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Diz Osteoartritinde İntraartiküler Hyalüronik Asit ve Tenoksikamın Ağrı ve Diz Eklem Fonksiyonları Üzerine Etkilerinin Karşılaştırılması

Year 2018, Volume: 2 Issue: 3, 149 - 158, 13.11.2018
https://doi.org/10.30565/medalanya.419286

Abstract

Amaç: Bu çalışmada gonartrozlu hastalarda intraartiküler
hyalüronik asit (HA) ve tenoksikam uygulanmasının eklem hareket açıklığı (EHA)
ve ağrı üzerine etkilerinin karşılaştırılması amaçlanmıştır.

Hastalar
ve Yöntem:
Bu çalışma prospektif,
randomize olmayan kontrollü ve tek kör olarak planlanmıştır.
  ACR (American College of Rheumatology)
kritelerine göre Grade II ve Grade III osteoartrit (OA) tanısı konulmuş 60
hasta çalışmaya ardışık olarak alındı. Hastalar iki gruba ayrılarak
  birinci gruba birer hafta arayla 3 doz
intraartiküler HA, diğer gruba ise tek doz intraartiküler tenoksikam
uygulandı.
  Grupların tedavi öncesi ve
sonrası VAS ve EHA değerleri karşılaştırıldı.

Bulgular: HA Grubu’nda yer alan hastaların 20’si (%66.6) kadın, 10’u
(%33.3) erkekti ve bu hastaların yaş ortalaması 59.6 (yaş aralığı 45-75) yıl
idi. Tenoksikam Grubu'nda yer alan hastaların 24’ü (%80) kadın, 6’sı (%20)
erkekti ve bu grubun yaş ortalası 61.5 (yaş aralığı 45-75) yıl idi. Tedavi
sonrası her iki grupta da tedavi öncesine göre 1. Gün, 15. Gün, 1. ay, 2. ay ve
3. ay değerlerinde VAS, dizin fleksiyon ve ekstansiyon EHA’sında artış
saptanmıştır (p<0.05). Gruplar arası değişim miktarları
karşılaştırıldığında, erken dönemde Tenoksikam Grubu’ndaki değişiklikler daha
belirgindi fakattedavi sonrası 3. ay değerlerinde iki grup açısından fark
saptanmadı (p>0.05).


























Sonuç: Grade 2-3 diz OA’li hastalarda intraartikuler HA ve
tenoksikam uygulamalarının etkin ve güvenilir yöntemler olduğu; fakat
tenoksikamın HA’ya göre erken dönemde ağrıyı azaltma ve EHA’yı arttırmada daha
etkili olduğu görüldü.

References

  • 1. Vincent KR, Conrad BP, Fregly BJ, Vincent HK. The Pathophysiology of Osteoarthritis: A Mechanical Perspective on the Knee Joint. PM R. 2012;4(50):S3-S9.
  • 2. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Casp J Int Med. 2011;2(2):205-212.
  • 3. Aslan A, Kırdemir V, Atay T, Baykal YB, Aytekin Ö, Aydoğan FC. [The Efficacy of Intra-Articular Injection of Hyaluronic Acid With Supplemental Peroral Vitamin E Following Arthroscopic Debridement in the Treatment of Knee Osteoarthritis: A Prospective, Randomized, Controlled Study]. Turk J Phys Med Re hab 2012;58:199-203.
  • 4. Khan M, Adili A, Winemaker M, Bhandari M. Management of osteoarthritis of the knee in younger patients. CMAJ. 2018;190(3):E72-E79.
  • 5. Schiphof D, van den Driest JJ, Runhaar J. Osteoarthritis year in review 2017: rehabilitation and outcomes. Osteoarthritis Cartilage. 2018;26(3):326-340.
  • 6. Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum. 2018 Jan 31. pii: S0049-0172(17)30650-9.
  • 7. Erbas M, Simsek T, Kiraz HA, Sahin H, Toman H. Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis. Braz J Anesthesiol. 2015;65(5):333-7.
  • 8. Orak MM, Ak D, Midi A, Laçin B, Purisa S, Bulut G. Comparison of the effects of chronic intra-articular administration of tenoxicam, diclofenac, and methylprednisolone in healthy rats. Acta Orthop Traumatol Turc. 2015;49(4):438-46.
  • 9. Oztuna V, Eskandari M, Bugdayci R, Kuyurtar F. Intra-articular injection of tenoxicam in osteoarthritic knee joints with effusion. Orthopedics. 2007;30(12):1039-42.
  • 10. Jackson DW, Evans NA, Thomas BM. Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am. 2002;84-A(9):1522-7.
  • 11. Altman RD, Block DA, Brandt KD, Cooke DV, Greenwald RA, et al. Osteoarthritis: definitions and criteria. Ann Rheum Dis. 1990;49(3):201.
  • 12. Ozkan FU, Uzer G, Türkmen I, et al. Intra-articular hyaluronate, tenoxicam and vitamin E in a rat model of osteoarthritis: evaluation and comparison of chondroprotective efficacy. Int J Clin Exp Med 2015;8(1):1018-1026.
  • 13. Carabba M, Paresce E, Angelini M, et al. The İntraarticular treatment of the osteoarthritis of the knee: A comparative study between hyaluronic asid and orgotein. Eur J Rheumatol Inflamm. 1992;12:47-52.
  • 14. Corrado EM, Peluso GF, Gigliotti S, et al. The effect of intraarticular administration of hyaluronic asid on osteoarthritis of knee: A clinical study with immunological and biochemical evaluation. Eur J Rheum Inflamm. 1995;15:47-56.
  • 15. Petrella RJ, DiSilvestro MD, Hildebrand C. : Effects of hyaluronate sodium on pain and physical functioning in osteoarthritis of the knee. A randomized, double-blind, placebo- controlled clinical trial. Arch Intern Med; 2002;162: 292-298.
  • 16. Fisher NM, Gresham G, Pendergast DR. : Effects of a quantitative pogressive rehabilitation program applied unilaterally to the osteoarthritic knee. Arch Phys Med Rehabil 1993;74: 1319-1326.
  • 17. Unlu Z, Ay K, Tuzun C. Comparison of intra-articular tenoxicam and oral tenoxicam for pain and physical functioning in osteoarthritis of the knee. Clin Rheumatol. 2006;25(1):54-61.
  • 18. Huskisson EC, Donnely S. Hyaluronic asit in treatment of osteoarthritis of the knee. Rheumatology (Oxford); 1999;38: 7: 602-7.

Comparison of the Effects of Intra-articular Hyaluronic Acid and Tenoxicam on Pain and Knee Joint Functions in Knee Osteoarthritis

Year 2018, Volume: 2 Issue: 3, 149 - 158, 13.11.2018
https://doi.org/10.30565/medalanya.419286

Abstract

Aim: The objective of this study is comparing the effects of
intra-articular hyaluronic acid (HA) and tenoxicam aplications on joint range
of motion (ROM) and pain in patients with gonarthrosis.

Patients
and Method:
This study was designed
as prospective, non-randomized controlled, and single-blinded trial. 60
patients diagnosed with Grade II and Grade III osteoarthritis (OA) according to
the American College of Rheumatology (ACR) criteria were consecutively
enrolled. Patients were divided into two groups whereby the first group
received intra-articular HA three times a week and the other group received a
single dose intra-articular tenoxicam. Pre-treatment and after-treatment VAS
and ROM values of the groups were compared.

Results: In the HA Group, 20 patients (66.6%) were female, 10
patients (33.3%) were male and the mean age of them was 59.6 years (range 45-75
years). In the Tenoxicam Group, 24 patients (80%) were female, 6 (20%) patients
were male, and the average age of this group was 61.5 years (range 45-75
years). VAS scores knee flexion and extension ROM values on the 1st day, the
15th day, the 1st month,the2nd month, and the 3rd month after the treatment,
significantly improved in both groups (p <0.05). When the change levels in
the groups were compared, the changes in the Tenoxicam Group were more
prominent in the early period, but there was no difference between the two
groups in terms of the 3rd-month values after the treatment (p> 0.05).


























Conclusion: It was seen that intra-articular HA and tenoxicam administration
seem to be effective and reliable methods in Grade 2-3 knee OA patients; but
tenoxicam was more effective in reducing pain and relieving joint movements
compared to HA injection in the early periods.

References

  • 1. Vincent KR, Conrad BP, Fregly BJ, Vincent HK. The Pathophysiology of Osteoarthritis: A Mechanical Perspective on the Knee Joint. PM R. 2012;4(50):S3-S9.
  • 2. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Casp J Int Med. 2011;2(2):205-212.
  • 3. Aslan A, Kırdemir V, Atay T, Baykal YB, Aytekin Ö, Aydoğan FC. [The Efficacy of Intra-Articular Injection of Hyaluronic Acid With Supplemental Peroral Vitamin E Following Arthroscopic Debridement in the Treatment of Knee Osteoarthritis: A Prospective, Randomized, Controlled Study]. Turk J Phys Med Re hab 2012;58:199-203.
  • 4. Khan M, Adili A, Winemaker M, Bhandari M. Management of osteoarthritis of the knee in younger patients. CMAJ. 2018;190(3):E72-E79.
  • 5. Schiphof D, van den Driest JJ, Runhaar J. Osteoarthritis year in review 2017: rehabilitation and outcomes. Osteoarthritis Cartilage. 2018;26(3):326-340.
  • 6. Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum. 2018 Jan 31. pii: S0049-0172(17)30650-9.
  • 7. Erbas M, Simsek T, Kiraz HA, Sahin H, Toman H. Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis. Braz J Anesthesiol. 2015;65(5):333-7.
  • 8. Orak MM, Ak D, Midi A, Laçin B, Purisa S, Bulut G. Comparison of the effects of chronic intra-articular administration of tenoxicam, diclofenac, and methylprednisolone in healthy rats. Acta Orthop Traumatol Turc. 2015;49(4):438-46.
  • 9. Oztuna V, Eskandari M, Bugdayci R, Kuyurtar F. Intra-articular injection of tenoxicam in osteoarthritic knee joints with effusion. Orthopedics. 2007;30(12):1039-42.
  • 10. Jackson DW, Evans NA, Thomas BM. Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am. 2002;84-A(9):1522-7.
  • 11. Altman RD, Block DA, Brandt KD, Cooke DV, Greenwald RA, et al. Osteoarthritis: definitions and criteria. Ann Rheum Dis. 1990;49(3):201.
  • 12. Ozkan FU, Uzer G, Türkmen I, et al. Intra-articular hyaluronate, tenoxicam and vitamin E in a rat model of osteoarthritis: evaluation and comparison of chondroprotective efficacy. Int J Clin Exp Med 2015;8(1):1018-1026.
  • 13. Carabba M, Paresce E, Angelini M, et al. The İntraarticular treatment of the osteoarthritis of the knee: A comparative study between hyaluronic asid and orgotein. Eur J Rheumatol Inflamm. 1992;12:47-52.
  • 14. Corrado EM, Peluso GF, Gigliotti S, et al. The effect of intraarticular administration of hyaluronic asid on osteoarthritis of knee: A clinical study with immunological and biochemical evaluation. Eur J Rheum Inflamm. 1995;15:47-56.
  • 15. Petrella RJ, DiSilvestro MD, Hildebrand C. : Effects of hyaluronate sodium on pain and physical functioning in osteoarthritis of the knee. A randomized, double-blind, placebo- controlled clinical trial. Arch Intern Med; 2002;162: 292-298.
  • 16. Fisher NM, Gresham G, Pendergast DR. : Effects of a quantitative pogressive rehabilitation program applied unilaterally to the osteoarthritic knee. Arch Phys Med Rehabil 1993;74: 1319-1326.
  • 17. Unlu Z, Ay K, Tuzun C. Comparison of intra-articular tenoxicam and oral tenoxicam for pain and physical functioning in osteoarthritis of the knee. Clin Rheumatol. 2006;25(1):54-61.
  • 18. Huskisson EC, Donnely S. Hyaluronic asit in treatment of osteoarthritis of the knee. Rheumatology (Oxford); 1999;38: 7: 602-7.
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Research Article
Authors

Recai Özkılıç This is me 0000-0003-1343-3887

Tolgahan Kuru 0000-0003-1245-6390

Serdar İpek 0000-0002-7608-885X

Ekrem Keskin 0000-0002-4303-8012

Cengiz Işık

Yasin Emre Kaya This is me 0000-0002-5412-8355

Publication Date November 13, 2018
Submission Date April 27, 2018
Acceptance Date June 4, 2018
Published in Issue Year 2018 Volume: 2 Issue: 3

Cite

Vancouver Özkılıç R, Kuru T, İpek S, Keskin E, Işık C, Kaya YE. Diz Osteoartritinde İntraartiküler Hyalüronik Asit ve Tenoksikamın Ağrı ve Diz Eklem Fonksiyonları Üzerine Etkilerinin Karşılaştırılması. Acta Med. Alanya. 2018;2(3):149-58.

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