Intra-articular HA Research Articles

Single Shot of Knee Intraarticular Injection of Platelets Rich Plasma versus Hyaluronic Acid Injections for Symptomatic Knee Osteoarthritis. An Observational Prospective Study

The aim of this study was to evaluate the effectiveness and safety of intra-articular PRP and HA in KOA patients. Methods: The current work was prospective randomized observational. Participants were divided into two groups. Group 1; 1 intra-articular PRP injection (15 mL) in 72 patients and Group 2; A single intra-articular injection of HA (80 mg/4 mL) was administered to 72 patients. All patients were evaluated before infiltration and 1, 3, 6, and 12 months after injection. Results: No significant difference was detected in the demographic distribution (gender and age) and Grade RT, Grade RL, Grade II OA and Grade III OA classifications of patients who received intra-articular PRP or HA injection for knee OA (p>0.05). Compared with the HA group WOMAC mean of 48.8 and p<0.05, there was no significant change in the PRP groups with the WOMAC mean of 68.9. At month 3, each group had significantly reduced overall WOMAC score compared to baselines in both groups. The mean WOMAC was 48.2 in the HA and 47.9 in the PRP group (P<0.001). At 6 months, the average WOMAC score of the PRP group was 39.4, while this rate was 56.3 in the HA group (P<0.001). The PRP group showed a steady improvement, while those treated with HA showed a rapid deterioration. At 12 months, the HA group's WOMAC scores (74.1) returned to baseline levels. The mean WOMAC of the PRP group was (58.9) (P<0.001). Conclusion: The overall PRP improvement outweighs HA injections

Ultrasound-Guided Injections of HYADD4 for Knee Osteoarthritis Improves Pain and Functional Outcomes at 3, 6, and 12 Months without Changes in Measured Synovial Fluid, Serum Collagen Biomarkers, or Most Synovial Fluid Biomarker Proteins at 3 Months.

Prior studies have demonstrated improved efficacy when intra-articular (IA) therapeutics are injected using ultrasound (US) guidance. The aim of this study was to determine if clinical improvement in pain and function after IA hyaluronic acid injections using US is associated with changes in SF volumes and biomarker proteins at 3 months. 49 subjects with symptomatic knee OA, BMI < 40, and KL radiographic grade II or III participated. Subjects with adequate aspirated synovial fluid (SF) volumes received two US-guided IA-HA injections of HYADD4 (24 mg/3 mL) 7 days apart. Clinical evaluations at 3, 6, and 12 months included WOMAC, VAS, PCS scores, 6 MWD, and US-measured SF depth. SF and blood were collected at 3 months and analyzed for four serum OA biomarkers and fifteen SF proteins. Statistical differences were observed at 3, 6, and 12 months compared to baseline values, with improvements at 12 months for WOMAC scores (50%), VAS (54%), and PCS scores (24%). MMP10 levels were lower at 3 months without changes in SF volumes, serum levels of C2C, COMP, HA, CPII, or SF levels of IL-1 ra, IL-4, 6, 7, 8, 15, 18, ILGFBP-1, 3, and MMP 1, 2, 3, 8, 9. Baseline clinical features or SF biomarker protein levels did not predict responsiveness at 3 months. Clinical improvements were observed at 12 months using US needle guidance for IA HA, whereas only one SF protein biomarker protein was different at 3 months. Larger studies are needed to identify which SF biomarkers will predict which individual OA patients will receive the greatest benefit from IA therapeutics.

Association of HMGB1 levels in synovial fluid with the severity of temporomandibular joint osteoarthritis

BackgroundHMGB1 usually serves as a damage-associated molecular pattern (DAMP) molecule (also known as alarmin) that regulates the inflammatory and immune responses via different receptors or direct uptake. Numerous studies have reported the association between HMGB1 and inflammatory diseases; however, its role in temporomandibular joint (TMJ) osteoarthritis (OA) has not been elucidated. In this retrospective study, we aimed to investigate HMGB1 levels in the synovial fluid (SF) in patients with TMJOA and TMID, their correlation with TMJOA and TMID severity, and the therapeutic effect of sodium hyaluronate (hyaluronic acid, HA) on TMJOA.MethodsSF samples were analyzed for 30 patients with TMJ internal derangement (TMJID) and TMJOA, along with visual analog scale (VAS) scores, radiographic stages, and mandibular functional limitations. The SF levels of HMGB1, IL-1β, IL-18, PGE2, RAGE, TLR4, and iNOS were determined via an enzyme-linked immunosorbent assay. To evaluate the therapeutic effects of HA, pre-treatment and post-treatment clinical symptoms were also compared in patients of the TMJOA group who had received an intra-articular injection of HA.ResultsVAS and Jaw Functional Limitation Scale (JFLS) scores were significantly higher in the TMJOA group than in the TMNID group, as were SF levels of HMGB1, TLR4, IL-1β, IL-18, PGE2, and iNOS. The synovial HMGB1 level was positively correlated with the VAS score (r = 0.5512, p = 0.0016) and mandibular functional limitations (r = 0.4684, p = 0.0054). The cut-off value for the HMGB1 level as a diagnostic biomarker was 986.8 pg/ml. The SF level of HMGB1 yielded an area under the curve value (AUC) of 0.8344 for predicting TMJOA. HA alleviated TMJ disorders by significantly reducing the VAS score and improving the maximum extent of mouth opening in both the TMJID and TMJOA groups (p < 0.05). Moreover, patients in both the TMJID and TMJOA groups exhibited significant improvement in the JFLS score following HA treatment.ConclusionsOur results indicate that HMGB1 is a potential marker for predicting the severity of TMJOA. Intra-articular HA injection exerts a positive therapeutic effect on TMJOA; however, further investigations are warranted to validate its therapeutic effect in the late phase of visco-supplementation treatment.

A single centre, open label, pilot study evaluating the effect of intra-articular hyaluronic acid injection on pain and functionality when injected into the ankle (tibio-talar and sub-talar) joint in patients with haemophilic arthropathy.

Ankle arthropathy commonly affects persons with haemophilia (PWH). Joint damage causes loss of movement, pain and reduced function. Current treatments are limited. Viscosupplementation has been used to treat other patient groups with joint damage. Viscosupplements serve to augment or act as a substitute for synovial fluid and may ameliorate the effects of cartilage loss by cushioning joints and reducing pain. This study evaluated intra-articular Ostenil Plus™ (HA) for ankle arthropathy in PWH. Reduction in pain was the primary outcome. A single centre open label pilot study. PWH and significant ankle arthropathy, according to MRI scores, were recruited. Participants received intra-articular HA injections at baseline and 6 months. Follow up assessments were completed three-monthly for 1 year. Pain was assessed by the Visual Analogue Scale (VAS). Participant perceptions of overall changes to pain, function and quality of life were sought. Twenty-four participants were recruited, three withdrew. Twenty-six joints were injected. Twenty participants had severe haemophilia. Mean age 35 years. Participants reported significant reduction in pain over the study. VAS baseline: 5.62; 6 month 3.92; 12-month 3.42, P<.0001. Joint function improved together with ankle HJHS. No change was seen for EQ-5D-5L. Sixteen participants reported reductions in ankle pain and stiffness and greater confidence in undertaking physical activities. No significant adverse reactions were reported. Ostenil Plus™ treatment improves pain, function and patient perception of functional ability in PWH and ankle arthropathy. This study supports the use of HA as a safe treatment in PWH.

Improvement in condition specific and generic quality of life outcomes in patients with knee osteoarthritis following single intraarticular viscosupplementation injection

BackgroundNon-operative management of Osteoarthritis (OA) can be challenging. The intra-articular injection with hyaluronic acid (IAHA), corticosteroids and Platelet rich plasma are some of the popular modalities which are increasingly being employed as a stop-gap strategy before considering any surgical intervention for OA management. Among these, the intra-articular HA (IAHA) has been widely studied with variable and conflicting results. MethodThis was a prospective observational study conducted in adults with knee OA. Suitable patients were given IAHA (Synvisc-One®) on an out-patient basis. They were assessed in terms of VAS score, WOMAC score and SF36 scores at successive follow-up visits at 8, 24 and 52 weeks. Results50 patients were recruited in this study and followed for 52 weeks post injection of HA. Mean and SD values of VAS, WOMAC and SF36 scores were on a decreasing trend in each follow up visit. Percentage change between the visits was also statistically significant. The improvement in pain scores at successive visits was significant in KL grade 1 OA than grade 2 or 3 indicating strong association between them. ConclusionShort-term (up to one year) beneficial effects of intra-articular viscosupplementation with HA in early primary knee OA can be seen with a decreasing trend in the intensity of pain and an increasing trend in improving the physical functioning and health-related quality of life.

Comparative study of clinical and functional outcome of treatment of mild to moderate osteoarthritis of knee joint between intra articular platelet rich plasma and Hyaluronic acid injection

Aim: To compare the clinical and functional outcomes of treatment of mild to moderate osteoarthritis of knee joint by using intra-articular platelet-rich plasma injection versus hyaluronic acid injection. Methods: Total of 60 patients with grade 0 to grade 2 osteoarthritis were included in the study, of which 30 were treated with intra-articular PRP and the other 30 with intra-articular HA. Patients was evaluated before and after the procedure using Visual Analogue Scale (VAS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) at 6, 12, 24 weeks respectively.Results: Both groups had clinical improvement but excellent results were seen in the group of patients receiving platelet-rich plasma injections indicated by their VAS and WOMAC scores at 6, 12 week and 24 week follow-up. No severe adverse effects were observed in both the groups. Conclusions: Our comparative study analyzed that application of autologous Platelet rich plasma is a safe and effective method in the treatment of mild to moderate stages of knee osteoarthritis. Significant better results was seen with 6 months of follow-up compared to hyaluronic acid. Moreover platelet rich plasma is cost effective than hyaluronic acid injection.

Effects of Hyaluronan Molecular Weight on the Lubrication of Cartilage-Emulating Boundary Layers.

Osteoarthritic joints contain lower-molecular-weight (MW) hyaluronan (hyaluronic acid, HA) than healthy joints. To understand the relevance of this HA size effect for joint lubrication, the friction and surface structure of cartilage-emulating surfaces with HA of different MWs were studied using a surface force balance (SFB) and atomic force microscopy (AFM). Gelatin (gel)-covered mica surfaces were coated with high-MW HA (HHA), medium-MW HA (MHA), or low-MW HA (LHA), and lipids of hydrogenated soy l-α-phosphatidylcholine (HSPC) in the form of small unilamellar vesicles, using a layer-by-layer assembly method. SFB results indicate that the gel-HHA-HSPC boundary layer provides very efficient lubrication, attributed to hydration lubrication at the phosphocholine headgroups exposed by the HA-attached lipids, with friction coefficients (COF) as low as 10–3–10–4 at contact stresses at least up to P = 120 atm. However, for the gel-MHA-HSPC and gel-LHA-HSPC surfaces, the friction, initially low, increases sharply at much lower pressures (up to 30–60 atm at most). This higher friction with the shorter chains may be due to their weaker total adhesion energy to the gelatin, where the attraction between the negatively charged HA and the weakly positively charged gelatin is attributed largely to counterion-release entropy. Thus, the complexes of LHA and MHA with the lubricating HSPC lipids are more easily removed by shear during sliding, especially at high stresses, than the HHA-HSPC complex, which is strongly adhered to gelatin. This is ultimately the reason for lower-pressure lubrication breakdown with the shorter polysaccharides. Our results provide molecular-level insight into why the decrease in HA molecular weight in osteoarthritic joints may be associated with higher friction at the articular cartilage surface, and may have relevance for treatments of osteoarthritis involving intra-articular HA injections.

Comparison of intra-articular steroid injection and hyaluronic acid in mono-articular synovitis knee

Introduction: Mono articular presentation of rheumatoid arthritis is infrequent and has been previously reported to involve the hip and knee joints. Rheumatoid arthritis is a common symmetrical chronic inflammatory arthritis with the prevalence of 1% worldwide. Mono- articular rheumatoid arthritis is a rare entity reported to initially affect large joints such as hips and knees, progressing to a poly articular presentation within 3 to 5 years. Synovitis is an important component of rheumatoid arthritis, so we conducted a study to include all the recurrent effusion of knee cases, and we have compared the functional outcome of intra-articular steroid injection and hyaluronic acid in the treatment of such cases. Material and Methods: 40 cases of recurrent effusion of knee joint attending the OPD or emergency services at Government Medical College and Rajindra hospital, Patiala between July 2016 to July 2019 were evaluated with the clinical examination, haematological investigations and radiological investigations. In all the cases, the joint was aspirated with a 16 G Needle and aspirated fluid was sent for pus cultural sensitivity in a microbiology Department of our hospital and was sent for CBNAAT to chest and TB hospital of our hospital. In Group 1, following the aspiration, injection of local corticosteroid (methylprednisolone acetate 80 mg) was given and in group 2, injection of hyaluronic acid was given, followed by a short course of antibiotics for 5 days and short course of non-steroidal anti-inflammatory drugs was given for 10 days and a crêpe bandage was applied for 2 days. The results were assessed by VAS for pain and KOOS (Knee Injury and Osteoarthritis Outcome Score) scores. Results: In all 40 patients, the pus cultural sensitivity was negative for any microorganism and CBNAAT was negative in all the 40 patients. By comparing the results obtained in KOOS scale it was seen that symptoms improved after six months in both steroid (P = 0.017) and HA groups (P = 0.004). Besides, daily activity improved in both steroid (P = 0.027) and HA groups (P = 0.047). On the contrary, pain did not decrease 6 months after intervention in both steroid (P = 0.096) and HA groups (P = 0.17) Conclusion: Mono articular synovitis in an otherwise seronegative patient is due to recurrent inflammatory response due to recurrent stress or any other intra articular pathology. Patients are advised rest, and a short course of steroidal anti-inflammatory drugs, which also helped to relieve the inflammation. This was markedly improved by intra-articular HA injection as shown by the recovery in intra-articular HA injection group as compared to the steroid group.

Several Variables Response to 2.2% Intra-Articular Injections of Hyaluronic Acid

Objectives of the research: to assess the effects of TMJ 2.2 hyaluronic acid injection on following TMJ pain, TMJ clicking, maximum opening capacity and lateral mandibular movements. This study include one hundred patients (77females and 23males) whom complain from clicking and pain at their TMJ with or without limitation of mandibular movements. The age ranged between 9-65 years old. Hyaluronic acid 2.2% were used for intra- articular injection unilaterally at the upper compartment of the most painful TMJ. Assessment of pain was done by using the visual analogue scale (0-10), the intensity of clicking was evaluated by stethoscope using basser clicking score, lateral movements were calculated by using ruler and recorded into special case sheet, and any complications that reported by the patients were recorded. These data were recorded before treatment and one, two, three weeks post injections, also one month after the last injection. SPSS (statistical package of social science) window 11.5 version was used for statistical investigation with chi square and paired T tests with P ≤ 0.001 as a significant value. The outcome of this study reveals that age cluster between (21-30) years was the most prevailing age, it signify (29%) of the entire trial, whereas the age group over 50 years was the least represented age group, it signify 7%, Female were presented in this study more often than males at a ratio of (3.3 -1). Regarding TMJ pain, there were significant differences (P≤ 0.001) before and after intra-articular drug administration. Significant differences P≤ 0.001were found in clicking scores means before and after intra-articular HA injections there were significant differences P≤ 0.001 in maximum opening capacity means before and after TMJ injections. There were significant differences in both lateral left and right movements means P ≤ 0.001 before and after TMJ injections of hyaluronic acid. This study conclude that HA 2.2% TMJ injection is an effective method in treating different TMJ diseases including temoporomandibular disorders, it reduce pain, clicking and improve mandibular motion, their effect persist even one month beyond last injection, it is effective, safe, painless, not costly, with no side effects like steroid, with no complications, usually no need to another drugs following injections like antibiotic and analgesic. We recommend that this modalities as the best treatment for TMDs. Also we conclude that females seek treatment more often than males at a ratio 3.3:1.

Effects of Viscosupplementation on Knee Joint Arthrokinematics - Pilot Study.

Osteoarthritis is one of the most common dysfunctions of the musculoskeletal system and viscosup-plementation is becoming an increasingly popular treatment in OA. However, current knowledge regarding biomechanical changes in synovial joints reveals many discrepancies. Therefore, the aim of our study was to evaluate the effect of visco-supplementation on knee joint arthrokinematics as analyzed by vibroarthrography. Seventeen individuals diagnosed with moderate knee osteoarthritis (VSC) were examined before and after a single injection of hyaluronate. A control group consisted of 30 asymptomatic individuals. During alter-nating extension/flexion of the knee joint, a 6-second vibroarthrographic signal was recorded using an accelerometer. The following parameters were calculated: variance (VMS), amplitude (R4), and spectral power density in the 50-250 Hz (P1) and 250-450 Hz (P2) bands. Statistical analysis showed significant differences (p&lt;0.05) in the values of R4 and P2, which were higher in the VSC group than among the controls. After viscosupplementation, the values of R4, P1 and P2 in the VSC group de-creased to a level not significantly different from that seen among the controls. 1. After a single intra-articular HA injection, joint motion-related vibrations were reduced, which was recorded as a decreased intensity of vibroacoustic emission. 2. This suggests that the use of viscosupplementation in pa-tients with moderate knee osteoarthritis may improve qualitative aspects of arthrokinematics.

Single intra-articular injection of lightly cross-linked hyaluronic acid reduces knee pain in symptomatic knee osteoarthritis: a multicenter, double-blind, randomized, placebo-controlled trial.

The primary objective was to demonstrate the safety and effectiveness of Monovisc™ in the relief of joint pain in patients with idiopathic knee OA compared to saline injection. It was hypothesized that patient success, defined as ≥ 50% improvement from baseline and ≥ 20mm absolute improvement from baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) visual analog scale (VAS) pain score, would be greater in the Monovisc™ group compared to the Saline control group. In this multicenter, double-blind, randomized, placebo-controlled trial, patients with idiopathic, symptomatic, knee OA were randomized to either 4ml single injection of Monovisc™ or 4ml injection of 0.9% saline. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess patient outcomes at 2, 4, 8, 12, 20, and 26 weeks post-injection. The primary effectiveness endpoint was a 50% improvement and ≥ 20mm improvement from baseline in the WOMAC pain through 26 weeks. Secondary outcome measures included a ≥ 20mm improvement from baseline on the WOMAC physical function, patient global assessment, evaluator global assessment, and knee range of motion. 369 patients (154 male, 215 female) were randomized to either Monovisc™ or saline. The Monovisc™ group had a significantly greater rate of patient success (e.g. ≥ 50% improvement and ≥ 20mm absolute improvement from baseline in the WOMAC pain through Week 26) compared to saline (p = 0.043). Monovisc™, a single-injection intra-articular HA device, is a safe and effective treatment for providing a clinically meaningful reduction in knee pain within 2 weeks. The results of this study support the use of a single injection of hyaluronic acid (Monovisc™) for patients with symptomatic knee OA in patients older than 45 years, as a safe and effective alternative for patients who may want an alternative treatment modality or may not be candidates for partial or total knee replacement. I, multicenter, double-blind, randomized, placebo-controlled trial.

Intra-articular oxygen-ozone therapy in knee osteoarthritis: Results of a 31-week randomized, single-blind study versus intra-articular hyaluronic acid

Intra-articular (IA) oxygen-ozone (O2O3) has recently grown as a novel therapeutic option in knee osteoarthritis (KOA) and few studies in literature explored its safety and impact on pain and functional status in these patients. The aim of this study was to assess the effectiveness and safety of IA O2O3 compared to ialuronic acid (HA) in terms of pain, knee function, and health-related quality of life in patients affected by KOA over 31 weeks. In this randomized, single-blind, controlled study patients aged ≥ 60 years affected by KOA have been enrolled and randomly allocated to receive 4 IA knee injections once per week for 4 consecutive weeks of O2O3 or HA (T0–T3) and a follow-up visit 4 weeks after the fourth injection (T4). Patients having a Visual Analogue Scale (VAS) ≥ 4 at 6 months follow-up visit (T5) underwent a second treatment cycle (T5–T8) and a 1-month follow-up visit (T9). All adverse events occurred, VAS, Oxford Knee Questionnaire, 12-Item Short Form Health Survey, and European Quality of Life-5 dimensions scores have been assessed. Forty-six patients (mean aged 70.8 ± 2.4 years) were enrolled and randomly allocated to O2O3 (n = 23) or HA treatment group (n = 23). Nineteen patients reported a VAS ≥ 4 at T5, undergoing a second treatment cycle: 10 in O2O3 group and 9 in HA group. There were no significant differences in adverse events occurrence between the two groups. VAS scores showed a statistically significant reduction (P < 0.013) compared to baseline during both treatment cycles in both groups. At both follow-up visits (T4 and T9) the VAS score was significantly lower in the HA group compared to O2O3 group (P < 0.013). IA O2O3 therapy could be comparable to IA HA in terms of safety profile and effectiveness in reducing pain in patients with KOA, even on a multiple injection cycles and long term follow-up.

Joint nociceptor nerve activity and pain in an animal model of acute gout and its modulation by intra-articular hyaluronan.

The mechanisms whereby deposition of monosodium urate (MSU) crystals in gout activates nociceptors to induce joint pain are incompletely understood. We tried to reproduce the signs of painful gouty arthritis, injecting into the knee joint of rats suspensions containing amorphous or triclinic, needle MSU crystals. The magnitude of MSU-induced inflammation and pain behavior signs were correlated with the changes in firing frequency of spontaneous and movement-evoked nerve impulse activity recorded in single knee joint nociceptor saphenous nerve fibers. Joint swelling, mechanical and cold allodynia, and hyperalgesia appeared 3 hours after joint injection of MSU crystals. In parallel, spontaneous and movement-evoked joint nociceptor impulse activity raised significantly. Solutions containing amorphous or needle-shaped MSU crystals had similar inflammatory and electrophysiological effects. Intra-articular injection of hyaluronan (HA, Synvisc), a high-MW glycosaminoglycan present in the synovial fluid with analgesic effects in osteoarthritis, significantly reduced MSU-induced behavioral signs of pain and decreased the enhanced joint nociceptor activity. Our results support the interpretation that pain and nociceptor activation are not triggered by direct mechanical stimulation of nociceptors by MSU crystals, but are primarily caused by the release of excitatory mediators by inflammatory cells activated by MSU crystals. Intra-articular HA decreased behavioral and electrophysiological signs of pain, possibly through its viscoelastic filtering effect on the mechanical forces acting over sensitized joint sensory endings and probably also by a direct interaction of HA molecules with the transducing channels expressed in joint nociceptor terminals.

Intra-articular hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis.

To compare the efficacy of ultrasound-guided intra-articular (IA) treatment with platelet-rich plasma (PRP) versus viscosupplementation (hyaluronic acid HA) in hip osteoarthritis.METHODS: A total of 43 patients affected bymonolateral severe hip osteoarthritis (OA) were included in the study. Patients were randomized to receive either intra-articularPRP (3 ml) or HA (30 mg/2 ml; 1,000-2,900 kDa), 3 injections in total - 1/week. Clinical assessments for each patient weremade at baseline (T0), 4 (T1), and 16 weeks (T2) of follow-up. The primary efficacy outcome was pain reduction as measuredby VAS and by WOMAC pain subscale. Data analysis revealed that, compared to T0, in the PRP-treated group VAS scores significantly decreased at T1 but not at T2, thereby indicating an early effect on pain which was not maintained at alonger term follow-up. In the HA group a significant decrease of both VAS and WOMAC values was registered only betweenT0 and T2. Intra-articular PRP had an immediate effect on pain that was not maintained at longer term follow-up when, on the contrary, the effects of intra-articular HA were evident.

Material on the basis of partially crosslinked solution of HA derivative for synovial fluid viscosupplementation

Material on the basis of partially crosslinked solution of HA derivative for synovial fluid viscosupplementation

Temporal effects of intra-articular HA and/or corticosteroids on OA synovial fluid boundary lubricant composition: a case series

Temporal effects of intra-articular HA and/or corticosteroids on OA synovial fluid boundary lubricant composition: a case series

A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints

ObjectiveThe aim of this study was to compare the efficacy of intra-articular injections of three different agents with well known anti-inflammatory properties. Materials and methodBetween April 2010 and January 2013 a total of 100 patients who were diagnosed as temporomandibular joint disorder in the Department of Otolaryngology at Bozok University School of Medicine were prospectively studied. Patients with symptoms of jaw pain, limited or painful jaw movement, clicking or grating within the joint, were evaluated with temporomandibular CT to investigate the presence of cartilage or capsule degeneration.In the study group there were 55 female and 45 male patients who were non-responders to conventional anti-inflammatory treatment for TMJ complaints. The patients were randomly divided into four groups consisting of a control group and three different groups who underwent intra-articular injection of one given anti-inflammatory agent for each group. We injected saline solution to intra-articular space in the control group. Of three anti-inflammatory agents including hyaluronic acid (HA, Hyalgan intra-articular injection, Sodium hyaluronate 10 mg/ml, 2 ml injection syringe, Bilim Pharmaceutical Company, Istanbul, Turkey); betamethasone (CS, Diprospan flacon, 7.0 mg betamethasone/1 ml, Schering-Plough Pharmaceutical Company, Istanbul, Turkey) and; tenoxicam (TX, Tilcotil flacon, 20 mg tenoxicam/ml, Roche Pharmaceutical Company, Istanbul, Turkey) were administered intra-articularly under, ultrasonographic guidance. Following the completion of injections the, changes in subjective symptoms were compared with visual analogue scales, (VAS) scores at 1st and 6th weeks' follow-up visits between four groups. ResultsThe HA group did significantly better pain relief scores compared to the, other groups at 1st and 6th weeks (p < 0.05). TX and CS groups' pain scores were better than control group values (p < 0.05, for both agents). The pain relief effect of TX was noted to decrease significantly between the 1st and 6th week (p < 0.05) (Fig. 1). We did not observe the same pattern in HA, CS and control (saline) groups between 1st and 6th week (p > 0.05). ConclusionWe found that HA produced better pain relief scores when compared to the other anti-inflammatory agents studied. The main disadvantage of HA is its relatively higher cost. Additionally it does not have a reimbursement status by state or private health insurance systems in Turkey. Despite the lower VAS scores, intra-articular TX and CS may be assessed as more economic alternatives to intra-articular HA injections.

Suprascapular Nerve Block versus Intra-articular Hyaluronic Acid Injection in Hemiplegic Shoulder Pain

Results: Both groups showed significant improvements in pain assessed by VAS, but the changes between the two groups were not significantly different. There were no significant improvements and did not show any significant differences between the two groups in FMS, WMFT, Brunnstrom stage, MAS and ROM of shoulder joint. On several items of the BPI concerning the interference of patient’s function (activity, mood, work, and enjoy), only SSNB group showed significant improvement, even though the differences between the two groups were not significant. Conclusion: Both SSNB and intra-articular HA injection were safe and effective in pain and functional ability in hemiplegic shoulder pain. But comparing the interference of patient’s function caused by pain, only SSNB showed significant improvement. (Brain & NeuroRehabilitation 2014; 7: 118-125)

Intra-Articular Hyaluronic Acid as Treatment in Elderly and Middle-Aged Patients with Knee Osteoarthritis

Introduction: Osteoarthritis is the most common age-related degenerative joint disease. It affects all the joints containing hyaline cartilage. Knee osteoarthritis is the most cumbersome in terms of prevalence and disability. The aim of this study to evaluate the efficacy of intra-articular hyaluronic acid in patients with knee osteoarthritis with regard to joint pain and function, as well as patient satisfaction, assessed at one month and at one year, and by age group.Methods:In this prospective randomised study, 172 patients who were diagnosed knee OA and who received three consecutive intra-articular injections of HA weekly were included. Patients 65 years of age or older were accepted as the “elderly group”, and those under 65 were accepted as the “middle-aged group”. Clinical evaluations of efficacy and safety were conducted at the beginning of the study, one month after the third injection, and one year after the third injection.Results:In the two groups, the intragroup analysis revealed significant improvements following injection when compared with preinjection values. According to the last followup controls (after 12 months) in the middle-aged group, VAS activity pain, VAS rest pain, WOMAC physical function, and WOMAC pain values were found to be statistically lower when compared with pre-injection values. In the elderly group, no statistically significant differences were found between pre-injection and after 12 months.Conclusion:We can conclude that intra-articular joint HA injections are effective in both young and old patients with OA with regard to pain and functional status over a short-term period. Further, HA injections in patients younger than 65 years can be planned for a one-year period.

Comparison of Intra-articular Hyaluronic Acid Injections With Transcutaneous Electric Nerve Stimulation for the Management of Knee Osteoarthritis: A Randomized Controlled Trial

ObjectiveTo compare the effects of intra-articular hyaluronic acid (HA; ARTZ) and transcutaneous electric nerve stimulation (TENS) in the treatment of patients with knee osteoarthritis. DesignA prospective, randomized controlled trial. SettingRehabilitation clinic of a teaching hospital. ParticipantsPatients with knee osteoarthritis (N=50; aged 51–80y) were randomly assigned to the HA group (n=27) or the TENS group (n=23). InterventionsThe HA group received intra-articular HA injection into the affected knee once a week for 5 consecutive weeks, and the TENS group received a 20- minute session of TENS 3 times a week for 4 consecutive weeks. Main Outcome MeasuresThe primary outcome measures used were the visual analog scale (VAS) for pain and the Lequesne index. The secondary outcome measures were range of motion of the knee, walking time, pain threshold, patient global assessment, and disability in activities of daily living. All subjects were assessed at baseline, and at 2 weeks, 2 months, and 3 months after the treatments were completed. ResultsThe TENS group exhibited a significantly greater improvement in VAS than the HA group at 2 weeks' follow-up (4.17±1.98 vs 5.31±1.78, respectively; P=.03). In addition, the TENS group also exhibited a significantly greater improvement in the Lequesne index than the HA group at 2 weeks' follow-up (7.78±2.08 vs 9.85±3.54, respectively; P=.01) and at 3 months' follow-up (7.07±2.85 vs 9.24±4.04, respectively; P=.03). ConclusionsTENS with silver spike point electrodes was observed to be more effective than intra-articular HA injection for patients with knee osteoarthritis in improving the VAS for pain at 2 weeks' follow-up as well as the Lequesne index at 2 weeks' and 3 months' follow-up.