Abstract
Introduction: application of hyaluronic acid gel for intraarticular administration is actual topic of modern orthopaedic concerning to its therapeutical efficacy. Objective: to assess the influence of different concentrations of proFLEX® INTRA on the synovial fluid and biochemical blood markers in patients with the 2nd knee osteoarthritis stage in the different age groups. Materials and methods: 30 patients with Kellgren–Lawrence stage II knee osteoarthritis were examined. The first group consisted of 15 patients aged 40–50 years, in the second group the average age of patients was 50–70 years. Each group was divided into 3 subgroups (a, b, c) of 5 patients. In each group the first subgroup of patients received intra-articular 1 injection of proFLEX® INTRA 10 mg/ml 2.0 ml, І-b, ІІ-b — 12 mg/ml 2.5 ml, І-с, ІІ-с — 20 mg/ml 3.0 ml. Results: an inflammatory-dystrophic process in the knee joint of patients was found in both groups, which was more expressed in elderly patients. The dynamics of blood markers in patients of the 1st and 2nd groups after the treatment showed a decreasing the level of inflammatory and dystrophic processes in the knee joints. In the 1st group 1 month after intra-articular injection, the content of glycoproteins and chondroitin sulfates (CS) decreased, did not reach the normative values. In subgroup II-c the level of glycoproteins and CS decreased, the concentration of interleukin-6 (IL-6) remained elevated comparing to subgroups II-a and II-b. Conclusions: it was found that patients with stage II knee osteoarthritis had increased CS and lower levels of hyaluronic acid in their synovial fluid. Markers of inflammation (glycoproteins and IL-6) and destruction markers (CS) in the blood serum changed unidirectionally and indicated a decreasing in the activity of inflammatory process after the injection of hyaluronic acid gel, which was clinically confirmed 1 month after intra-articular injection. In this case, the results after the reexamination of blood biomarkers of patients aged 40–50 years indicated a higher efficiency of hyaluronic acid gel injection with a concentration of 10 and 12 mg/ml, aged 50–70 years — a concentration of 20 mg/ml was confirmed by a decrease in the level of glycoproteins, CS and IL-6 in the blood of patients.
Highlights
Внутрисуставное введение различных препаратов гиалуроновой кислоты при лечении ранних стадий гонартроза на сегодня применяется достаточно широко в ортопедической практике как в монотерапии, так и в комбинации с другими препаратами [1,2,3,4]
По оценке Oxford Knee Score (OKS) максимальный балл был 22, тогда как во ІІ группе — от 23 до 26
Результаты лечения по динамике болевого синдрома (VAS при ходьбе) и состоянию пациентов по шкале OKS в I группе приведены в табл. 2
Summary
Исследование проведено на базе отделов патологии суставов и лабораторной диагностики и иммунологии ГУ «ИППС им. проф. Больных разделили на 2 группы: в I вошло 15 лиц в возрасте 40–50 лет, во II — 15 (50–70 лет). Пациентов I и II групп разделили на подгруппы по 5 человек в каждой — І-a, І-b, І-c и IІ-a, IІ-b, IІ-c соответственно. Материалы исследования прошли экспертизу комитета по биоэтике при ГУ «ИППС им. Ситенко НАМН» в соответствии с международными требованиями и получили положительное заключение (протокол No 203 от 27.04.2020). Критерии включения пациентов были следующие: гонартроз ІІ стадии односторонний, І группа (n = 15) — возраст от 40 до 50 лет, ІІ группа (n = 15) — возраст от 50 до 70 лет; женщин — по 8, мужчин — по 7 в каждой группе Таблица 1 Сравнительная характеристика пациентов I (от 40 до 50 лет) и II групп (от 50 до 70 лет)
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