Eklem İçi Kortizon Enjeksiyonu Sonrası Diz Osteoartriti Olan Hastaların Durumu- Retrospektif Çalışma

Year 2022, Volume: 9 Issue: 1, 1 - 8, 30.06.2022

Faruk İbrahimoğlu Nurayet Canbaz Emre Şenocak

Abstract

Amaç: Diz osteoartriti, kıkırdak dokunun dejenerasyonuna bağlı olarak ortaya çıkan, ağrı, tutukluk ve fonksiyonel bozulmaya neden olan hareket kısıtlılığı ile karakterize dejeneratif bir hastalıktır. Bu çalışma, eklem içi kortizon enjeksiyonunun ağrı ve işlevsellik üzerine etkisini retrospektif bir derleme ile incelemeyi amaçladı.
Gereç ve Yöntem: Semptomatik diz osteoartriti için triamsinolon asetonid ile tedavi edilen 102 hastanın verileri geriye dönük olarak gözden geçirildi. Veriler 40 mg/ay (2 ay süreyle) kortizon enjekte edilen hastaların tıbbi kayıtlarından elde edildi. Hastalar Lequesne Fonksiyonellik İndeksi-LFI skorlarının şiddetine göre üç gruba ayrıldı ve demografik bilgileri ile fonksiyonel durumları değerlendirildi. Değerlendirmeler başlangıçta ve 2 ayın sonunda tekrarlandı. Gruplar indeksin ağrı, yürüme mesafesi ve günlük yaşam aktiviteleri alt başlıklarına göre karşılaştırıldı.
Bulgular: Grupların fonksiyonel etkilenim şiddetlerinin yaşla birlikte arttığı tespit edildi. Grup içi analizler neticesinde, ikinci doz enjeksiyonlardan sonra tüm gruplarda ağrı, yürüme mesafesi, günlük yaşam aktiviteleri ve toplam LFI skorlarında anlamlı iyileşmeler gözlendi (p<0.05). Gruplar arası analizde ise, ciddi handikap ve çok ağır handikap grupları arasında yukarıdaki parametreler açısından fark yoktu (p>0.05). En önemli farklar, çok ağır handikaplı bireyler ile ciddi handikapa sahip olan bireyler arasındaydı (p<0.05). Regresyon analizi sonuçlarına göre; yüksek hadikaplı bireylerde günlük yaşam aktivitesindeki etkilenimin %29.80’i ağrı faktörü tarafından açıklanabilmekteydi.
Sonuç: Eklem içi kortizon müdahalesi, semptom şiddeti yüksek olan bireylerde bu semptomları azaltmak için uygulanabilen, kolay ulaşılabilir, düşük maliyetli, etkili bir yöntemdir.

Keywords

Eklem içi enjeksiyon, kortizon, diz osteoartriti, işlevsellik, ağrı

Status of Patients with Knee Osteoarthritis After Intra-Articular Cortisone Injection-A Retrospective Study

Abstract

Objective: Knee osteoarthritis is a degenerative disease that occurs due to degeneration of the cartilage tissue and is characterized by pain, stiffness, and limitation of movement that causes functional impairment. This study aimed to examine the effect of intra-articular cortisone injection on pain and functionality with a retrospective review.
Methods: Data of 102 patients treated with triamcinolone acetonide for symptomatic knee osteoarthritis were retrospectively reviewed. Data were obtained from the medical records of the patients injected with 40 mg/month (for 2 months) cortisone. The patients were divided into three groups according to the severity of the Lequesne Functionality Index-LFI scores, demographics and functional status were evaluated. Assessments were repeated at baseline and at the end of 2 months. The groups were compared according to the sub-headings of the index: pain, walking distance, and activities of daily living.
Results: The functional impact intensity of the groups increased with age. When compared intra-group analysis, significant improvements were observed in pain, walking distance, daily life activities, and total LFI scores of all groups after second doses of injections (p<0.05 for all). In the inter-group analysis, there was no difference between the severe handicap and very severe handicap groups in terms of the above parameters (p>0.05). The most significant differences were between individuals with severe handicaps and individuals with an extreme severely handicaps (p<0.05 for all). According to the regression analysis; 29.80% of the effect on activities of daily living can be predicted by the pain in the very severe handicap group.
Conclusion: Intra-articular cortisone is an easily accessible, low-cost, effective method that can be applied in individuals with high symptom severity to reduce these symptoms.

Keywords

Intra-articular injection, cortisone, knee osteoarthritis, functionality, pain

References

• 1. Köylü SU, Bozkurt S, Nazlıkul H. Gonartrozda nöralterapi̇ni̇n etki̇nli̇ği̇. Bilim Tamamlayıcı Tıp, Regülasyon ve Nöralterapi Derg. 2019;13(1):13–5.
• 2. Raeissadat SA, Ghazi Hosseini P, Bahrami MH, Salman Roghani R, Fathi M, Gharooee Ahangar A, et al. The comparison effects of intra-articular injection of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factor (PRGF), Hyaluronic Acid (HA), and ozone in knee osteoarthritis; a one year randomized clinical trial. BMC Musculoskelet Disord [Internet]. 2021;22(1):1–14. Available from: http://10.0.4.162/s12891-021-04017-x
• 3. Bandak E, Overgaard AF, Kristensen LE, Ellegaard K, Guldberg-Møller J, Bartholdy C, et al. Exercise therapy and patient education versus intra-articular saline injections in the treatment of knee osteoarthritis: an evidence-based protocol for an open-label randomised controlled trial (the DISCO trial). Trials [Internet]. 2021;22(1). Available from: http://10.0.4.162/s13063-020-04952-5
• 4. Bistolfi A, Roato I, Fornelli G, Sabatini L, Massè A, Ferracini R. Treatment of knee osteoarthritis by intra-articular injection of concentrated autologous adipose tissue: a twenty four month follow-up study. Int J Orthop Sci. 2021;45(3):627–33.
• 5. Gilat R, Haunschild ED, Knapik DM, Evuarherhe A, Parvaresh KC, Cole BJ. Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis. Int Orthop. 2021;45(2):345–54.
• 6. Li D, Wang Y, Shen Y. A randomized study protocol comparing the platelet-rich plasma with hyaluronic acid in the treatment of symptomatic knee osteoarthritis. Medicine (Baltimore). 2021;100(2).
• 7. Riddle DL, Stratford PW. Unilateral vs bilateral symptomatic knee osteoarthritis: Associations between pain intensity and function. Rheumatology. 2013;52(12):2229–37.
• 8. Araujo ILA, Castro MC, Daltro C, Matos MA. Quality of Life and Functional Independence in Patients with Osteoarthritis of the Knee. Knee Surg Relat Res. 2016;28(3):219–24.
• 9. Gümüş K, Ünsal A. Osteoartritli Bireylerin Günlük Yasam Aktivitelerinin Değerlendirilmesi. Turk J Osteoporos. 2014;20(3).
• 10. McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis a randomized clinical trial. JAMA. 2017;317(19):1967–75.
• 11. Özden F, Nadiye Karaman Ö, Tuğay N, Yalın Kilinç C, Mihriban Kilinç R, Umut Tuğay B. The relationship of radiographic findings with pain, function, and quality of life in patients with knee osteoarthritis. J Clin Orthop Trauma. 2020;11:512–7.
• 12. Sliepen M, Mauricio E, Lipperts M, Grimm B, Rosenbaum D. Objective assessment of physical activity and sedentary behaviour in knee osteoarthritis patients - Beyond daily steps and total sedentary time. BMC Musculoskelet Disord. 2018;19(1):1–10.
• 13. Soran N, Altindaǧ Ö, Demirkol A, Tabur H. Diz osteoartritinde radyolojik bulgular ve klinik parametrelerle ilişkisi. Turk J Phys Med Rehabil. 2008;54:59–62.
• 14. Yavuz U, Sökücü S, Albayrak A, Öztürk K. Efficacy comparisons of the intraarticular steroidal agents in the patients with knee osteoarthritis. Rheumatol Int. 2012;32(11):3391–6.
• 15. Uslu Güvendi E, Aşkin A, Güvendi G, Koçyiğit H. Comparison of efficiency between corticosteroid and platelet rich plasma injection therapies in patients with knee osteoarthritis. Arch Rheumatol. 2018;33(3):273–81.
• 16. Nabi BN, Sedighinejad A, Mardani-Kivi M, Haghighi M, Roushan ZA, Tehran SG, et al. Comparing the effectiveness of intra-articular platelet-rich plasma and corticosteroid injection under ultrasound guidance on pain control of knee osteoarthritis. Iran Red Crescent Med J. 2018;20(3).
• 17. Elksniņš-Finogejevs A, Vidal L, Peredistijs A. Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: A single-center prospective randomized controlled study with a 1-year follow up. J Orthop Surg Res. 2020;15(1):1–10.
• 18. Klokker L, Osborne R, Wæhrens EE, Norgaard O, Bandak E, Bliddal H, et al. The concept of physical limitations in knee osteoarthritis: as viewed by patients and health professionals. Qual Life Res. 2015;24(10).
• 19. Kumar S, YS H. Analysis of pattern of change of VAS and WOMAC between autologous bone marrow derived mesenchymal stem cells enhanced with platelet rich plasma versus platelet rich plasma in osteoarthritis knee. Int J Orthop Sci. 2017;3(1).
• 20. Pollock RD, Carter S, Velloso CP, Duggal NA, Lord JM, Lazarus NR, et al. An investigation into the relationship between age and physiological function in highly active older adults. J Physiol. 2015;593(3).
• 21. Alves JC, Bassitt DP. Quality of life and functional capacity of elderly women with knee osteoarthritis. Einstein (Sao Paulo). 2013;11(2).
• 22. Raeissadat SA, Ahangar AG, Rayegani SM, Sajjadi MM, Ebrahimpour A, Yavari P. Platelet-rich plasma-derived growth factor vs hyaluronic acid injection in the individuals with knee osteoarthritis: A one year randomized clinical trial. J Pain Res. 2020;13:1699–711.
• 23. Korpershoek J V., Vonk LA, De Windt TS, Admiraal J, Kester EC, Van Egmond N, et al. Intra-articular injection with Autologous Conditioned Plasma does not lead to a clinically relevant improvement of knee osteoarthritis: a prospective case series of 140 patients with 1-year follow-up. Acta Orthop. 2020;91(6):743–9.
• 24. Sánchez M, Delgado D, Sánchez P, Muiños-López E, Paiva B, Granero-Moltó F, et al. Combination of Intra-Articular and Intraosseous Injections of Platelet Rich Plasma for Severe Knee Osteoarthritis: A Pilot Study. Biomed Res Int. 2016;2016:1–10.