Intra-articular hyaluronic acid injection versus oral non-steroidal anti-inflammatory drug for the treatment of knee osteoarthritis: a multi-center, randomized, open-label, non-inferiority trial (original) (raw)
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Anti-Inflammatory Drugs in Management of Knee Osteoarthritis
Pakistan Armed Forces Medical Journal, 2019
Objective: To compare the outcome of intra-articular hyaluronic acid injection with oral non-steroidal antiinflammatory drugs in knee osteoarthritis in terms of mean pain score. Study Design: Randomized controlled trial. Place and Duration of Study: Outpatient orthopedics department of Combined Military Hospital, Rawalpindi from February 2015 to July 2016. Patients and Methods: A total of 60 patients with knee osteoarthritis were enrolled as per inclusion and exclusion criteria by non-probability consecutive sampling. Thirty patients were assigned to group “A” and were given intra-articular injection of hyaluronic acid 20 mg (2 ml) into the knee joint aseptically for five consecutive weeks. Group “B”, having thirty patients, was given oral non-steroidal anti-inflammatory drug Celecoxib200mg/Naproxen 500mg twice daily after meals for twelve weeks. Outcome measure was mean pain score using visual analogue scale at twelve week follow-up. Results: Statistically significant improvement i...
International Journal of Research in Orthopaedics
Background: Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling and stiffness. Intra-articular hyaluronic acid or steroids are being used for its treatment. The purpose of the present study was to assess the effect of intra articular hyaluronic acid in comparison to steroids for knee osteoarthritis.Methods: A prospective randomized study including 70 patients (121 knees) diagnosed with osteoarthritis of knee, were randomly divided into two groups: 35 patients (58 knees) were given intra-articular hyaluronic acid and 35 patients (63 knees) were given intra-articular methylprednisolone. The outcome was evaluated with knee society score (KSS) and visual analog scale (VAS) before the injection and 1, 3 and 6 months after the injection.Results: The mean KSS pain and function scores increased while VAS decreased in both the groups. All the scores showed improvement at 6 months follow up. In both the groups, the scores at 6 months were significantly...
Romanian Journal of Physical Therapy, 2022
Introduction: Intra-articular Hyaluronic acid (IAHA) injection provides intra-articular (IA) anti-inflammatory effect and improves synovial fluid flow dynamics and viscoelasticity. The aim of this prospective observational, clinical study was to evaluate the safety and efficacy of Hyaluronic Acid (HA) (40mg/2ml) 3 times with one week interval for the treatment of osteoarthritis (OA). Methods and materials: A total of 105 adults with OA were enrolled in the study. Each patient received 3 injection cycles of HA with one week interval. WOMAC OA Index was used to assess the effectiveness of injection and SF-36 to observe the change in quality of life. Physical examination was performed before injection and at the 3rd and 6th months following injection. Results: WOMAC score showed significant reduction from baseline (61.6) to 3rd treatment procedure visit (32.1), 3 months (16.2) and 6 months follow up visit (4.8) respectively (p<0.001). Significant improvement was observed in quality of life from baseline values to 3 month and 6 month follow up visit (p<.0001) Discussion: Studies have shown that HA is safe and well tolerated to achieve clinically significant improvement in patients with mild to moderate knee OA. It is presented that repeated IAHA injections are an effective treatment for knee OA, and reduce pain and contribute to recovery. It was concluded that HA with higher molecular weight improved pain more and suggested that the use of HA products may be effective in knee OA. A significant increase was observed in SF-36 parameters reporting quality of life with IAHA, and HMW-IAHA added to usual care is effective for knee OA in working individuals. Conclusion: Three weekly IA injections of HA provided pain relief and functional improvements with high treatment satisfaction in patients with painful knee OA lasted for a minimum 6 months.
Osteoarthritis (OA) is a chronic condition characterized by a loss of joint cartilage and is a major cause of disability in Canada, with an estimated CN$195 billion annual cost. Knee OA leads to persistent pain and loss of function, and treatment goals primarily focus on symptom relief and retention of function. Intra-articular hyaluronic acid (IAHA) has therapeutic benefits, and numerous recently published meta-analyses (MAs) and commentaries have highlighted new evidence on the role of IAHA therapy for knee OA. A diverse, multidisciplinary group of specialists met independently in closed sessions to review findings from eight MAs with literature search end dates no earlier than 2012 to address controversies surrounding IAHA therapy for mild-to-moderate knee OA within the Canadian treatment context. Outcomes from a total of eight MAs were reviewed, and consistent and statistically significant improvements in pain, function and stiffness up to 26 weeks were found with IAHA therapy compared with IA placebo or controls, regardless of MA size or trial quality. These findings are in line with those of a Cochrane review, another recent systematic review and patient satisfaction survey. Overall, three MAs reported outcomes based on molecular weight (MW), with the two reporting effect sizes showing significantly improved pain outcomes for higher compared with lower MW HAs. Recent evidence suggests that HA therapy is well tolerated with no increased risk of serious adverse events compared with placebo and the full therapeutic effect of IAHA therapy appears to have considerable clinical importance, consisting of the combined IA placebo and HA therapeutic effects. IAHA therapy is a welltolerated and effective option for patients with mild-to-moderate knee OA failing first-line pharmacological therapy.
Osteoarthritis and Cartilage, 1995
The aim of this study was to determine the comparative efficacy and safety of intra-artieular (i/a) triamcinolone hexacetonide (TH) and i/a hyaluronic acid (HA) in inflammatory knee osteoarthritis. A randomized double-blind comparative trial was carried out in a rheumatology outpatient department. There were 63 patients (24 male, 39 female, mean age 70.5 years) with bilateral symptomatic knee osteoarthritis with effusion. Each was given five HA injections at weekly intervals; or 20 mg TH followed by four placebo (saline) injections. Patients were examined weekly during the treatment period and then at monthly intervals for a further 6 months. Assessment included recording of: visual analog scores (VAS) for pain; duration of stiffness; range of movement; joint effusion; local heat; synovial thickening; joint-line and periarticular tenderness. The principal outcome measure was pain on a self-selected activity assessed by VAS. The two groups were comparable at entry and no significant differences between the groups developed at any time during the treatment period. However there was a high drop-out rate and intention to treat analysis failed to demonstrate statistically significant differences between the groups. In patients remaining in the study, significantly less pain was experienced by the HA group during the 6 month follow-up period. Other parameters showed a similar trend in favor of HA. We could not, however, demonstrate significant differences between the placebo and active treatments. HA may therefore be a useful additional therapy for symptomatic knee osteoarthritis and may have a long duration of action.
The Journal of Bone and Joint Surgery, 2016
Background: The treatment of knee osteoarthritis with hyaluronic acid or corticosteroid injection has been widely used. The purpose of this study was to compare the efficacy of hyaluronic acid (hylan G-F 20) with triamcinolone acetonide as a single intra-articular injection for knee osteoarthritis. Methods: This study was a prospective, randomized, double-blind clinical trial. Participants with symptomatic knee osteoarthritis were recruited. They were randomized to receive a single-shot, intra-articular injection of either 6 mL of hylan G-F 20 or 6 mL of a solution comprising 1 mL of 40-mg triamcinolone acetonide and 5 mL of 1% lidocaine with epinephrine. The primary outcomes were knee pain severity, knee function, and range of motion at 6 months. Ninety-nine patients were assessed before injection and underwent a 6-month follow-up. Patients and evaluators were blinded. Multilevel regression models were used to estimate differences between the groups. Results: At the 6-month follow-up, compared with patients who took hylan G-F 20, patients who took triamcinolone acetonide had similar improvement in knee pain, knee function, and range of motion. The difference in mean outcome scores between groups was, with regard to knee pain, a visual analog scale (VAS) score of 3 points (95% confidence interval [95% CI], 26 to 11 points); with regard to knee function, a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of 0 points (95% CI, 28 to 6 points); and, with regard to range of motion, flexion of 21°(95% CI, 25°to 2°) and extension of 0°(95% CI, 20.5°to 0.5°). However, patients who took triamcinolone acetonide had better pain improvement from 24 hours until 1 week after injection; the mean difference between groups with regard to the VAS score was 12 points (95% CI, 5 to 20 points; p = 0.002) at 24 hours and 9 points (95% CI, 1 to 15 points; p = 0.018) at 1 week. At 2 weeks after injection, patients who took triamcinolone acetonide also had better knee functional improvement; the mean difference between groups for the modified WOMAC score was 6 points (95% CI, 0.7 to 12 points; p = 0.03). Both groups had improvement in pain, knee function, and range of motion during the 6-month follow-up (p < 0.0001). Conclusions: Triamcinolone acetonide provided similar improvement in knee pain, function, and range of motion compared with hylan G-F 20 at the 6-month follow-up, with better pain control in the first week and better knee functional improvement in the second week.