AB0598 EFFICACY of Ultrasound Guided Injections of a Cross-Linked Sodium Hyaluronate Combined with Triamcinolone Hexacetonide for Osteoarthritis of the Knee (original) (raw)
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Cartilage, 2017
To evaluate the efficacy and safety of an intraarticular injection of Cingal (Anika Therapeutics, Inc., Bedford, MA) compared with Monovisc (Anika Therapeutics, Inc., Bedford, MA) or saline for the treatment of knee osteoarthritis. This multicenter, double-blind, saline-controlled clinical trial randomized subjects with knee osteoarthritis (Kellgren-Lawrence grades I-III) to a single injection of Cingal (4 mL, 88 mg hyaluronic acid [HA] plus 18 mg triamcinolone hexacetonide [TH]), Monovisc (4 mL, 88 mg HA), or saline (4 mL, 0.9%). The primary efficacy outcome was change in WOMAC (Western Ontario and McMaster Universities Arthritis Index) Pain Score through 12 weeks with Cingal versus saline. Secondary outcomes included Patient and Evaluator Global Assessments, OMERACT-OARSI Responder index, and WOMAC Total, Stiffness, and Physical Function scores through 26 weeks. A total of 368 patients were treated (Cingal, n = 149; Monovisc, n = 150; saline, n = 69). Cingal improvement from basel...
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.
Arthritis Research & Therapy, 2014
Introduction: While many of the commonly used conservative treatments for knee osteoarthritis (OA) have been recognized to be effective, there is still insufficient evidence available. Among the pharmacological treatments for knee OA, oral non-steroidal anti-inflammatory drugs (NSAIDs) act rapidly and are recommended for the management of OA. However, frequent and serious adverse effects of NSAIDs have been recognized. Intra-articular injections of hyaluronic acid (IA-HA) for the treatment of knee OA have been shown to reduce pain and improve joint function. However, there has been no qualified direct comparison study of the efficacy and safety between IA-HA and NSAIDs for patients with knee OA. The aim of this study was to clarify the efficacy and safety of early-phase IA-HA in comparison to those of NSAIDs for patients with knee OA.
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.
International journal of physical education, sports and health, 2020
Knee osteoarthritis is a widespread disability that represents a large proportion of the population with significant effects on affected individuals, health care systems and extensive socio-economic costs. It is a pathologic condition that affects the entire joint, including the cartilage, the hypochondriac bone, the ligaments, the synovial membrane and the surrounding muscles and not exclusively the articular cartilage as previously established. Clinically, the knee joint is the most common form of osteoarthritis, followed by the extremities of the hand and hip. The present study aimed to compare the perceived pain in the diagnosis of knee osteoarthritis by using ultrasound-guided hyaluronic acid injection versus the classical anatomically-guided hyaluronic acid injection. The sample of the present study consisted of 48 patients suffering from osteoarthritis of the knee who visited the Orthopedic Outpatient Clinics of the General Panarkadikon Hospital, in Tripoli, Greece, between N...
SpringerPlus, 2016
Osteoarthritis (OA) is the most common chronic condition of the joints that takes place when the cartilage or a low friction surface between joints breaks down which leads to pain, stiffness and swelling. The purpose of the present study was to evaluate the therapeutic effect of intra-articular hyaluronic acid (HA) in comparison to corticosteroids (CS) for knee osteoarthritis. 140 patients with knee osteoarthritis, who were followed for 3 months, were randomized to receive intra-articular injection of either hyaluronic acid or corticosteroid. By receiving one injection of drug during the enrollment in the study, the patients were treated. With the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), and the visual analog pain scale, an independent, blinded evaluator assessed the patients three times. The mean age of the patients in the corticosteroid group were 57 ± 1.9 years and in Hyaluronic acid group were 58.5...
Managing knee ostheoarthritis: efficacy of hyaluronic acid injections
Acta reumatologica portuguesa, 2013
Osteoarthritis (OA) is the most common form of chronic arthritis worldwide. The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. The use of intra-articular viscosupplementation in the nonoperative management of patients with osteoarthritis has become quite popular. Recent clinical data have demonstrated that the anti-inflammatory and chondroprotective actions of hyaluronic acid viscosupplementation reduce pain, from 4 to 14 weeks after injection, while improving patient function. Viscosupplements are comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events, and hyaluronic acid has more prolonged effects than IA corticosteroids. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra...
Orthopedics and Rheumatology Open Access Journal, 2017
Background: Osteoarthritis is one of the most common degenerative disorders of cartilage in old age the treatment and prevention of which poses a tremendous challenge. The aim of this study was to compare the effects of hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis. Materials and Methods: In this clinical trial, 34patients with knee osteoarthritis were enrolled. Patients were randomly divided into two groups. In this study hyaluronic acid was administrated at a dose of 20mg per 2ml (3 infusions every 2 weeks) and triamcinolone acetate was administrated at a dose of 40mg per 1cc and 1cc of lidocaine (1injection). Pain, joint stiffness, movement restriction and grad of osteoarthritis were compared in the two groups. Results: The results showed that hyaluronic acid relieved movement restriction (41.58 to 28.35) (PV = 0.001) and corticosteroids reduced pain (14.52 to 12.52) (PV = 0/011) in patients Conclusion: The results suggested the effect of hyaluronic acid on reducing restriction of movement and corticosteroids on pain relief in patients.