Changes in Nitric Oxide Level and Thickness Index of Synovial Fluid in Osteoarthritis Patients following Intraarticular Injection of Sodium Hyaluronate

Laifeng Li,Cunming Zhang,Demin Li,Hui Wang

doi:10.4314/tjpr.v15i3.29

Abstract

Purpose: To monitor the changes in nitric oxide levels and synovium thickness index in synovial fluid following intra-articular injection of sodium hyaluronate.Methods: One hundred patients diagnosed with osteoarthritis of the knee from April 2014 to January 2015 in The Third Hospital of Jinan, Jinan, Shandong, China were selected and categorized into three phases; namely, mild, moderate and severe. Patients received a 20 mL sodium hyaluronate injection into the articular cavity of the knee once per week for 15 weeks, with continuous observation. The Visual Analogue Scale (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores were recorded after five weeks. A total of 56 patients (78 knees) remaining in serious condition after 5 weeks were divided into mild, moderate, and severe groups and treated with sodium hyaluronate once a week. Internationally reorganized VAS and WOMAC scores were adopted as clinical observation indices to indicate the curative effect of sodium hyaluronate among the 56 patients after 15 weeks of treatment. The conditions of the patients in the two phases were compared.Results: After 5 weeks of treatment, treatment effective rate in the mild, moderate and severe groups was 72.92, 66.10 and 28.57 %, respectively, with an overall effective rate of 78 %. After 15 weeks of treatment, treatment effective rate in mild, moderate, and severe groups was 96.77, 95.45 and 66.67 %, respectively, with an overall effective rate of 67.95 %.Conclusions: Clinically curative effect of sodium hyaluronate is significant for mild and moderate phase patients after intra-articular injection of sodium hyaluronate, while the effect is insignificant in severe patients. Thus, sodium hyaluronate can effectively improve nitric oxide levels in synovial fluid, reduce synovium thickness, enhances articular cavity lubrication and effectively alleviates disease severity.Keywords: Osteoarthritis, Knee, Intra-articular injection, Sodium hyaluronate, Nitric oxide, Synovium thickness, WOMAC

Highlights

Sodium hyaluronate is the major component of synovial fluid and one of the components of cartilage matrix
Synovial fluid nitric oxide (NO) levels in patients with mild, moderate and severe knee osteoarthritis significantly improved after both 5 weeks and 15 weeks of treatment compared to baseline levels
We demonstrated that the mechanism of action of sodium hyaluronate includes the improvement of joint fluid secretion, reduction in synovial fluid NO levels, and a decrease in synovium thickness

Summary

INTRODUCTION

Sodium hyaluronate is the major component of synovial fluid and one of the components of cartilage matrix. Several groups have demonstrated that sodium hyaluronate has a lasting pain-relieving effect among patients with knee osteoarthritis, and this effect has been observed clinically. Chen et al [1] treated knee osteoarthritis by injecting sodium hyaluronate into the articular cavity of 484 patients (610 knees) and evaluated the effect of treatment using the Lysholm’s knee score. Concurrent joint mobilization and intra-articular sodium hyaluronate injection may improve the effects of sodium hyaluronate treatment, but may reduce pain and improve the effusion quantity and motion of joints in patients with knee osteoarthritis. Iodine and ether were applied to the skin to sterilize the puncture point, and any synovial fluid present in the knee joint was extracted prior to the injection of 20 mL sodium hyaluronate. The effect of treatment was evaluated via range of motion of the knee joint

Main outcome measures

RESULTS

DISCUSSION

CONCLUSION