Intra-articular Hyaluronic Injection Research Articles

Pharmacological interventions for early-stage frozen shoulder: a systematic review and network meta-analysis.

To evaluate the efficacy of pharmacological interventions for treating early-stage, pain predominant, adhesive capsulitis, also known as frozen shoulder. We performed a systematic review in accordance with PRSIMA guidelines. Searches were conducted on PUBMED, EMBASE and Cochrane Central Register of Controlled Trials on the 24th of February 2022. Outcomes were shoulder pain, shoulder function and range of movement. Synthesis involved both qualitative analysis for all studies and pairwise meta-analyses followed by a network meta-analysis for randomised controlled trials (RCTs). A total of 3,252 articles were found, of which 31 met inclusion criteria, and 22 of these were RCTs. Intraarticular (IA) injection of corticosteroids (8 RCTS, 340 participants) and IA injection of platelet-rich plasma (PRP) (3 RCTs, 177 participants) showed benefit at 12 weeks compared with physical therapy in terms of shoulder pain and function, while oral non-steroidal anti-inflammatories (NSAIDs) (2 RCTs, 44 participants) and IA injection of hyaluronate (2 RCTs, 42 participants) did not show a benefit. Only IA PRP showed benefit over physical therapy for shoulder range of movement. These results shows that IA corticosteroids IA PRP injections are beneficial for early-stage frozen shoulder. These findings should be appraised with care considering the risk of bias, heterogeneity, and inconsistency of the included studies. We believe that research focused on early interventions for frozen shoulder could improve patient outcomes and lead to cost-savings derived from avoiding long-term disability. Further well-designed studies comparing with standardised physical therapy or placebo are required to improve evidence to guide management.

PATIENT PERSPECTIVES ON ORTHOBIOLOGICS FOR OSTEOARTHRITIS

Disease modifying approaches are commonly applied in OA patients. An aging society with better life expectancies is increasing in Europe and the globe. Orthobiologics cover intraarticular hyaluronan injections and also cellular therapies. Cellular therapies range from platelet rich plasma (PRP) applications to exosomes. Short term follow-up of limited number of patients revealed favorable results in clinical cellular therapies. Most of these studies evaluated decrease of pain and increase in function. Recent basic science studies focused on the action mechanism of orthobiologic therapies however patient perspective is less studied. Our research team has recently performed a qualitative study on the patient perspective of hyaluronan injection of the knee joint. Findings of that study will be shared and future patient knowledge based options on orthobiologics will be discussed.

Do Glucocorticoid Injections Increase the Risk of Knee Osteoarthritis Progression Over 5 Years?

Recent findings have demonstrated that intraarticular (IA) glucocorticoid injections can be deleterious for knees with osteoarthritis (OA). This study was undertaken to assess, in a real-life setting, the risk of knee OA progression in patients who received IA glucocorticoid injections over a 5-year follow-up period. We used marginal structural modeling with inverse probability of treatment weighting to determine the causal association between IA glucocorticoid injections and the 5-year risk of disease progression in patients with symptomatic knee OA from the Knee and Hip Osteoarthritis Long-term Assessment cohort. OA progression was defined as an incident total knee replacement (TKR) and/or radiographic worsening (Kellgren/Lawrence [K/L] grade or joint space narrowing [JSN]). We also examined these outcomes in knees that received IA hyaluronan (IAHA) injections. Among the 564 patients with knee OA included in the study sample, 51 (9.0%) and 99 (17.5%) received IA glucocorticoid or IAHA injections, respectively, and 414 (63.1%) did not receive any injection during follow-up. Compared to untreated knees, those treated with IA glucocorticoid injections had a similar risk of incident TKR (hazard ratio [HR] 0.92 [95% confidence interval (95% CI) 0.20, 4.14]; P = 0.91) or K/L grade worsening (HR 1.33 [95% CI 0.64, 2.79]; P = 0.44). IAHA injections had no effect on the risk of TKR (HR 0.81 [95% CI 0.14, 4.63]; P = 0.81) or K/L grade worsening (HR 1.36 [95% CI 0.85, 2.17]; P = 0.20). Similar results were obtained for JSN, and when TKR and radiographic outcomes were combined. In this study, IA glucocorticoid injections for symptomatic knee OA did not significantly increase the 5-year risk of incident TKR or radiographic worsening. These findings should be interpreted cautiously and replicated in other cohorts.

Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis compared with intra-articular hyaluronan injections based on trial data

BackgroundEffective symptom control in painful knee osteoarthritis (OA) may improve patient quality of life. In a randomised crossover trial (NCT03381248), COOLIEF* cooled radiofrequency ablation (CRFA) reduced pain and stiffness and improved physical function and quality of life compared with intra-articular hyaluronan (HA) injections. The present study aimed to establish the cost effectiveness of CRFA versus intra-articular HA injections for treating moderate-to-severe OA knee pain from a US Medicare perspective.MethodsWe conducted a cost-effectiveness analysis using utility data (EQ-5D) from the randomised crossover trial of CRFA versus intra-articular HA injections, which had follow-ups at 1, 3, 6, and 12 months. Patients in the HA group with unsatisfactory outcomes (e.g., continued pain) at 6 months could cross over to CRFA. Economic analysis outcomes included quality-adjusted life-years (QALYs), costs, and cost effectiveness (cost per QALY gained). Base-case analyses were modelled on a 6-month time horizon (to trial crossover). Due to limited trial data in the HA arm beyond 6 months, scenarios explored potential outcomes to 12 months if: 1) Utility with HA persisted for a further 6 months; 2) A second HA injection was received at 6 months and achieved the same utility change for the second 6 months. In both scenarios, the CRFA arm used trial data for patients who received CRFA from baseline to 12 months. Alternative costing scenarios were also explored.ResultsCRFA resulted in an incremental QALY gain of 0.020 at an incremental cost of US$1707, equating to an incremental cost-effectiveness ratio (ICER) of US$84,392 per QALY over 6 months, versus intra-articular HA injections. Extending the analysis to 12 months and assuming persistence in utility in the HA arm resulted in a larger utility gain for CRFA (0.056 QALYs) and a lower ICER of US$30,275 per QALY. If patients received a second HA injection, the incremental benefit of CRFA out to 12 months was reduced (QALY gain 0.043) but was offset by the costs of the second HA injection (incremental cost US$832). This resulted in an ICER of US$19,316 per QALY.ConclusionsCRFA is a cost-effective treatment option for patients with OA-related knee pain considering the typical US threshold of US$100,000/QALY.

Effects and Safety of Intra-Articular Sodium Hyaluronate Injection for the Treatment of Ankle Osteoarthritis: A Prospective Clinical Trial

Various nonoperative treatments have been implemented to reduce pain and improve the quality of life in patients with ankle osteoarthritis. Among these treatments, intra-articular hyaluronate injection has proven efficacy and safety in patients with knee osteoarthritis. The purpose of this study was to evaluate the efficacy and complications of hyaluronate injection using various clinical scoring systems. This study included 37 patients with unilateral ankle osteoarthritis (grade 2 or 3 according to the Takakura classification) who did not respond to previous pharmacological treatment. 3 weekly hyaluronate injections (2 mL Hyruan Plus®) were administered. The efficacy of intra-articular hyaluronate injection was evaluated on the basis of patient-reported foot and ankle clinical assessment at a mean follow-up of 13.8 ± 8.3 (range 6-33) months. Ankle Osteoarthritis Scale scores for pain and disability, American Orthopedic Foot and Ankle Society ankle-hindfoot scores, and visual analog scale for pain significantly improved at the final follow-up compared to that before intra-articular hyaluronate injection (p ≤ .05). When patients were dichotomized according to age, sex, body mass index, symptom duration, and Takakura classification, all these factors were not related to clinical outcomes. This study suggests that 3 weekly intra-articular hyaluronate injections can be performed safely to reduce pain and improve function without serious complications in patients with early or intermediate-grade ankle osteoarthritis when patients inadequately respond to medication. Larger controlled studies are needed to clarify the effects of hyaluronate injection and identify patients who can benefit most from hyaluronate injection.

Evaluation of Intra-articular Injection of Simvastatin versus Hyaluronic Acid in Treatment of Internal Derangement of Temporomandibular Joint

ABSTRACTIntroduction: TMJ Internal Derangement is a common form of temporomandibularjoint disorder. Almost 80% of adult symptomatic patients with TMD have some form ofID. Temporomandibular joint arthrocentesis consists of lavage of upper joint space ofTMJ done with no direct vision, aiming primarily to remove necrotic tissue, bloodand pain mediators from the joint. One of these therapeutic substances is hyaluronicacid; which is a polysaccharide of the family of glycosaminoglycans, which can befound in many extracellular tissues, including synovial fluid and cartilage. Simvastatinsare group of drugs which have good results in regeneration of degenerated TMJ.Aim: This study aimed to evaluate the intra-articular injection of simvastatin versussodium hyaluronate following arthrocentesis for management of internal derangement(ID) of the temporomandibular joint(TMJ). Patients and methods: Thirty patients withinternal TMJ derangement were included in this study. All patients were subjected topreoperative clinical examination and preoperative magnetic resonance imaging (MRI)for the affected joints. Arthrocentesis was performed firstly for the affected joints inall patients followed by intra-articular injection of 1ml. simvastatin twice a month (ingroup I) and sodium hyaluronate twice a month ( in group II).Clinical follow up weredone at 24 hours post-operatively, one week, one month,and six months. Then, after sixmonths MRI was repeated to compare with preoperative images. Results: Better resultswere recorded with simvastatin group in comparison to sodium hyaluronate group; at 1week, 1 month,and six months intervals; which was superior to arthrocentesis followedby sodium hyaluronate intra-articular injection. Patients in group I showed better MRIfindings in comparison to group II where the position of the disc was almost returnedto its normal anatomical position. Conclusion: Arthrocentesis followed by simvastatinintra-articular injection was superior to the combination of arthrocentesis and sodiumhyaluronate intra-articular injection for management of TMJ internal derangementssymptoms.

Single intra-articular injection of a novel stabilized cross-linked hyaluronate in the treatment of knee osteoarthritis: compared with a united states-approved similar

Purpose: Nowadays, intra-articular hyaluronate (IAHA) injection is one of the common treatments to improve the symptoms of knee osteoarthritis (OA). A recent meta-analysis showed that the most effective and safe HA products were those that derive HA from biological fermentation and have a molecular weight ≧3000kDa. Through cross-linked technique, the molecular weight of HA can be amplified to near infinity, and the time HA remains in the knee also can be prolonged, potentially increasing the efficacy and duration of the treatment effects and providing a single-injection choice.

Effect of Intra-articular Triamcinolone vs Hyaluronate Injection in Zygapophyseal Joint Arthropathy: A Prospective Randomized Controlled Trial

Effect of Intra-articular Triamcinolone vs Hyaluronate Injection in Zygapophyseal Joint Arthropathy: A Prospective Randomized Controlled Trial

DIAGNOSIS DAN TATALAKSANA KOMPREHENSIF OSTEOARTRITIS

DIAGNOSIS DAN TATALAKSANA KOMPREHENSIF OSTEOARTRITIS

Hyaluronate Injections after Anterior Cruciate Ligament Reconstruction Does Not Improve Running Mechanics

Mitigating inflammation early after anterior cruciate ligament reconstruction (ACLR) may help strength and biomechanical outcomes further in rehabilitation. PURPOSE: The purpose of this study was to determine if hyaluronate injections (HI) administered early after surgery improves strength and running mechanics six months after ACLR. METHODS: Nineteen individuals (Table 1) who suffered an ACL tear during sport participation were enrolled in a randomized double-blind controlled trial to test a post-operative intraarticular HI compared to a placebo one week after surgery (one patient screen failed, and one withdrew after surgery). Six months post-surgery individuals completed isokinetic quadriceps strength (IKQS) at 60°/second and a biomechanical analysis of overground running using 3D motion capture and force plates. Visual 3D was used to calculate bilateral lower extremity biomechanics including knee excursion (KEX) from initial contact to peak knee flexion, and peak vertical ground reaction forces (VGRF). Inverse dynamics were used to calculate internal peak knee abduction moments (KAM), and peak knee extension moments (KEM). A repeated measures analysis of variance was used to determine differences between groups (injection vs control) and limb (involved and uninvolved). An alpha value of 0.05 was used. RESULTS: There were no significant differences between the injection group and the control group in peak IKQS or running mechanics, and there was no significant group x limb interaction. In both the injection group and the control group, the involved limb exhibited significantly lower IKQS and KEM, less KEX, and lower peak VGRF (Table 1) compared to the uninvolved limb. CONCLUSION: The individuals who received the HI post-surgery did not present with improved strength or running mechanics six months post ACLR compared to control subjects. Future research should investigate further benefits of neuromuscular and physiological factors from a HI.

Evaluation of the effect of experimentally induced cartilage defect and intra-articular hyaluronan on synovial fluid biomarkers in intercarpal joints of horses

BackgroundInflammatory and degenerative activity inside the joint can be studied in vivo by analysis of synovial fluid biomarkers. In addition to pro-inflammatory mediators, several anabolic and anti-inflammatory substances are produced during the disease process. They counteract the catabolic effects of the pro-inflammatory cytokines and thus diminish the cartilage damage. The response of synovial fluid biomarkers after intra-articular hyaluronan injection, alone or in combination with other substances, has been examined only in a few equine studies. The effects of hyaluronan on some pro-inflammatory mediators, such as prostaglandin E2, have been documented but especially the effects on synovial fluid anti-inflammatory mediators are less studied. In animal models hyaluronan has been demonstrated to reduce pain via protecting nociceptive nerve endings and by blocking pain receptor channels. However, the results obtained for pain-relief of human osteoarthritis are contradictory. The aim of the study was to measure the synovial fluid IL-1ra, PDGF-BB, TGF-β1 and TNF-α concentrations before and after surgically induced cartilage defect, and following intra-articular hyaluronan injection in horses. Eight Standardbred horses underwent bilateral arthroscopic surgeries of their intercarpal joints under general anaesthesia, and cartilage defect was created on the dorsal edge of the third carpal bone of one randomly selected intercarpal joint of each horse. Five days post-surgery, one randomly selected intercarpal joint was injected intra-articular with 3 mL HA (20 mg/mL).ResultsOperation type had no significant effect on the synovial fluid IL-1ra, PDGF-BB, TGF-β1 and TNF-α concentrations but compared with baseline, synovial fluid IL-1ra and TNF-α concentrations increased. Intra-articular hyaluronan had no significant effect on the biomarker concentrations but a trend of mild improvement in the clinical signs of intra-articular inflammation was seen.ConclusionsCreation of the cartilage defect and sham-operation lead to an increase of synovial fluid IL-1ra and TNF-α concentrations but changes in concentrations of anabolic growth factors TGF-β1 and PDGF-BB could not be documented 5 days after the arthroscopy. Intra-articular hyaluronan was well tolerated. Further research is needed to document possible treatment effects of intra-articular hyaluronan on the synovial fluid biomarkers of inflammation and cartilage metabolism.

Viscosupplementation for knee osteoarthritis: a focus on Hylan G-F 20.

Knee osteoarthritis is a chronic degenerative joint disease characterized by destruction of articular cartilage with resultant para-articular bone changes. It is a major cause of disability in older persons and is managed by surgical and nonsurgical interventions. Pharmacotherapy includes acetaminophen, nonsteroidal anti-inflammatory agents, and intra-articular steroids. Another treatment option is viscosupplementation with intra-articular injection of hyaluronan (HA). The full mechanism of action of exogenous HA is uncertain, but studies indicate that it may promote endogenous HA production, reduce inflammation, prevent degeneration of cartilage and promote cartilage regeneration. Clinically, HA may improve symptoms of osteoarthritis and delay time to total knee replacement surgery. However, clinical studies are heterogenous and of varying quality, and thus there is a need for more robust studies to determine the place of viscosupplementation in the management of knee osteoarthritis.

High molecular weight hyaluronan protects cartilage from degradation by inhibiting aggrecanase expression.

ABSTRACTHyaluronan (HA) is an extracellular matrix (ECM) component of articular cartilage and has been used to treat patients with osteoarthritis (OA). A disintegrin and metalloproteinases with thrombospondin motifs (ADAMTSs) play an important role in cartilage degradation in OA. We have previously reported that ADAMTS4 and ADAMTS9 were induced by cytokine stimulation. However, the effect of HA on the cytokine‐inducible ADAMTS9 has never been investigated. Moreover, it is unclear whether HA protects cartilage by suppressing aggrecan degradation. Here, we examined the effects of HA on ADAMTS expression in vitro and on cartilage degradation in vivo. ADAMTS9 expression was higher than that of the other aggrecanases (ADAMTS4 and 5) in human chondrocytes, chondrocytic cells, and rat cartilage. ADAMTS4 and 9 mRNA levels were upregulated in cytokine‐stimulated chondrocytes and chondrocytic cells. Pre‐incubation with HA significantly inhibited ADAMTS9 mRNA expression in cytokine‐stimulated cells. In a rat OA model, Adamts5 and 9 mRNA levels were transiently increased after surgery; intra‐articular HA injections attenuated the induction of Adamts5 and 9 mRNA. HA also blocked aggrecan cleavage by aggrecanase in OA rats in a molecular size‐dependent manner. These results demonstrate that HA attenuates induced aggrecanases expression in OA and thereby protects articular cartilage degradation by this enzyme. Our findings provide insight into the molecular basis for the beneficial effects of HA in OA. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:3247–3255, 2018.

Modeling and Staging of Osteoarthritis Progression Using Serial CT Imaging and Arthroscopy.

The objective of this study was to describe in life methods by which osteoarthritis can be staged in order to time therapeutic interventions that are relevant to osteoarthritis (OA) clinical trials. Twenty-two sheep underwent arthroscopic meniscal destabilization to induce OA. Serial computed tomography (CT) imaging and arthroscopy were used to monitor osteoarthritis progression at 3-month intervals over 9 months. Eleven sheep received 1 intra-articular injection of hyaluronate 3 months after OA induction and another group of 11 received saline. A linear mixed model was used to define the trajectory of shape change in the medial joint compartment. Ordinal logistic regression was used to investigate the association between morphological changes and sclerosis. Three months after meniscal destabilization there were early bipolar chondral lesions in the medial compartment of the knee, as well as osteophytes and bone remodeling. Superficial fissures and cartilage cracks progressed to discrete areas of cartilage thinning and fibrillation on the medial tibial plateau by 6 months that became cartilage erosions by nine months. A linear mixed effect model demonstrated significant change in medial compartment length and width with over time (P < 0.05) for both groups. A significant association between severity of sclerosis and medial compartment morphology was also observed. The induction of osteoarthritic lesions with meniscal release model can be followed using noninvasive and minimally invasive procedures allowing for real-time decisions about redosing therapies, or other changes such as extending trial timelines without sacrificing animals to conduct assessments.

The effect of intra-articular hyaluronate and tramadol injection on patients with adhesive capsulitis of the shoulder.

BACKGROUND: Local administration of opioids causes effective analgesia without adverse effects related to the central nervous system. After the beneficial demonstration of peripheral opioid receptors in joint synovia, intra-articular opioid injections were used for pain treatment. Clinical studies have reported the safety and efficacy of hyaluronate injection in the shoulder joint of patients with osteoarthritis, periarthritis, rotator cuff tears, and adhesive capsulitis.OBJECTIVES: To estimate the efficacy of intra-articular hyaluronate and tramadol injection for adhesive capsulitis of the shoulder compared with that of intra-articular hyaluronate injection alone.METHODS: Thirty patients with adhesive capsulitis of the shoulder were randomized to the hyaluronate group ( 16) or the tramadol group ( 14). Hyaluronate group members were administered five weekly intra-articular hyaluronate injections; tramadol group members were administered three weekly intra-articular hyaluronate and tramadol injections and then two weekly intra-articular injections of hyaluronate. Visual Analog Scale (VAS), passive range of motion (PROM) of the shoulder joint, and Shoulder Pain and Disability Index (SPADI) scores were assessed at baseline and weeks 1, 2, 3, 4, and 6 after the initial injection.RESULTS: A significant improvement was observed in VAS, PROM, and SPADI scores between time points in both groups. In comparison in both groups at weeks 1 and 2 after the initial injection the VAS scores of the tramadol group were significantly lower than those of the hyaluronate group.CONCLUSIONS: Intra-articular hyaluronate with tramadol showed more rapid and strong analgesic effects than intra-articular hyaluronate alone and did not induce any adverse effects.

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.

A Comparative Study on Effectiveness of Intra-articular Injection of Steroid and Steroid Plus High Molecular Weight Hyaluronate in Primary Osteoarthritis Knee

A Comparative Study on Effectiveness of Intra-articular Injection of Steroid and Steroid Plus High Molecular Weight Hyaluronate in Primary Osteoarthritis Knee

Lubricin Deficiency Negatively Impacts the Development of Subchondral Bone and this Cannot be Rescued through Intra-Articular Injection of Lubricin, Hyaluronan or Corticosteroids

Lubricin Deficiency Negatively Impacts the Development of Subchondral Bone and this Cannot be Rescued through Intra-Articular Injection of Lubricin, Hyaluronan or Corticosteroids

Traditional Chinese Medications for Knee Osteoarthritis Pain: A Meta-Analysis of Randomized Controlled Trials.

Traditional Chinese medication (TCM) has analgesic and anti-inflammatory effects in patients with knee osteoarthritis (OA). We conducted the first systematic review of the best quantitative and qualitative evidence currently available in order to evaluate the effectiveness of TCM in relieving pain in knee OA. A comprehensive literature search was conducted using three English and four Chinese biomedical databases from their inception through March 1, 2015. We included randomized controlled trials of TCM for knee OA with intervention durations of at least two weeks. The effects of TCM on pain and other clinical symptoms were measured with the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The total effectiveness rate, which was used to assess overall pain, physical performance and wellness, was also measured. Two researchers independently extracted data on study design, population characteristics, duration, intervention, outcomes, risk of bias, and primary results. We performed a random-effects meta-analysis when appropriate. We also explored factors that could explain the heterogeneity by conducting subgroup and meta-regression analyses. Twenty-three studies, totaling 2362 subjects, met the eligibility criteria. Treatments were formulated with an average of 8 Chinese herbs and were prescribed based on the traditional Chinese diagnostic method of syndrome differentiation. The mean treatment duration was seven weeks, with oral administration occurring one to three times a day. Compared with non-steroidal anti-inflammatory drugs and intra-articular hyaluronate injections, 18 of the studies showed significantly improved VAS pain scores (Mean Difference [MD] [Formula: see text] 0.56; 95% confidence interval [CI], 0.18 to 0.94; [Formula: see text]), six of the studies showed significantly improved WOMAC pain subscale scores (MD [Formula: see text] 2.23; 95% CI, 0.56 to 3.91; [Formula: see text]), and 16 of the trials showed significantly improved total effectiveness rates (risk ratio [Formula: see text] 1.12; 95% CI, 1.05 to 1.19; [Formula: see text] 0.0003). In addition, TCM showed a lower risk of adverse events than standard western treatments. This evidence suggests that TCM is safe and effective for improving pain, function, and wellness in treatments of knee OA. However, there is inherent clinical heterogeneity (diverse TCM formulations, controls, and treatment regimens) among the included trials. Despite these limitations, the potential analgesic effects of TCM warrant further methodologically rigorous research to determine the clinical implications of TCM on pain management in knee OA.

Treatment of knee osteoarthritis with combination of traumeel s and zeel t: review mozart clinical investigation

Traditional treatment of osteoarthritis is focused on the symptoms’ decrease using pain-killers, nonsteroid anti-inflammatory drugs (NSAIDs), intraarticular corticosteroid injections, hyaluronic acid and so on. Nevertheless, such a therapy has some limitation due to the possible side effects and contraindications, especially in elderly people with concomitant diseases. Traumeel S consists of 14 components with vegetal and mineral origins, that determine its anti-inflammatory, anti-exudative, anesthetic, restorative and immune-modeling action. Zeel T provides chondroprotective, anti-inflammatory, anesthetic effects that promotes restoration of metabolic and reparative processes in joint cartilage. Goal: to expose the results of multicenter randomized placebo-control double-blind investigation MOZArT («Management of Оsteoarthritis of the Knee with Zeel and Traumeel Injections») to evaluate the efficacy and safety of the intraarticular injections of Traumeel S and Zeel T in comparison with placebo. The methods: 232 patients from 24 centers in USA were involved in the investigation. Patients (119) from the main group took the injection of Traumeel S and Zeel T, 113 participants from control group – physiological solution as a placebo. Three injection of every remedy were carried out with 1-week interval between the injections. WOMAC A scale was used to assess the results. Results: under the conditions of Traumeel S and Zeel T usage significant reducing of pain by 60 % according to WOMAC A scale was observed after 2nd injection and during the following 12 weeks. The effect of mentioned combined therapy was compared with the results of intra-articular corticosteroid and hyaluronic acid injection and peroral diclofenac. Safety profiles of Traumeel S and Zeel T were more optimal in comparison with peroral NSAIDs, without any risk from cardiac-vascular and gastro-intestinal systems.