Short-Term Efficacy of Intraarticular Hyaluronic Acid Injection in Gonarthrosis

Öz

Introduction:

Gonarthrosis is a chronic, degenerative disease that causes pain and stiffness. There are many treatment methods defined as conservative and surgical. Intra-articular hyaluronic acid injection is one of these methods. There are different preparations routinely used in the treatment. There is no clear evidence of which is more effective. We aimed to investigate the effectiveness of HA preparations with different molecular weights on pain and functionality of patients with gonarthrosis.

 

Material and Methods

30 of 55 patients (ranging 40-80 years old) diagnosed  as bilateral gonarthrosis were enrolled in the study. Patients were randomly divided into 3 groups (Hyalgan (N = 10), Orthovics (N = 10), Synvisc (N = 10)). Patients were evaluated before and after treatment. Clinical examination, Visual Analogue Scale, WOMAC score, stiffness and physical condition, 15 m walking time and 15 steps up and down performance were evaluated.

 

Results

             There was no significant difference between the groups in terms of age, body mass index (BMI) and symptom duration (p: 0.917, p: 0.721, p: 0.519, respectively). In all three groups, pre-treatment VAS scores (motion, rest and night) significantly decreased after treatment (p <0.001). According to WOMAC results, pain, stiffness decreased significantly after treatment (p <0.001). There was no significant difference between the groups in any parameter (p> 0.05).

Conclusion

The results of this study revealed no statistically significant difference between HA preparations in WOMAC and VAS scores; However, HA has been found to be effective and should be used in the treatment of early stage gonarthrosis.

Anahtar Kelimeler

• Hyaluronic acid,injection,Gonarthrosis,Molecular weight

Gonartrozda İntra-artiküler Hyalüronik Asid Enjeksiyonunun Kısa Dönem Etkinliği

Öz

Giriş:

Gonartroz, ağrı ve sertliğe neden olan kronik, dejeneratif bir hastalıktır. Konservatif ve cerrahi olarak tanımlanan birçok tedavi yöntemi vardır. Eklem içi hyaluronik asit enjeksiyonu bu yöntemlerden biridir. Tedavide rutin olarak kullanılan farklı preparatlar vardır ve hangisinin daha etkili olduğuna dair net bir kanıt yok. Farklı molekül ağırlıklarına sahip HA preparatlarının gonartrozu olan hastaların ağrı ve işlevselliği üzerine etkilerini araştırmayı amaçladık.

Gereç ve Yöntem

İki taraflı gonartroz tanısı konan 55 hastanın 30'u (40-80 yaşları arasında) çalışmaya alındı. Hastalar rastgele 3 gruba ayrıldı (Hyalgan (N = 10), Ortez (N = 10), Synvisc (N = 10)). Hastalar tedaviden önce ve sonra değerlendirildi. Klinik muayene, Görsel Analog Skala, WOMAC skoru, sertlik ve fiziksel durum, 15 m yürüme süresi ve 15 basamak yukarı ve aşağı performans değerlendirildi.

Bulgular

Gruplar arasında yaş, vücut kitle indeksi (BKİ) ve semptom süresi açısından anlamlı fark yoktu (sırasıyla p: 0.917, p: 0.721, p: 0.519). Her üç grupta da tedavi öncesi VAS skorları (hareket, dinlenme ve gece) tedaviden sonra anlamlı olarak azaldı (p <0.001). WOMAC sonuçlarına göre tedaviden sonra ağrı, sertlik belirgin olarak azaldı (p <0.001). Herhangi bir parametrede gruplar arasında anlamlı fark bulunmadı (p> 0.05).

Sonuç

Bu çalışmanın sonuçları, WOMAC ve VAS skorlarındaki HA preparatları arasında istatistiksel olarak anlamlı bir fark olmadığını ortaya koydu; Bununla birlikte, HA'nın etkili olduğu ve erken evre gonartroz tedavisinde kullanılması gerektiği bulunmuştur.

Anahtar Kelimeler

• Hyaluronik asit,enjeksiyon,Gonartroz,Moleküler ağırlık

Kaynakça

1. 1. Pereira D, Peleteiro B, Araujo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage. 2011;19:1270-85.
2. 2. Bennell KL, Hinman RS, Metcalf BR, Buchbinder R, McConnell J, McColl G, et al. Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2005;64:906-12.
3. 3. Pagnano M, Westrich G. Successful nonoperative management of chronic osteoarthritis pain of the knee: safety and efficacy of retreatment with intra-articular hyaluronans. Osteoarthritis Cartilage. 2005;13:751-61.
4. 4. Oliveira MZ, Albano MB, Namba MM, da Cunha LA, de Lima Goncalves RR, Trindade ES, et al. Effect of hyaluronic acids as chondroprotective in experimental model of osteoarthrosis. Rev Bras Ortop. 2014;49:62-8.
5. 5. Kotevoglu N, Iyibozkurt PC, Hiz O, Toktas H, Kuran B. A prospective randomised controlled clinical trial comparing the efficacy of different molecular weight hyaluronan solutions in the treatment of knee osteoarthritis. Rheumatol Int. 2006;26:325-30.
6. 6. Bashaireh K, Naser Z, Hawadya KA, Sorour S, Al-Khateeb RN. Efficacy and safety of cross-linked hyaluronic acid single injection on osteoarthritis of the knee: a post-marketing Phase IV study. Drug Des Devel Ther. 2015;9:2063-72.
7. 7. Tasciotaoglu F, Oner C. Efficacy of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis. Clin Rheumatol. 2003;22:112-7.
8. 8. Brandt KD, Block JA, Michalski JP, Moreland LW, Caldwell JR, Lavin PT. Efficacy and safety of intraarticular sodium hyaluronate in knee osteoarthritis. ORTHOVISC Study Group. Clin Orthop Relat Res. 2001;130-43.

9. 9. de Rezende MU, de Campos GC. Viscosupplementation. Rev Bras Ortop. 2012;47:160-4.
10. 10. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039-49.
11. 11. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494-502.
12. 12. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833-40.
13. 13. Frank A, Moll J, Hort J. A comparison of three ways of measuring pain. Rheumatology. 1982;21:211-7.
14. 14. Monticone M, Frizziero A, Rovere G, Vittadini F, Uliano D, S LAB, et al. Hyaluronic acid intra-articular injection and exercise therapy: effects on pain and disability in subjects affected by lower limb joints osteoarthritis. A systematic review by the Italian Society of Physical and Rehabilitation Medicine (SIMFER). Eur J Phys Rehabil Med. 2016;52:389-99.
15. 15. Karatosun V, Unver B, Gocen Z, Sen A. Comparison of two hyaluronan drugs in patients with advanced osteoarthritis of the knee. A prospective, randomized, double-blind study with long term follow-up. Clin Exp Rheumatol. 2005;23:213-8.
16. 16. Miltner O, Schneider U, Siebert CH, Niedhart C, Niethard FU. Efficacy of intraarticular hyaluronic acid in patients with osteoarthritis--a prospective clinical trial. Osteoarthritis Cartilage. 2002;10:680-6.
17. 17. Petrella RJ, Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee. J Rheumatol. 2006;33:951-6.
18. 18. Adams ME, Lussier AJ, Peyron JG. A risk-benefit assessment of injections of hyaluronan and its derivatives in the treatment of osteoarthritis of the knee. Drug Saf. 2000;23:115-30.
19. 19. Altman RD, Bedi A, Karlsson J, Sancheti P, Schemitsch E. Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee. Am J Sports Med. 2016;44:2158-65.
20. 20. Raman R, Dutta A, Day N, Sharma HK, Shaw CJ, Johnson GV. Efficacy of Hylan G-F 20 and Sodium Hyaluronate in the treatment of osteoarthritis of the knee -- a prospective randomized clinical trial. Knee. 2008;15:318-24.
21. 21. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1-12.
22. 22. Atamaz F, Kirazli Y, Akkoc Y. A comparison of two different intra-articular hyaluronan drugs and physical therapy in the management of knee osteoarthritis. Rheumatol Int. 2006;26:873-8.
23. 23. Berenbaum F, Grifka J, Cazzaniga S, D'Amato M, Giacovelli G, Chevalier X, et al. A randomised, double-blind, controlled trial comparing two intra-articular hyaluronic acid preparations differing by their molecular weight in symptomatic knee osteoarthritis. Ann Rheum Dis. 2012;71:1454-60.
24. 24. Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004;86-A:538-45.
25. 25. Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003;290:3115-21.
26. 26. Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Mullner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ. 2005;172:1039-43.
27. 27. Karlsson J, Sjogren LS, Lohmander LS. Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology (Oxford). 2002;41:1240-8.
28. 28. Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther. 1998;20:410-23.
29. 29. Wobig M, Bach G, Beks P, Dickhut A, Runzheimer J, Schwieger G, et al. The role of elastoviscosity in the efficacy of viscosupplementation for osteoarthritis of the knee: a comparison of hylan G-F 20 and a lower-molecular-weight hyaluronan. Clin Ther. 1999;21:1549-62.
30. 30. Rydell N, Balazs EA. Effect of intra-articular injection of hyaluronic acid on the clinical symptoms of osteoarthritis and on granulation tissue formation. Clin Orthop Relat Res. 1971;80:25-32.