Efficacy of single-dose hyaluronic acid products with two different structures in patients with early-stage knee osteoarthritis
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[Purpose] There are many types of hyaluronic acid preparations, but no clear data are available about which preparations is more effective. The aim of this trial was to investigate the effectiveness of different types of hyaluronic acid preparations on pain and function of inpatients with knee osteoarthritis. [Subjects and Methods] All patients were diagnosed by clinical examination and x-ray. Ostenil PLUS® was injected into 28 patients (group 1, 1.6 million daltons), and MONOVISC® (group 2, 2.5 million daltons) was injected into 46 patients. Demographic data and Western Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were used for clinical evaluation at 1, 3, and 6 months post injection. [Results] In both groups, baseline Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were higher compared with those in subsequent evaluations. Based on the pre- and post-injection data, a significant reduction in all scores was observed after the injections for in both groups. According to intergroup comparisons, there was no significant difference in any of the scores between the two groups. [Conclusion] There were no difference in Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores in patients with knee osteoarthritis injected with two different hyaluronic acid structures in short-term preparations.Keywords:
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Osteoarthritis, involves mainly in the knees, is a disease characterized by a mixture of degradative and reparative processes in the articular cartilage. Many compounds have been used intra-articularly. Of those, corticosteroids are very potent anti-inflammatory agents. Although intra-articular injections have been used for the symptomatic treatment of osteoarthritis, corticosteroids injections may suppress cartilage proteoglycan synthesis, worsen cartilage lesion, or even cause degenerative lesions in normal cartilage. Viscosupplementation is a novel, safe, and possibly effective form of local treatment for osteoarthritis. It aims at supplying replacement hyaluronic acid into the joint space to return the elasticity and viscosity of the synovial fluid to normal. Hyaluronic acid, a polysaccharide, is a natural component of cartilage and plays an essential part in the viscoelastic properties of the synovial fluid. Although there is still insufficient information to permit a conclusion concerning the effect of this treatment, if any, on the progression of osteoarthritis in humans, considerable evidence supports the positive effects of hyaluronic acid on joint cellular and immunological function.
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[Purpose] There are many types of hyaluronic acid preparations, but no clear data are available about which preparations is more effective. The aim of this trial was to investigate the effectiveness of different types of hyaluronic acid preparations on pain and function of inpatients with knee osteoarthritis. [Subjects and Methods] All patients were diagnosed by clinical examination and x-ray. Ostenil PLUS® was injected into 28 patients (group 1, 1.6 million daltons), and MONOVISC® (group 2, 2.5 million daltons) was injected into 46 patients. Demographic data and Western Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were used for clinical evaluation at 1, 3, and 6 months post injection. [Results] In both groups, baseline Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were higher compared with those in subsequent evaluations. Based on the pre- and post-injection data, a significant reduction in all scores was observed after the injections for in both groups. According to intergroup comparisons, there was no significant difference in any of the scores between the two groups. [Conclusion] There were no difference in Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores in patients with knee osteoarthritis injected with two different hyaluronic acid structures in short-term preparations.
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Patients with knee osteoarthritis often are treated with viscosupplementation (intra-articular injections of hyaluronic acid [HA]). HA injections are expensive, and their efficacy is controversial. In this meta-analysis, researchers identified randomized trials of viscosupplementation that had at least 4 weeks of follow-up and at least 30 patients per treatment group; …
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Objective: The aim of the present study was to compare the effectiveness of intraarticular injections of hyaluronic acid (HA) versus dextrose (DX) in combination with periarticular prolotherapy (PrT) in the treatment of recreational athletes with knee osteoarthritis. Material and Methods: A total of 54 patients who had chronic knee osteoarthritis (OA) were included in the study. The patients were divided into two groups as PrT+HA (intraarticular hyaluronic acid combined with periarticular prolotherapy, n=27) and PrT+DX (intraarticular dextrose combined with periarticular prolotherapy, n=27). Clinical efficacy and pain were evaluated via the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at pre-treatment and one, three and six-month follow-ups. Results: Intra-group statistical analyses revealed significant improvements in PrT+HA and PrT+DX groups for WOMAC and VAS scores compared with baseline (p<0.001). When the two groups were compared, VAS and WOMAC scores in the first month follow-ups were significantly better in the PrT+DX group (p=0.022 and p=0.03, respectively) while sixth month follow-up scores were significantly better in the PrT+HA group (p<0.001 and p<0.005 respectively). Conclusions: Both of the intraarticular injections (HA and DX) are efficacious and safe in treating knee osteoarthritis. HA offers advantage of higher treatment success, while DX offers clinical efficacy with less cost.
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Intra-articular hyaluronic acid viscosupplementation is gaining popularity as a treatment option in the nonoperative management of patients with osteoarthritis. Recent clinical studies have demonstrated that the anti-inflammatory, anabolic, and chondroprotective actions of hyaluronic acid reduce pain and improve patient function. With evidence mounting in support of the efficacy of this treatment modality for patients with osteoarthritis, its potential use in additional patient populations and for other pathologies affecting the knee is being investigated. The current article reviews the use of intra-articular hyaluronic acid viscosupplementation in the management of knee osteoarthritis and presents the potential for expanding its indications for other joints and alternative patient subpopulations. Additionally, future directions for the use of hyaluronic acid and areas of active research are discussed.
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In clinical practice viscosupplementation with hyaluronic acid (HA) is common for the treatment of degenerative osteoarthritis (OA). Both molecular weight and concentration of HA have significant impact on its rheological properties, which in turn affects its therapeutic effects. The objective of this study is to evaluate the effectiveness of a double HA preparation for the treatment of knee osteoarthritis with respect to pain reduction, joint function improvement and concomitant medication consumption reduction. One thousand and fourteen patients (521 males and 693 females) with a mean age of 62.4 years old, suffering from OA of the knee, were enrolled into this study. All patients received two intra-articular injections one week apart and a third injection one month after the second one. Concomitant medication was recorded and evaluated at follow up visits. Evaluation was performed at baseline, day 30 and day 180, on several parameters: knee pain by visual analog scale (VAS) 0-10 cm, Lequesne Index, and consumption of concomitant medications including non-steroidal anti-inflammatory drugs, analgesics and chondoprotective supplementations. A statistically significant reduction in pain VAS score was recorded at D30 (38.01±17.68; P<0.01) before the third injection, and D180 (25.91±15.33; P<0.01) check-points comparing to baseline (67.12±15.99). Similarly, remarkable reduction in Lequesne Index was shown at D30 (5.91±4.01; P<0.01) in 1214 patients before the third injection, and D180 (3.59±3.45; P<0.01) (with 938 patients) when compared to the baseline (11.60±5.13). Patients also consumed less concomitant medications after the treatment course. The beneficial effects were maintained for up to six months. Intra-articular injection of a double HA preparation of low molecular weight and high molecular weight of different concentrations was well tolerated, and generated satisfactory results in terms of pain control, joint function improvement and concomitant medication reduction for the management of knee OA.
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Osteoarthritis is characterized by progressive articular cartilage degeneration, changes in subchondral bone and synovial inflammation, leading to pain and disability. Viscosupplementation with hyaluronic acid has been widely investigated due to the viscoelastic properties of this compound to manage pain improving the ability to perform daily activities in patients affected by osteoarthritis. In the present study we investigated the clinical effectiveness of viscosupplementation with a new highly cross-linked hyaluronic acid, Variofill®, in patients affected by bilateral knee osteoarthritis in comparison with the widely used Synvisc®. A total of 20 patients, aged between 24–74 years and affected by bilateral knee osteoarthritis, participated in this pilot randomized triple-blind clinical study. They received two injections (2 ml each) of Synvisc® in their left knee and 2 injections (2 ml each) of Variofill® in their right knee spaced 15 days apart. Visual Analogue Scale and Western Ontario McMaster Universities Osteoarthritis Index score were used to evaluate the efficacy of hyaluronic acid injections before and 3 and 6 months after treatment. Both treatment regimens resulted in a significant improvement vs baseline in all endpoints at 3 and 6 months (p < 0.001). Treatment with Variofill® resulted in a high percentage improvement in Visual Analogue Scale pain, Western Ontario McMaster Universities Osteoarthritis Index score pain and physical activity, when compared to Synvisc® viscosupplementation, at 6 months (p < 0.05). These results are encouraging for larger clinical trials with Variofill® in larger cohorts of patients affected by osteoarthritis of the knee.
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