as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: a systematic review and network meta-analysis of randomised controlled trials. Br J Sports Med 2020; 55:256-261. [DOI: 10.1136/bjsports-2020-102179] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 01/13/2023]
Abstract
ObjectiveIntra-articular (IA) injections represent a commonly used modality in the treatment of hip osteoarthritis (OA). Commonly used injections include corticosteroids (CCS), hyaluronic acid (HA) and platelet-rich plasma (PRP). A network meta-analysis allows for comparison among more than two treatment arms and uses both direct and indirect comparisons between interventions. The objective of this network meta-analysis is to compare the efficacy of the various IA injectable treatments in treating hip OA at up to 6 months of follow-up.DesignThis is a systematic review and network meta-analysis. Bayesian random-effects model was performed to assess the direct and indirect comparisons of all treatment options.Data sourcesPubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception to October 2019.Eligibility criteria for selected studiesRandomised controlled trials assessing the efficacy of CCS, HA, PRP and placebo in the form of IA saline injection for patients with hip OA.ResultsEleven randomised controlled trials comprising 1353 patients were included. For pain outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection. For functional outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection. Regarding change from baseline at 2–4 months and 6 months, pooled data demonstrated that all interventions (including placebo), with the exception of HA+PRP, led to a clinically important improvement in both pain, exceeding the minimal clinically important difference.ConclusionEvidence suggests that IA hip saline injections performed as well as all other injectable options in the management of hip pain and functional outcomes.
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Pelletier JP, Raynauld JP, Abram F, Dorais M, Paiement P, Martel-Pelletier J. Intra-articular corticosteroid knee injection induces a reduction in meniscal thickness with no treatment effect on cartilage volume: a case-control study. Sci Rep 2020; 10:13789. [PMID: 32796866 PMCID: PMC7427978 DOI: 10.1038/s41598-020-70064-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/02/2020] [Indexed: 12/31/2022] Open
Abstract
Although intra-articular corticosteroid injections (IACI) are commonly used for the treatment of knee osteoarthritis (OA), there is controversy regarding possible deleterious effects on joint structure. In this line, this study investigates the effects of IACI on the evolution of knee OA structural changes and pain. Participants for this nested case–control study were from the Osteoarthritis Initiative. Knees of participants who had received an IACI and had magnetic resonance images (MRI) were named cases (n = 93), and each matched with one control (n = 93). Features assessed at the yearly visits and their changes within the follow-up period were from MRI (cartilage volume, meniscal thickness, bone marrow lesions, bone curvature, and synovial effusion size), X-ray (joint space width), and clinical (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain score) data. Participants who received IACI experienced a transient and significantly greater rate of loss of the meniscal thickness (p = 0.006) and joint space width (p = 0.011) in the knee medial compartment in the year they received the injection, compared to controls. No significant effect of the IACI was found on the rate of cartilage loss nor on any other knee structural changes or WOMAC pain post-treatment. In conclusion, a single IACI in knee OA was shown to be safe with no negative impact on structural changes, but there was a transient meniscal thickness reduction, a phenomenon for which the clinical relevance is at present unknown.
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Affiliation(s)
- Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Suite R11.412A, Montreal, QC, H2X 0A9, Canada.
| | - Jean-Pierre Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Suite R11.412A, Montreal, QC, H2X 0A9, Canada
| | - François Abram
- Medical Imaging Research and Development, ArthroLab Inc., Montreal, QC, H2K 1B6, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-L'Île-Perrot, QC, J7V 0S2, Canada
| | | | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Suite R11.412A, Montreal, QC, H2X 0A9, Canada
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Li B, Zhang Y, Bi L. Comparative efficacy of treatments for patients with knee osteoarthritis: a network meta-analysis. Eur J Med Res 2020; 25:27. [PMID: 32690088 PMCID: PMC7370491 DOI: 10.1186/s40001-020-00426-1] [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: 11/20/2018] [Accepted: 07/07/2020] [Indexed: 01/17/2023] Open
Abstract
Background Knee osteoarthritis is a common cause of musculoskeletal pain and a leading cause of disability and healthcare economic burden. The optimum treatment for knee osteoarthritis is still inconclusive. A network meta-analysis is required to assess the efficacy and safety of treatments and provide more scientific medical evidence. Methods Relevant studies were searched through PubMed, Embase, and Cochrane Library electronic databases from the inception to October 2018. Continuous outcomes such as pain, stiffness, physical function and total scores were expressed as the mean differences with 95% credible interval. Surface under the cumulative ranking curve illustrated the rank probability of each therapy under different outcomes. Results Nineteen studies were included in this study, with a total of 2395 patients. For knee pain, platelet-rich plasma (0.691) was ranked at the first place, followed by hyaluronic acid combined with platelet-rich plasma (0.670) and hyaluronic acid (0.402). In terms of stiffness, hyaluronic acid combined with platelet-rich plasma (0.743) enjoyed the highest value, platelet-rich plasma (0.603) was the next and hyaluronic acid (0.386) was the third. As for physical function, the rank was hyaluronic acid combined with platelet-rich plasma (0.772), platelet-rich plasma (0.608) and hyaluronic acid (0.343). For total scores, the order given by surface under the cumulative ranking was hyaluronic acid combined with platelet-rich plasma (0.765), platelet-rich plasma (0.624) and hyaluronic acid (0.37). Conclusions Hyaluronic acid combined with platelet-rich plasma showed the best efficacy in improving stiffness, physical function, and total scores, while platelet-rich plasma appeared the best in terms of pain reduction.
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Affiliation(s)
- Bingtong Li
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130000, Jilin, China
| | - Yuzheng Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Liqi Bi
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130000, Jilin, China.
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Vangsness CT, Adamson TC, Daley MJ. Consequences on Private Insurance Coverage: The AAOS Clinical Practice Guidelines and Hyaluronic Acid Injections. J Bone Joint Surg Am 2020; 102:920-926. [PMID: 32079873 PMCID: PMC7508284 DOI: 10.2106/jbjs.19.00272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- C. Thomas Vangsness
- Department of Orthopedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California,Email address for C.T. Vangsness Jr.:
| | - Thomas C. Adamson
- Department of Rheumatology, Sharp Rees-Stealy Medical Group, San Diego, California
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Yang Y, Li P, Zhu S, Bi R. Comparison of early-stage changes of osteoarthritis in cartilage and subchondral bone between two different rat models. PeerJ 2020; 8:e8934. [PMID: 32341895 PMCID: PMC7179570 DOI: 10.7717/peerj.8934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/17/2020] [Indexed: 02/05/2023] Open
Abstract
Osteoarthritis (OA) is a chronic degenerative joint disease and the major cause of joint pain and disability in the elderly. It is mainly characterized by articular cartilage degradation and subchondral bone remodeling. There are two main types of OA: natural occurring OA and secondary OA, mainly associated with aging and trauma, respectively. In this study, we established two OA models in rat knee joints to simulate the two types of OA, using the type II collagenase injection (CI) and anterior cruciate ligament transection (ACLT), respectively. After intervention for 2-6 weeks, cartilage and subchondral bone changes were detected in histological staining, immunochemistry, and micro-CT. Results showed that both models with typical pathology changes of OA were successfully induced, while the development and severity of OA process in the models were different. In ACLT rats, the cartilage damage was milder, lasted for a shorter time, and subchondral bone reconstruction occurred earlier, compared with the changes in CI rats. The cartilage damage was secondary to subchondral bone change in ACLT rats, while subchondral bone change was secondary to cartilage degeneration in CI rats. In conclusion, the interaction between cartilage and subchondral bone is different between the natural-occurring and secondary OA models. These two models not only suggest potential different mechanisms of the two types of OA, but also provide new directions for OA treatment and prevention.
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Affiliation(s)
- Yutao Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Peiran Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Vitali M, Ometti M, Drossinos A, Pironti P, Santoleri L, Salini V. Autologous conditioned serum: clinical and functional results using a novel disease modifying agent for the management of knee osteoarthritis. J Drug Assess 2020; 9:43-51. [PMID: 32284907 PMCID: PMC7144201 DOI: 10.1080/21556660.2020.1734009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
Objective: The purpose of this study was to investigate the potential ability of autologous conditioned serum (ACS) to decrease pain and improve joint functionality in patients affected by knee osteoarthritis (OA). Methods: Fifteen patients with clinical and radiological signs of OA of the knee were recruited for this study. Each patient received 4 injections of ACS (Orthokine; orthogen, Dusseldorf, Germany) at the site of OA once per week for 4 weeks. Clinical and functional evaluation was performed using the VAS scale for pain, WOMAC scale and KSS functional and clinical scores before the first injection, at one week, at two weeks, at three weeks, at one month and at six months. Statistical analysis was done with the Wilcoxon Signed-Rank Test. Results: Our results show an improvement of all the evaluation scales at 6 months follow-up. Particularly, VAS scales among all patients decreased by 35.8% (p = .00148), KSS functional scores improved by 38.2% (p = .00148), KSS clinical scores improved by 28.9% (p = .00236) and WOMAC scores were reduced by 19.8% (p = .00188). Few adverse effects were observed in our sample. The most common complaint was pain and swelling in the subsequent days after performing the intra-articular injection. Only one patient reported rigidity following the injection of the ACS. Conclusion: Our results, in conjunction with preexisting studies in the medical literature regarding ACS, demonstrate the viability of this therapy for the treatment of knee OA, showing positive influence on pain and joint function without significant adverse effects.
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Affiliation(s)
- Matteo Vitali
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Marco Ometti
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Andreas Drossinos
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Pierluigi Pironti
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Luca Santoleri
- Immunohematology and Transfusion Medicine, IRRCS Ospedale San Raffaele, Milan, Italy
| | - Vincenzo Salini
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
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DENG KF, SHENG FF, WEI XC, JIANG Y, ZHU Y, LIAO ZL, CHEN RL. Electroacupuncture combined with thunder-fire moxibustion for knee osteoarthritis of cold-damp type: A randomized controlled trial 电针联合雷火灸治疗寒湿型膝骨性关节炎: 随机对照试验. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2020. [DOI: 10.1016/j.wjam.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Conrozier T, Monfort J, Chevalier X, Raman R, Richette P, Diraçoglù D, Bard H, Baron D, Jerosch J, Migliore A, Henrotin Y. EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis. Cartilage 2020; 11:47-59. [PMID: 29926748 PMCID: PMC6921960 DOI: 10.1177/1947603518783455] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The 3 aims of the work were to identify population subgroups that can benefit the most from viscosupplementation (VS), to provide recommendations on injection techniques, and to discuss VS appropriateness in clinical situations that are commonplace in daily practice. METHODS The task force members voted on their degree of agreement on 27 statements, 36 recommendations, and 22 clinical scenarios using a 9-point scale. The strength of agreement/appropriateness/recommendation (SOA/SOR) was classified as strong if the median agreement score was ≥8. The level of consensus (LOC) was also obtained. RESULTS Among the assumed predictors for VS failure, obesity, radiographic severity, large synovial fluid effusion, severe patellofemoral involvement, major malalignment, and gross joint instability received a large majority of agreements. The lateral mid-patellar approach was recommended for knee injection. Imaging guidance was unanimously recommended for hip and ankle. Agreement was achieved to strictly respect the dosing regimen proven by controlled trials. There was agreement for treating with VS patients with mild to moderate knee and hip OA, with normal weight or moderate overweight, insufficiently improved by first-line therapies, or who do not wish get oral treatment or who have contraindications to pain killers. The group considered the patient's wishes as a key element in therapeutic decision making. CONCLUSION Based on literature data and clinical experience, the EUROVISCO group proposed a set of recommendations for optimizing the results of VS, aimed to help practitioners, especially in some cases in which the patients' specificities make the therapeutic decision difficult.
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Affiliation(s)
- Thierry Conrozier
- Department of Rheumatology, Hôpital Nord
Franche-Comté, Belfort, France,Thierry Conrozier, Department of
Rheumatology, Hôpital Nord Franche-Comté, 100 route de MOVAL, CS 10499
Trevenans, 90015 Belfort, France.
| | - Jordi Monfort
- Servei de Reumatologia, Hospital del
Mar, Barcelona, Spain
| | - Xavier Chevalier
- Paris XII University, UPEC, Department
of Rheumatology, Henri Mondor Hospital, Creteil, France
| | - Raghu Raman
- Academic Department of Orthopaedics,
Hull and East Yorkshire NHS Trust Castle Hill Hospital, Cottingham, UK
| | - Pascal Richette
- Université Paris Diderot, UFR Médicale,
Hôpital Lariboisière, Paris, France
| | - Demirhan Diraçoglù
- Department of Physical Medicine and
Rehabilitation, Istanbul University and Istanbul Faculty of Medicine, Istanbul,
Turkey
| | - Hervé Bard
- Department of Orthopaedics-Rheumatology,
American Hospital of Paris, Neuilly/Seine, France
| | - Dominique Baron
- Centre de réadaptation fonctionnelle de
Lannion-Trestel, Trévou-Tréguignec, France
| | - Jörg Jerosch
- Orthopedic Department,
Johanna-Etienne-Hospital, Neuss, Nordrhein-Westfalen, Germany
| | - Alberto Migliore
- U.O.S. of Rheumatology, Ospedale San
Pietro Fatebenefratelli, Rome, Italy
| | - Yves Henrotin
- Bone and Cartilage Research Unit,
Université de Liège, CHU Sart-Tilman, Liège, Belgium
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Zhang R, Li L, Chen B, Liu H, Liu J, Zhang L, Xiu Z. Acupotomy versus nonsteroidal anti-inflammatory drugs for knee osteoarthritis: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17051. [PMID: 31490401 PMCID: PMC6739018 DOI: 10.1097/md.0000000000017051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA), a common clinical chronic osteoarthropathy, has adverse effects on the working ability and life quality of patients. At present, acupotomy and nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely applied on KOA in China and has achieved satisfactory results. However, there is no systematic review comparing the effectiveness of these two therapies for KOA. Therefore, this study will assess the efficacy and safety of acupotomy in treating KOA. METHODS AND ANALYSIS Several databases including CNKI, Wanfang Database, CBM, VIP, PubMed, Cochrane library, Web of Science, and Embase will be used by two independent researchers to search the related clinical RCTs about acupotomy therapy for KOA patients until May 2019. Subsequently, meta-analysis will be conducted by using Review Manager 5.3, and the related data will be analyzed by using the method for GRADE. The continuous data will be presented as the WMD or SMD with 95% CI, while dichotomous data will be shown as the RR with 95% CI. CONCLUSION Our results review will provide evidence to determine whether acupotomy can achieve the effect of NSAIDs, or whether it has advantages and safety compared with NSAIDs for patients with KOA. ETHICS AND DISSEMINATION This study will not involve personal information. The ethical approval will not be required. This systematic review will be disseminated electronically through a peer-reviewed journal or international conference presentations. PROSPERO REGISTRATION NUMBER CRD42019129089.
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Affiliation(s)
- Renpan Zhang
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004
- Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Lixiang Li
- Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Bin Chen
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004
| | - Hong Liu
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004
| | - Jing Liu
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004
| | - Liangzhi Zhang
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004
| | - Zhongbiao Xiu
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004
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Conrozier T, Eymard F, Chouk M, Chevalier X. Impact of obesity, structural severity and their combination on the efficacy of viscosupplementation in patients with knee osteoarthritis. BMC Musculoskelet Disord 2019; 20:376. [PMID: 31421686 PMCID: PMC6698328 DOI: 10.1186/s12891-019-2748-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/31/2019] [Indexed: 01/15/2023] Open
Abstract
Background Obesity and radiological severity have been identified to be independent predictors of a low rate of response to viscosupplementation (VS), in patients with knee osteoarthritis (OA). Is that enough to formally refute VS in such patients in whom surgery is sometimes contraindicated? Objectives To compare pain and function scores before and 6 months after knee VS, according to the weight status (obese versus non obese), the radiological severity (mild/moderate versus severe) and both combined. Methods Post-hoc analysis of a prospective, double blind, randomized, multicentre trial, comparing 2 viscosupplements, in patients with symptomatic knee OA. Patients were classified according to body mass index (BMI < or ≥ 30 kg.− 2), OARSI radiological grade (1–2 versus 3) and OMERACT-OARSI response criteria (Yes/No). WOMAC between-group comparisons (obese versus non-obese, OARSI 1–2 versus 3, and both combined) in all patients and in OMERACT-OARSI Responders, were achieved using Mannn-Whitney U test. Results One-hundred and sixty-six patients were analyzed: 28.3% were obese, 44% were OARSI grade 3, 42,2% were neither obese nor OARSI 3, whereas 14.5% were obese and OARSI 3. At baseline WOMAC pain score did not differ according to the patients sub-groups (p > 0.05). Six months after VS, WOMAC pain decreased significantly in all patient sub-groups (all p < 0.01). At month 6, WOMAC pain sub-score was significantly lower in non-obese than in obese patients (4.9 ± 4.1 versus 7.1 ± 4.9; p = 0.008) and in patients OARSI 1–2 versus 3 (4.8 ± 4.3 versus 6.4 ± 4.5; p = 0.009). However, in responder patients there was no difference in pain score and pain decrease related to the weight status and the radiological score. Conclusion These results do not confirm our previous conclusions that recommended not performing VS in obese patients with severe knee OA. Although the chances of being a responder were much reduced in these patients, the benefit of patients who respond to treatment was similar to that of subjects with normal weight and mild/moderate OA. Different pain phenotypes, more than overweight and advanced disease, might be the main reason for the success or failure of VS.
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Affiliation(s)
- Thierry Conrozier
- Department of rheumatology, Hôpital Nord Franche-Comté, 100 route de Moval, CS 10490, Trevenans, 90015, Belfort, France.
| | - Florent Eymard
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
| | - Mickael Chouk
- Department of rheumatology, Hôpital Nord Franche-Comté, 100 route de Moval, CS 10490, Trevenans, 90015, Belfort, France
| | - Xavier Chevalier
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
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Ringe J, Hemmati-Sadeghi S, Fröhlich K, Engels A, Reiter K, Dehne T, Sittinger M. CCL25-Supplemented Hyaluronic Acid Attenuates Cartilage Degeneration in a Guinea Pig Model of Knee Osteoarthritis. J Orthop Res 2019; 37:1723-1729. [PMID: 30977553 DOI: 10.1002/jor.24312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 02/04/2023]
Abstract
There is evidence that the application of mesenchymal stromal cells (MSCs) counteracts osteoarthritis (OA) progression. However, the prospect of extracting and expanding these cells might be limited. The aim of this study was to investigate whether hyaluronic acid (HA) supplemented with MSC-recruiting chemokine C-C motif ligand 25 (CCL25) can influence the natural course of spontaneous OA in the guinea pig. CCL25 concentration in synovial fluid (SF) was quantified with enzyme-linked immunosorbent assay. Boyden chamber cell migration assay was used to test CCL25-mediated migration of guinea pig MSC. Forty-nine 11-month-old male guinea pigs were divided into seven groups. The main treatments consisted of five intra-articular injections of HA in pure form and in combination with three doses of CCL25 (63, 693, and 6,993 pg) given at a weekly interval. The severity of cartilage damage was assessed by using a modified Mankin score. The measured average physiological concentration of CCL25 in SF of animals is 85 ± 39 pg/ml. MSC showed a 3.2-fold increase in cell migration at 1,000 nM CCL25 in vitro demonstrating the biological migratory activity of CCL25 on these cells. In vivo, treatment with HA alone did not reduce OA progression. Similarly, OA scores were not found significantly reduced after treatment with 63 pg CCL25 + HA. However, when compared to pure HA, treatment with 693 pg CCL25 + HA and 6,993 pg CCL25 + HA significantly reduced the OA score from 10.1 to 7.4 (-28%) and 8.4 (-20%), respectively. These data suggest that intra-articular injections of HA supplemented with CCL25 attenuates OA. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1723-1729, 2019.
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Affiliation(s)
- Jochen Ringe
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Charitéplatz 1, 10117, Berlin, Germany
| | - Shabnam Hemmati-Sadeghi
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Charitéplatz 1, 10117, Berlin, Germany
| | - Kristin Fröhlich
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Engels
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Charitéplatz 1, 10117, Berlin, Germany
| | - Katja Reiter
- Julius Wolff Institute and Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Föhrer Straße 15, 13353, Berlin, Germany
| | - Tilo Dehne
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Sittinger
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Charitéplatz 1, 10117, Berlin, Germany
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McElheny K, Toresdahl B, Ling D, Mages K, Asif I. Comparative Effectiveness of Alternative Dosing Regimens of Hyaluronic Acid Injections for Knee Osteoarthritis: A Systematic Review. Sports Health 2019; 11:461-466. [PMID: 31340715 DOI: 10.1177/1941738119861545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Viscosupplementation is widely used for management of knee osteoarthritis. Many formulations of hyaluronic acid (HA) are available, ranging from a single injection to a series of up to 5 injections per treatment. OBJECTIVE To compare efficacy between single and multiple HA injection formulations. DATA SOURCES MEDLINE, EMBASE, Cochrane, Web of Science, Scopus databases were all searched. STUDY SELECTION Full-text prospective randomized and nonrandomized controlled human trials, cohort studies, and cost-effectiveness evaluations in the English language comparing different injection regimens of viscosupplementation were included. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION Data were collected using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Four databases were searched by a librarian and the principal investigator, identifying 6196 articles for screening. RESULTS Eleven studies met the inclusion criteria. Of the studies comparing single- with multiple-injection formulations of HA for treatment of knee osteoarthritis, there was no consistent difference in patient-reported outcomes. Furthermore, 5-injection formulations do not appear to be superior to 3-injection formulations. CONCLUSION There are limited head-to-head trials comparing viscosupplementation formulations that differ based on number of injections, and in particular, there is a paucity of trials evaluating single-injection formulations. Based on the currently available data, there appears to be similar efficacy with the possibility for greater cost-effectiveness and less patient inconvenience with single-injection formulations.
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Affiliation(s)
| | | | - Daphne Ling
- Hospital for Special Surgery, New York, New York
| | - Keith Mages
- Weill Cornell Medical College, New York, New York
| | - Irfan Asif
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
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Kopka M, Sheehan B, Degen R, Wong I, Hiemstra L, Ayeni O, Getgood A, Beavis C, Volesky M, Outerbridge R, Matache B. Arthroscopy Association of Canada Position Statement on Intra-articular Injections for Knee Osteoarthritis. Orthop J Sports Med 2019; 7:2325967119860110. [PMID: 31367647 PMCID: PMC6643188 DOI: 10.1177/2325967119860110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Michaela Kopka
- Michaela Kopka, MD, FRCSC, DipSportMed, Banff Sport Medicine, PO
Box 1300, Banff, AB T1L 1B3, Canada (
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Henrotin Y, Bannuru R, Malaise M, Ea HK, Confavreux C, Bentin J, Urbin-Choffray D, Conrozier T, Brasseur JP, Thomas P, Hick AC, Marinello A, Giordan N, Richette P. Hyaluronan derivative HYMOVIS® increases cartilage volume and type ii collagen turnover in osteoarhritic knee: data from MOKHA study. BMC Musculoskelet Disord 2019; 20:293. [PMID: 31215422 PMCID: PMC6580647 DOI: 10.1186/s12891-019-2667-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The objective of this pilot study was to identify biological, clinical or structural biomarkers of an intra-articular hyaluronic acid injection efficacy (HYMOVIS®) for the design of a larger placebo-controlled clinical trial studying the disease-modifying activity of this treatment. METHODS Forty six patients with symptomatic knee Osteoarthritis (OA) were enrolled in this open-label, prospective, multicenter, pilot study. Patients received two treatment cycles of intra-articular injections (3 mL) of HYMOVIS® (8 mg/mL of hyaluronic acid hexadecylamide) at 6 months interval. Each treatment cycle involved two intra-articular injections 1 week apart. All patients had Magnetic Resonance Imaging (MRI) of the target knee at baseline and 1 year, and blood samples to assess joint biomarkers. The primary outcome was the change in type II collagen-specific biomarkers (Coll2-1, Coll2-1NO2 and CTX-II) after HYMOVIS® treatment versus baseline. Secondary endpoints included levels changes in aggrecan chondroitin sulfate 846 epitope (CS-846), Cartilage Oligomeric Matrix Protein (COMP), procollagen type II N-terminal propeptide (PIIANP), Matrix Metalloprotease (MMP)-3, Myeloperoxidase (MPO) and Interleukin (IL)-6 serum biomarkers, the ratio Coll2-1/PIIANP, CTX-II/PIIANP, variation of MRI cartilage volume, and Knee injury and Osteoarthritis Outcome Score (KOOS) index. RESULTS Coll2-1 serum levels significantly increased overtime while Coll2-1NO2 levels were only increased at D360. Serum PIIANP levels also progressively and significantly enhanced with time. In contrast, other serum biomarker levels including CTX-II, CS-846, COMP, MMP-3, MPO or IL-6 did not change significantly overtime. Interestingly, the ratios Coll2-1/PIIANP and CTX-II/PIIANP decreased, indicating a decrease of cartilage catabolism. Compared to baseline value, MRI cartilage volume and thickness increased in lateral femoral and lateral trochlea compartments and not in medial compartment. These results, in addition to an improvement of T2 mapping score suggest a positive structural effect of the product. Interestingly, WORMS effusion score, an indicator of synovitis, significantly decreased. Finally, global KOOS score and subscales significantly increased overtime while pain at rest, walking pain and patients or investigators global assessment of disease activity decreased. The safety profile was favorable with a low incidence of injection-site pain. CONCLUSION HYMOVIS®, a well-tolerated intra-articular treatment, significantly enhanced type II collagen turnover as suggested by the increase in Coll2-1 and PIIANP levels and cartilage volume observed by MRI in lateral knee compartment. Importantly, this study provides critical information for the design of a larger phase III clinical trial investigating Disease Modifying effect of HYMOVIS®. TRIAL REGISTRATION http://www.isrctn.com/ISRCTN12227846 11/02/2015.
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Affiliation(s)
- Yves Henrotin
- Bone and Cartilage Research Unit, Arthropole Liège, Université de Liège, Institute of Pathology, CHU Sart-Tilman, 4000 Liège, Belgium
- Artialis SA, GIGA Tower, CHU Sart-Tilman, Liège, Belgium
| | - Raveendhara Bannuru
- Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA USA
| | - Michel Malaise
- Service de Rhumatologie - CHU Sart-Tilman, Liège, Belgium
| | - Hang-korng Ea
- Service de Rhumatologie - Centre Viggo Petersen, Hôpital Lariboisière, Paris, France
| | | | - Jacques Bentin
- Service de Rhumatologie - CHU Brugmann, Bruxelles, Belgium
| | | | - Thierry Conrozier
- Service de Rhumatologie - Hôpital Nord Franche-Comté, Trévenans, France
| | | | - Philippe Thomas
- Service de Rhumatologie - CHR Metz-Thionville - Hôpital Bel Air, Thionville, France
| | | | | | | | - Pascal Richette
- Service de Rhumatologie - Centre Viggo Petersen, Hôpital Lariboisière, Paris, France
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Filippiadis D, Charalampopoulos G, Mazioti A, Alexopoulou E, Vrachliotis T, Brountzos E, Kelekis N, Kelekis A. Interventional radiology techniques for pain reduction and mobility improvement in patients with knee osteoarthritis. Diagn Interv Imaging 2019; 100:391-400. [PMID: 30935863 DOI: 10.1016/j.diii.2019.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/10/2019] [Accepted: 02/17/2019] [Indexed: 02/06/2023]
Abstract
Osteoarthritis of the knee is the most common cause of chronic knee pain being more prevalent in middle-aged and elderly patients. Symptomatic patients complain of pain and mobility impairment. Therapeutic armamentarium includes physical therapy, oral pharmacologic therapy, intra-articular injections, nerve ablation or modulation, trans-catheter arterial embolization, minimally invasive arthroscopic treatment and partial or total knee arthroplasty. Interventional radiology therapies for knee osteoarthritis include intra-articular injections, neurotomy and neuromodulation techniques as well as transcatheter intra-arterial therapies. These therapies aim to control pain and inflammation, improve mobility and function whilst the novel cell-based therapies have the potential for bone and cartilage regenerative repair facilitating the delay to surgery. The purpose of this review is to illustrate the technical aspects, the indications and the methodology of local therapies for knee osteoarthritis performed by interventional radiologists and provide current evidence.
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Affiliation(s)
- D Filippiadis
- 2(nd) Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - G Charalampopoulos
- 2(nd) Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Mazioti
- 2(nd) Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - E Alexopoulou
- 2(nd) Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - T Vrachliotis
- 2(nd) Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - E Brountzos
- 2(nd) Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - N Kelekis
- 2(nd) Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Kelekis
- 2(nd) Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Maheu E, Bannuru RR, Herrero-Beaumont G, Allali F, Bard H, Migliore A. Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: Results of an extensive critical literature review. Semin Arthritis Rheum 2019; 48:563-572. [DOI: 10.1016/j.semarthrit.2018.06.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/24/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022]
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47
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Li W, Pan Y, Yang Q, Guo ZG, Yue Q, Meng QG. Extracorporeal shockwave therapy for the treatment of knee osteoarthritis: A retrospective study. Medicine (Baltimore) 2018; 97:e11418. [PMID: 29979441 PMCID: PMC6076154 DOI: 10.1097/md.0000000000011418] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This retrospective study investigated the effect and safety of extracorporeal shockwave therapy (ESWT) for treatment of knee osteoarthritis (KOA).In this retrospective study, 105 patients with KOA were included. Of those, 60 patients underwent ESWT, whereas 45 patients received laser therapy. Effect was measured by the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, adverse events (AEs) were also recorded in this study. All outcome measurements were evaluated at the end of weeks 1, 6, and 12.Compared with the laser therapy, ESWT showed greater effect in KOA symptoms relief with regard to NRS, WOMAC total, and its subscores at week 6 (P < .05) and week 12 (P < .01) after treatment. No AE, however, occurred in both groups.The results of this retrospective study found that ESWT may be efficacious and safe for the treatment of patients with KOA. It, however, had an intrinsic limitation as a retrospective study. Prospective study with larger sample size is still needed to warrant the result of this study in the future.
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Affiliation(s)
- Wei Li
- Department of Medical Science, Institute of Harbin, The First Hospital of Harbin City, Harbin Medical University
| | - Yu Pan
- Department of Study Center, The First Affiliated Hospital of Harbin Medical University
| | - Qi Yang
- Department of Medical Science, Institute of Harbin, The First Hospital of Harbin City, Harbin Medical University
| | - Zheng-gui Guo
- Department of Medical Science, Institute of Harbin, The First Hospital of Harbin City, Harbin Medical University
| | - Qi Yue
- Department of Study Center, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing-Gang Meng
- Department of Medical Science, Institute of Harbin, The First Hospital of Harbin City, Harbin Medical University
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Ran J, Yang X, Ren Z, Wang J, Dong H. Comparison of intra-articular hyaluronic acid and methylprednisolone for pain management in knee osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg 2018; 53:103-110. [DOI: 10.1016/j.ijsu.2018.02.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 01/07/2023]
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Pelletier JP, Raynauld JP, Abram F, Dorais M, Delorme P, Martel-Pelletier J. Exploring determinants predicting response to intra-articular hyaluronic acid treatment in symptomatic knee osteoarthritis: 9-year follow-up data from the Osteoarthritis Initiative. Arthritis Res Ther 2018; 20:40. [PMID: 29490683 PMCID: PMC5831607 DOI: 10.1186/s13075-018-1538-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/05/2018] [Indexed: 12/27/2022] Open
Abstract
Background The weight of recommendation for intra-articular therapies such as hyaluronic acid injections varies from one set of guidelines to another, and they have not yet reached unanimity with respect to the usefulness of intra-articular hyaluronic acid (IAHA) injections for the symptomatic treatment of knee osteoarthritis (OA). Among the reasons for the controversy is that the current literature provides inconsistent results and conclusions about such treatment. This study aimed at identifying determinants associated with a better response to IAHA treatment in knee OA. Methods Subjects were selected from the Osteoarthritis Initiative database. Participants were subjects who had radiographic OA, received one IAHA treatment, and had data on demographics and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at visits before (T0) and after (T1; within 6 months) treatment. Pain was analyzed for demographic, clinical, and imaging characteristics at T0 and change over time (T0 to T1). Subjects with WOMAC pain > 0 at T0 were subdivided into Low, Moderate, and High pain groups based on tertile analysis. Further analyses were done with the High pain group (score ≥ 8), which was divided into responders (improvement in pain ≥ 20%) and nonresponders (unchanged or worsening of pain). Results Participants (n = 310) received a total of 404 treatments (one per knee). In the Low and Moderate pain groups vs the High pain group, participants had significantly lower score at T0 (p < 0.001), and the Low vs High pain group had significantly lower BMI (p = 0.002), greater joint space width (JSW) (p = 0.010) and knee cartilage volume (p ≤ 0.009), and smaller synovial effusion (p = 0.033). In the High pain group, responders vs nonresponders were usually younger (p = 0.014), with greater cartilage volume in the medial compartment (p = 0.046), a trend toward greater JSW, and a significant improvement in all WOMAC scores (p < 0.001), while nonresponders showed worsening of symptoms. Conclusions This study identified reliable predictive determinants that can distinguish patients who could best benefit from IAHA treatment: high levels of knee pain, younger, and less severe structural damage. These could be implemented in clinical practice as a useful guide for physicians.
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Affiliation(s)
- Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Suite R11.412, Montreal, QC, H2X 0A9, Canada.
| | - Jean-Pierre Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Suite R11.412, Montreal, QC, H2X 0A9, Canada
| | - François Abram
- Medical Imaging Research & Development, ArthroLab Inc, Montreal, QC, Canada
| | - Marc Dorais
- StatSciences Inc, Notre-Dame-de-l'Île-Perrot, QC, Canada
| | | | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Suite R11.412, Montreal, QC, H2X 0A9, Canada
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Silawal S, Triebel J, Bertsch T, Schulze-Tanzil G. Osteoarthritis and the Complement Cascade. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544117751430. [PMID: 29434479 PMCID: PMC5805003 DOI: 10.1177/1179544117751430] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022]
Abstract
Accumulating evidence demonstrates that complement activation is involved in the pathogenesis of osteoarthritis (OA). However, the intimate complement regulation and cross talk with other signaling pathways in joint-associated tissues remain incompletely understood. Recent insights are summarized and discussed here, to put together a more comprehensive picture of complement involvement in OA pathogenesis. Complement is regulated by several catabolic and inflammatory mediators playing a key role in OA. It seems to be involved in many processes observed during OA development and progression, such as extracellular cartilage matrix (ECM) degradation, chondrocyte and synoviocyte inflammatory responses, cell lysis, synovitis, disbalanced bone remodeling, osteophyte formation, and stem cell recruitment, as well as cartilage angiogenesis. In reverse, complement can be activated by various ECM components and their cleavage products, which are released during OA-associated cartilage degradation. There are, however, some other cartilage ECM components that can inhibit complement, underlining the diverse effects of ECM on the complement activation. It is hypothesized that complement might also be directly activated by mechanical stress, thereby contributing to OA. The question arises whether keeping the complement activation in balance could represent a future therapeutic strategy in OA treatment and in the prevention of its progression.
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Affiliation(s)
- Sandeep Silawal
- Department of Anatomy, Paracelsus Medical University, Nuremberg, Germany
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Germany
| | - Jakob Triebel
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Bertsch
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Gundula Schulze-Tanzil
- Department of Anatomy, Paracelsus Medical University, Nuremberg, Germany
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Germany
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