Birinci Karpometakarpal Eklem Osteoartritinin Tedavisi: Kortikosteroid ile Platelet Zengin Plazma – Randomize Karşılaştırmalı Çalışma

Öz

Amaç: İleri yaş erkek ve kadınların birinci parmağın karpometakarpal (KMK) eklem artrozu %35,8 sıklıkta görülmektedir. Çalışmamızda elde 1. parmak karpometakarpal eklem artrozunda kortikosteroid ve platelet zengin plazma (PZP) enjeksiyonunun klinik ve fonksiyonel sonuçlar üzerinde etkisinin karşılaştırılması amaçlanmıştır.
Materyal ve Metot: Bu çalışmada Ekim 2016 – Mart 2018 tarihleri arasında kliniğimize başvuran, elde 1. karpometakarpal eklemde osteoartrit tanısı konulan ve daha önce diğer konservatif tedavi yöntemlerinden fayda görmeyen, Eaton- Littler sınıflamasına göre evre 2 ve en az 24 hafta takip edilmiş olan 58 hasta prospektif çalışmaya dahil edildi. 1.,2.,3. ve 6. aylarda Dreiser ve VAS skorları ile değerlendirilerek sonuçlar istatistiksel olarak karşılaştırıldı.

Bulgular: Grupların enjeksiyon öncesi VAS ve Dreiser skorları arasında istatistiksel olarak anlamlı fark yoktu (sırası ile p=0,211 ve p=0,239). Her iki grubun kendi içinde enjeksiyon öncesi ile 4.,8.,12. ve 24. haftalardaki klinik skorları arasındaki fark istatistiksel olarak anlamlı olup, VAS ve Dreiser skorlarında düzelme istatistiksel anlamlı düzeyde olduğu tespit edildi (p <0,001). 24. Haftada her iki grup VAS ve Dreiser skoru sonuçlarında düzelme olduğu ve iki grubun klinik sonuçlarının benzer olduğu görülmüştür. 24. Haftada ağrı ve fonksiyonel iyileşme miktarı her ne kadar azalmış olsada enjeksiyon öncesi döneme göre istatistiksel olarak VAS ve Dreiser skorlarında anlamlı düşüş mevcuttur (p<0,05). 

Sonuç: PZP ve steroid enjeksiyonları karşılaştırıldığında 24. haftada Dreiser skoru ile elde edilen el fonksiyonlarında iyileşme ve VAS skoruna göre elde edilen ağrı derecesinde azalmanın her iki yöntem için benzer olduğu ve aralarında istatistiksel olarak anlamlı fark olmadığı tespit edilmiştir. Elimizdeki veriler değerlendirildiğinde, PRP’ nin birinci KMK eklem osteoartritinde etkinliği gösterilmiş olsa da; hazırlık sürecinin zor ve maliyetin daha fazla olması, kit temini güçlüğü gibi zorluklar sebebiyle steroid tedavisinin yerini alması zor görünmektedir.

Anahtar Kelimeler

• karpometakarpal eklem,osteoartrit,platelet zengin plazma,kortikosteroid

Treatment of the First Carpometacarpal Joint Osteoarthritis: Corticosteroid Versus Platelet Rich Plasma – A Randomized Comparative Study

Abstract

Objectives: The prevalence of arthrosis of the thumb carpometacarpal (CMC) joint is 35.8% in older males and females. In our study, it was aimed to compare the effect of corticosteroid and platelet-rich plasma (PRP) injection on the clinical and functional results in arthrosis of the first carpometacarpal joint of the hand.

Materials and Methods: 58 patients who presented to our clinic between October 2016 - March 2018 and were diagnosed with osteoarthritis of the first carpometacarpal joint of the hand, who did not previously benefit from other conservative treatment methods, who were stage 2 according to the Eaton-Littler classification and followed-up for at least 24 weeks were enrolled in this prospective study. Dreiser and VAS scores at months 1, 2, 3 and 6 were evaluated and the results were statistically compared.

Results: There was no statistically significant difference between the groups in terms of pre-injection VAS and Dreiser scores (p=0.211 and p=0.239, respectively). The difference between the clinical scores before the injection and at weeks 4, 8, 12 and 24 within each group was statistically significant, wherein the improvement in VAS and Dreiser scores was at a statistically significant level (p<0.001). It was observed that both groups exhibited an improvement in VAS and Dreiser scores and the clinical results of the two groups were similar at week 24. Although the amount of functional improvement and pain had decreased at week 24, VAS and Dreiser scores exhibited a statistically significant decrease in comparison to the pre-injection period (p<0.05).

Conclusion: Comparing PRP and steroid injections, it was observed that the improvement in hand functions according to the Dreiser score and the decrease in the level of pain according to the VAS score at week 24 were similar in both methods, and there was no statistically significant difference between them. In the light of current data, although the efficacy of PRP has been proven in osteoarthritis of the first CMC joint, replacing the steroid treatment with PRP seems difficult due to drawbacks such as the challenging preparation period, higher costs and difficulty of supplying the kits.

Keywords

• carpometacarpal joint,osteoarthritis,platelet rich plasma,corticosteroid

Kaynakça

1. Magnusson H, Karin, et al. Long term type 1 diabetes is associated with hand pain, disability and stiffness but not with structural hand osteoarthritis features–The Dialong hand study. PloS one, 2017; 12.5: e0177118.
2. Dougados M. Que faut-il réellement penser des traitements symptomatiques d’action lente dans l’ar throse? Rev Rhum [Fr Ed] 2006; 73: 993-7
3. Villafañe, J. H., Valdes, K., O’Brien et Al. Conservative management of thumb carpometacarpal osteoarthritis. An Italian survey of current clinical practice. Journal of bodywork and movement therapies, 2018; 22(1), 37-9.
4. Gobbı J Alberto Lad D, Karnatzıkos G. The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 2015, 23.8: 2170-7.
5. Song SU, Cha YD, Han JU, et al. Hyaline cartilage regeneration using mixed human chondrocytes and transforming growth factor-beta1-producing chondrocytes. Tissue Eng 2005;11:1516-26.
6. Song SU, Hong YJ, Oh IS, et al. Regeneration of hyaline articular cartilage with irradiated transforming growth factor beta-1 producing fibroblasts. Tissue Eng 2004;10:665- 72.
7. Buckwalter JA, Brown TD. Joint injury, repair, and remodeling: Roles in post-traumatic osteoarthritis. Clin Orthop Relat Res 2004;423:7-16.
8. Ochi M, Uchio Y, Kawasaki K, Wakitani S, Iwasa J. Transplantation of cartilage-like tissue made by tissue engineering in the treatment of cartilage defects of the knee. J Bone Joint Surg Br 2002;84:571-8.

9. Sgaglione NA, Miniaci A, Gillogly SD, Carter TR. Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy 2002; 18:9-32.
10. Alford JW, Cole BJ. Cartilage restoration, part 1: Basic science, historical perspective, patient evaluation, and treatment options. Am J Sports Med 2005;33:295-306.
11. Dieppe PA. Are intra-articular steroid injections useful for the treatment of the osteoarthritic joint? Br J Rheumatol 1991;30:199.
12. ACR subcommittee on osteoarthritis guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum 2000;43:1905–15.
13. Pendleton A, Arden N, Dougados M, Doherty M, Bannwarth B, Bijlsma JW,et al. EULAR recommendations for the management of knee osteoarthritis. Ann Rheum Dis 2000;59:936–44.
14. Joshi R. Intraarticular corticosteroid injection for first carpometacarpal osteoarthritis. J Rheumatol 2005;32:1305–6. [PubMed: 15996069]
15. Meenagh GK1, Patton J, Kynes C, Wright GD A randomised controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis. Ann Rheum Dis. 2004 Oct;63(10):1260-3.
16. Filardo G, Kon E, Della Villa S, et al. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. InOrthop 2010;34:909-15.
17. Filardo G, Presti ML, Kon E, Marcacci M. Nonoperative biological treatment approach for partial Achilles tendon lesion. Orthopedics 2010;33:120-3.
18. Kon E, Filardo G, Delcogliano M, et al. Platelet-rich plasma:New clinical application: A pilot study for treatment of jumper’s knee. Injury 2009;40:598-603.
19. Frisbie DD, Kawcak CE, Werpy NM, Park RD, McIlwraith CW. Clinical, biochemical, and histologic effects of intraarticular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis. Am J Vet Res 2007;68:290-6.
20. Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, Marcacci M, Kon E Platelet-Rich Plasma Intra-articular Knee Injections Show No Superiority Versus Viscosupplementation: A Randomized Controlled Trial Am J Sports Med. 2015 May 7. pii: 0363546515582027
21. E. Carlos Rodriguez-Merchan , Intraarticular Injections of Platelet-rich Plasma (PRP) in the Management of Knee Osteoarthritis Arch Bone Jt Surg. 2013 Sep; 1(1): 5–8.
22. Azarabadı, Javid Mohammadzadeh. Sıçanlarda donuk omuz modelinde, eklem içi kortikosteroid ve tembositten zengin plazma enjeksiyon etkilerinin karşılaştırılması. 2018. Başkent üniversitesi, Uzmanlık Tezi.