Comparison of the Effects of Different Molecular Weight Hyaluronic Acid Application in Knee Osteoarthritis

Abstract

Objective: The objective of this study was to evaluate the effect of different molecular weight (MW) hyaluronic acid (HA) application on pain and functional parameters in knee osteoarthritis (OA). Methods: This study was designed as retrospectively. Hospital records of the patients who received intraarticular HA injection therapy in our center were screened. The patients were divided into 3 categories according to the MW of the preparates as the follows; Group 1: 0,6-1,2 Milion Da of MW (N=26); Group 2: 1,1- 2,2 Million Da of MW (N=25); and Group 3: 1,7-2,1 Million Da of MW (N=25). All patients were assessed using Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) before the treatment and one month after the injection. Results: A total of 76 patients (61 females, 15 males) with a mean age of 62,1 years (minimum-maximum: 50-70 years) were included. VAS and WOMAC scores did improve significantly in all groups (all for p<0.001). However, no significant difference was observed between the groups in terms of the delta values of the VAS and WOMAC scores between the groups (p: 0,721 and p: 0,595, respectively). Conclusion: In conclusion, significant reductions in VAS and WOMAC scores were observed in all 3 patient groups in our study. Yet, there was no significant difference regarding the MW of HA preparations.

Keywords

• knee osteoarthritis
• hyaluronic acid
• pain

Project Number

2017-610

Diz Osteoartritinde Farklı Molekül Ağırlıklı Hyaluronik Asit Uygulamalarının Etkilerinin Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, diz osteoartritinde (OA) farklı moleküler ağırlıklı (MA) hyaluronik asit (HA) uygulamasının ağrı ve fonksiyonel parametreler üzerindeki etkisini değerlendirmektir. Yöntemler: Bu çalışma geriye dönük olarak planlandı. Merkezimizde intraartiküler HA enjeksiyon tedavisi alan hastaların hastane kayıtları tarandı. Preparatların MA'sına göre hastalar aşağıdaki gibi 3 kategoriye ayrıldı; Grup 1: 0,6-1,2 Milyon Da MA (N=26); Grup 2: 1,1- 2,2 Milyon Da MA (N=25); ve Grup 3: 1,7-2,1 Milyon Da MA (N=25). Tüm hastalar, tedaviden önce ve enjeksiyondan bir ay sonra Görsel Analog Skala (VAS) ve Western Ontario ve McMaster Universities Arthritis Index (WOMAC) kullanılarak değerlendirildi. Bulgular: Yaş ortalaması 62,1 yıl (minimum-maksimum: 50-70 yıl) olan toplam 76 hasta (61 kadın, 15 erkek) dahil edildi. VAS ve WOMAC skorları tüm gruplarda anlamlı olarak iyileşti (tümü için p<0,001). Ancak gruplar arasında VAS ve WOMAC puanlarının delta değerleri açısından gruplar arasında anlamlı bir fark gözlenmedi (sırasıyla p: 0,721 ve p: 0,595). Sonuç: Sonuç olarak, çalışmamızda her 3 hasta grubunda da VAS ve WOMAC skorlarında anlamlı düşüşler gözlendi. Ancak, HA preparatlarının MA'sı ile ilgili önemli bir fark yoktu.

Keywords

• Diz Osteoartriti
• Hyaluronik Asit
• Ağrı

Supporting Institution

Hacettepe Üniversitesi Tıp Fakültesi

Project Number

2017-610

References

1. 1. Pereira D, Ramos E, Branco J. Osteoarthritis. Acta Med Port 2015; 28:99- 106
2. 2. Breedveld FC. Osteoarthritis the impact of a serious disease. Rheudisease Rheumatology (Oxford) 2004; 43-44
3. 3. Kacar C, Gilgil E, Urhan S, Arikan V, Dündar U, Oksüz MC, et al. The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey. Rheumatol Int 2005; 25:201-204
4. 4. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003: 62;1145-1155
5. 5. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis. Ann Intern Med. 2015; 162:46–55
6. 6. Bagga H, Burkhardt D, Sambrook P, March L. Longterm effects of intraarticular hyaluronan on synovial fluid in osteoarthritis of the knee. J Rheumatol. 2006;33:946– 950
7. 7. Gigante A, Callegari L. The role of intra-articular hyaluronan in the treatment of osteoarthritis. Rheumatol Int 2011;31:427–444
8. 8. Rutjes AW, Jüni P, Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta- analysis. Ann Intern Med. 2012; 157:180–191

9. 9. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis a. index. 2005;13:28-33
10. 10. Aungst F, Aeschlimann A, Steiner W, Stucki G: Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis 2001; 60: 834-840
11. 11. Martins PC, Couto TE, Gama AC. Auditory-perceptual evaluation of the degree of vocal deviation: correlation between the Visual Analogue Scale and Numerical Scale. Codas. 2015;27:279-284
12. 12. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008; 16:137-162
13. 13. Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis Cartilage. 2005;13:769–781
14. 14. Nevitt MC, Felson DT, Williams EN, Grady D. The effect of estrogen plus progestin on knee symptoms and related disability in postmenopausal women: The Heart and Estrogen/Progestin Replacement Study, a randomized, double-blind, placebo- controlled trial. Arthritis Rheum. 2001;44:811–818
15. 15. Silverwood V, Blagojevic-Bucknall M Current Evidence on risk factors for knee osteoarthritis in older adults Osteoarthritis Cartilage. 2015;23:507-515
16. 16. Jarvholm, B., Lewold, S., Malchau, H., and Vingard, E. Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men. Eur J Epidemiol. 2005; 20: 537–542
17. 17. Gigante A, Callegari L. The role of intra-articular hyaluronan in the treatment of osteoarthritis. Rheumatol Int 2011;31:427–444
18. 18. Tobetto K, Nakai K, Akatsuka M, Yasui T, Ando T, Hirano S.Inhibitory effects of hyaluronan on neutrophil-mediated cartilage degradation.Connect Tissue Res. 1993;29:181-190.
19. 19. Coleman PJ, Scott D, Mason RM, Levick JR. Role of hyaluronan chain length in buffering interstitial now across synovium in rabbits. J Physiol 2000; 526:425-434
20. 20. Bingöl Ü, Yurtkuran M. Comparison of the Clinical Efficacy and Adverse Effects of Two Hyaluronan Preparations With Different Molecular Weights and a Methyl Prednisolone Acetate in Knee Osteoarthritis Turk J Phys Med Rehab 2013;59:189-200
21. 21. Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA 2003; 290:3115-121
22. 22. Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis CMAJ. 2005; 172: 1039–1043