Efficacy of Intraarticular Hyaluronic acid and Cortico- Steroid Co-Injection versus Hyaluronic acid in Knee Osteoarthritis
Keywords:
Hyaluronic acid, Corticosteroid, Knee Osteoarthritis, Visual Analog ScaleAbstract
Introduction: For knee osteoarthritis, intra-articular injections of Hyaluronic acid and corticosteroid have individually shown promise, nevertheless, the rate at which symptoms improve is a limiting factor for both treatments.
Aims and Objectives: To compare mean pain score in patients receiving combination of intra-articular Hyaluronic acid and corticosteroid versus Hyaluronic acid alone in osteoarthritic knee.
Place and Duration of Study: The randomized controlled trial was conducted in the Orthopedic Department of Shaikh Zayed Hospital, Lahore, from June 11, 2021, to December 11, 2021.
Materials and Methods: The study comprised a total of 64 patients fulfilling the inclusion criteria and after providing informed written consent with 32 patients each assigned to the Hyaluronic acid plus corticosteroid group (Group A) and Hyaluronic acid alone group (Group B). Lottery method was used to randomly divide patients into two groups. Pain was assessed at baseline and at 3 months via visual analog scale. All the data was recorded on preset performa and analyzed via SPSS version 20.
Results: Out of 64 patients enrolled in study, 15.6% were male and 34.4% were females in HA+CS group and 12.5% were male and 37.5% were females in HA alone group. Distribution of knee side, 9.4% patients had right while 40.6% had left side in HA + CS group and 23.4% had right while 26.6% had left side in HA alone group. Mean age of HA + CS group was 59.22±8.027 years and mean age of HA alone group was 57.34±6.378 years. Mean pain score was 01 in HA+CS group versus 4.13 in HA group (p<0.001).
Conclusion: In current study, we concluded that those individuals who underwent HA and CS co-treatment experienced reduction in mean pain score more as compared to those who received HA alone.
References
Wang SZ, Wu DY, Chang Q, Guo YD, Wang C, Fan WM. Intra-articular, single-shot co-injection of hyaluronic acid and corticosteroids in knee osteoarthritis: A randomized controlled trial. Experimental and therapeutic medicine. 2018 Sep 1;16(3):1928-34.
Sabzwari S, Fatmi Z, Khan AA. Elderly musculoskeletal disease burden in Karachi, Pakistan: Associations and implications for developing countries. Aging Medicine. 2021 Mar;4(1):19-25.
Roos EM, Arden NK. Strategies for the prevention of knee osteoarthritis. Nature Reviews Rheumatology. 2016 Feb;12(2):92-101.
Richardson C, Plaas A, Block JA. Intra-articular hyaluronan therapy for symptomatic knee osteoarthritis. Rheumatic Disease Clinics. 2019 Aug 1;45(3):439-51.
McArthur BA, Dy CJ, Fabricant PD, Valle AG. Long term safety, efficacy, and patient acceptability of hyaluronic acid injection in patients with painful osteoarthritis of the knee. Patient Preference and Adherence. 2012 Dec 12:905-10.
Harirforoosh S, Asghar W, Jamali F. Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. Journal of Pharmacy & Pharmaceutical Sciences. 2013;16(5):821-47.
Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2013 Sep 1;21(9):571-6.
Nguyen C, Lefèvre-Colau MM, Poiraudeau S, Rannou F. Evidence and recommendations for use of intra-articular injections for knee osteoarthritis. Annals of physical and rehabilitation medicine. 2016 Jun 1;59(3):184-9.
Maheu E, Rannou F, Reginster JY. Efficacy and safety of hyaluronic acid in the management of osteoarthritis: evidence from real-life setting trials and surveys. InSeminars in arthritis and rheumatism 2016 Feb 1 (Vol. 45, No. 4, pp. S28-S33). WB
Saunders.
Koenig KM, Ong KL, Lau EC, Vail TP, Berry DJ, Rubash HE, Kurtz S, Bozic KJ. The use of hyaluronic acid and corticosteroid injections among Medicare patients with knee osteoarthritis. The Journal of arthroplasty. 2016 Feb 1;31(2):351-5.
Vandeweerd JM, Zhao Y, Nisolle JF, Zhang W, Zhihong L, Clegg P, Gustin P. Effect of corticosteroids on articular cartilage: have animal studies said everything? Fundamental & clinical pharmacology. 2015 Oct;29(5):427-38.
Askari A, Gholami T, NaghiZadeh MM, Farjam M, Kouhpayeh SA, Shahabfard Z. Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail. Springerplus. 2016 Dec;5:1-6.
Leighton R, Åkermark C, Therrien R, Richardson JB, Andersson M, Todman MG, Arden NK, DUROLANE Study Group. NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non- inferiority trial. Osteoarthritis and cartilage. 2014 Jan 1;22(1):17-25.
Shimizu M, Higuchi H, Takagishi K, Shinozaki T, Kobayashi T. Clinical and biochemical characteristics after intra-articular injection for the treatment of osteoarthritis of the knee: prospective randomized study of sodium hyaluronate and corticosteroid. Journal of orthopaedic science. 2010 Jan;15:51-6.
Colen S, Van Den Bekerom MP, Mulier M, Haverkamp D. Hyaluronic acid in the treatment of knee osteoarthritis: a systematic review and meta- analysis with emphasis on the efficacy of different products. BioDrugs. 2012 Aug;26:257-68.
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. InSeminars in arthritis and rheumatism 2018 Oct 1 (Vol. 48, No. 2, pp. 168-175). WB Saunders.
Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC musculoskeletal disorders. 2015 Dec;16:1-0.
Richards MM, Maxwell JS, Weng L, Angelos MG, Golzarian J. Intra-articular treatment of knee osteoarthritis: From anti-inflammatories to products of regenerative medicine. Phys Sportsmed. 2016;44:101–108.
Laev SS, Salakhutdinov NF. Anti-arthritic agents: progress and potential. Bioorganic & medicinal chemistry. 2015 Jul 1;23(13):3059-80.
Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World journal of orthopedics. 2014 Jul 7;5(3):351.
Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, da Costa BR. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev: CD005328. 2015
Euppayo T, Punyapornwithaya V, Chomdej S, Ongchai S, Nganvongpanit K. Effects of hyaluronic acid combined with anti-inflammatory drugs compared with hyaluronic acid alone, in clinical trials and experiments in osteoarthritis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2017 Dec;18:1-4.
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