Intra-articular Injections Of HA Research Articles

Efficacy of Platelet-Rich Plasma Versus Hyaluronic Acid in Symptomatic Knee Osteoarthritis

Background: Osteoarthritis (OA) is one of the most common forms of arthritis and leading causes of disability. Intra-articular injection of PRP or steroid may provide benefit for patients suffering from osteoarthritis of knees, preventing, and delaying the need of a larger operative measures as many of the senile patients suffering from OA knee are quite hesitant to undergo any operative measure for the same. Materials and Methods: This was prospective type of study, with randomised selection of the patients for the assessment of outcome of treatment of symptomatic knee osteoarthritis with intra articular injections of PRP or hyaluronic acid. This study was carried out in the department of orthopaedics at our institute. In this study both injections given superolaterally weekly for 3 weeks. Study conducted over 2 years, a total of 50 patients suffering from OA knee were included in the study depending upon inclusion criteria. These patients were randomly selected for injection in a sequential manner i.e., case number 1,3,5,7 and so on sequentially were given injection HA. Case number 2,4,6,8 and so on sequentially were given injection PRP. Patients were evaluated prospectively at enrolment and at 6 weeks, 3 and 6-months follow-up with WOMAC and KSS scores. Results: PRP seems to be more efficient as compared to HA in salvaging knee in osteoarthritis. It can work as a salvaging agent in mild to moderate osteoarthritis of knee. HA injection has been found to be effective only in short term cases. Conclusion: The clinical results of this study show that both these non-surgical modalities (intraarticular injections of PRP or HA) are useful for the treatment of osteoarthritis of knee. Treatment with PRP shows significantly better outcome compared with HA group; with respect to WOMAC and KSS scores.

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

Temporomandibular joint arthrocentesis: a single-center experience and review of the literature.

The aim of this paper was to report our experience and to review the literature of arthrocentesis focusing on protocols and results. Arthrocentesis with supplemental hyaluronic acid was performed in patients with TMDs between January 2017 and December 2020 at the Division of Maxillofacial Surgery. The maximum interincisal opening (MIO) and pain score were recorded preoperatively (T0), 2 months postoperatively (T1), and 6 months postoperatively (T2). A literature search was performed to analyze the same parameters in patients with TMDs. Patient demographic, characteristics and treatment protocols used were also recorded. This retrospective analysis enrolled 45 patients. Twenty-two patients (20 females, 2 males) with mean age of 37.13 years with internal derangement were included in study group A. Study group B included 23 patients with degenerative joint disease (19 females and 4 males) with mean age of 55.73 years. The outcomes trend of MIO and pain during the follow-up period showed a gradual improvement. Fifty articles meeting the proposed scientific criteria were selected for the literature revision. A range of clinical and procedural variables were analyzed by grouping the studies into two broad categories based on the diagnosis of TMD. Based on our experience and on the basis of the most accredited scientific studies in the literature, intra-articular injections of HA are beneficial for the improvement of the pain and/or functional symptoms of TMDs.

Efficacy of tumor necrosis factor inhibitor combined with intra-articular injection of triamcinolone acetonide in the treatment of refractory rheumatoid arthritis synovitis: a retrospective study.

To investigate whether there is a difference in the efficacy of intra-articular injection of tumor necrosis factor (TNF) inhibitor and triamcinolone acetonide (HA) in rheumatoid arthritis (RA) patients with recurrent synovitis after the first intra-articular injection of HA. RA patients who relapsed 12weeks after the first HA treatment were enrolled in this study. After joint cavity extraction, recombinant human TNF receptor-antibody fusion protein (TNFR:FC) (25mg or 12.5mg) or HA (1ml or 0.5ml) was injected then. The changes in the visual analog scale (VAS), joint swelling index, and joint tenderness index before and 12weeks after reinjection were compared and analyzed. The changes in synovial thickness, synovial blood flow, and fluid dark zone depth before and after reinjection were observed by ultrasound. Forty-two RA patients were enrolled, including 11 males and 31 females, with an average age of 46.79 ± 12.61years and an average disease duration of 7.76 ± 5.44years. After 12weeks of intra-articular injection of HA or TNFR:FC, the VAS scores were significantly lower than those before treatment (P < 0.01). After 12weeks of injection, the scores of the joint swelling index and tenderness index in both groups were significantly decreased compared with those before treatment. There was no significant difference in synovial thickness under ultrasound in the HA group before and after injection, while the synovial thickness in the TNFR:FC group was significantly improved after 12weeks (P < 0.01). After 12weeks of injection, the grade of synovial blood flow signal in both groups decreased significantly compared with that before treatment, especially in the TNFR:FC group. After 12weeks of injection, the depth of the liquid dark area under ultrasound decreased significantly in the HA group and TNFR:FC group compared with that before treatment (P < 0.01). Intra-articular injection of a TNF inhibitor is an effective method for the treatment of recurrent synovitis after conventional hormone therapy. Compared with HA treatment, it can reduce synovial thickness. Key Points • Intra-articular injection of a TNF inhibitor is an effective method for the treatment of recurrent synovitis after conventional hormone therapy. • Compared with HA treatment, intra-articular injection of biological agents combined with glucocorticoids can not only relieve joint pain but also significantly inhibit joint swelling. • Compared with HA treatment, intra-articular injection of biological agents combined with glucocorticoids cannot only improve synovial inflammation but also inhibit synovial proliferation. • For the treatment of refractory RA synovitis, biological agents combined with glucocorticoid injection are an effective and safe option.

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.

Health Economic Evaluation of a High and Low Molecular Weight Hyaluronic Acid Formulation for the Treatment of Knee Osteoarthritis. Post Hoc Analyses from a Randomized Clinical Trial.

IntroductionIn a recent randomized placebo-controlled trial, a single intra-articular injection of a high and low molecular weight hyaluronic acid formulation (HA–HL) was shown to be effective in providing a clinically meaningful reduction in pain and functional limitation up to 24 weeks in subjects with painful knee osteoarthritis (OA). The objective of this post hoc analyses is to assess the cost-effectiveness of HA–HL compared with placebo using individual patient data from this clinical trial in a Swiss health care perspective.MethodsA total of 692 patients fulfilling the inclusion criteria were randomly allocated to HA–HL or placebo groups. Each patient received one intra-articular injection of HA–HL or placebo at baseline and was then followed-up for a total duration of 24 weeks with five follow-up visits (i.e., after weeks 1, 6, 12, 18, and 24). The EQ-5D-5L five-point verbal Likert scale was used to calculate the health utility and the related quality-adjusted life-years (QALYs) using the area-under-the-curve (AUC) method. For the costs, the price of HA-HL in Switzerland was used. The primary threshold for the incremental cost/effectiveness ratio (ICER) below which HA-HL was considered as cost-effective was 91,540 Swiss francs (CHF) per QALY (i.e., US $100,000).ResultsNo significant difference between the baseline characteristics of the HA–HL group and the placebo group was observed. With a mean ICER of 27,212 CHF per QALY (95% CI 20,135–34,289), HA–HL was considered as cost-effective compared to placebo. Sensitivity analyses (e.g., using lower or upper limit prices or using other threshold values) gave similar results, i.e., ICERs far below the threshold values of cost-effectiveness.ConclusionsThese results confirm the role of HA–HL as a cost-effective therapeutic option in the management of OA. However, more studies taking into account the utilization of other health care resources are needed.

Hybrid Hyaluronic Acid versus High Molecular Weight Hyaluronic Acid for the Treatment of Hip Osteoarthritis in Overweight/Obese Patients.

Background: Obesity is the main risk factor for hip osteoarthritis, negatively affecting the outcome of the disease. We evaluated the effectiveness of viscosupplementation with hybrid hyaluronic acid compared to that with high molecular weight hyaluronic acid in overweight/obese patients with hip osteoarthritis (OA). Methods: 80 patients were divided into two groups: a treatment group received two ultrasound-guided intra-articular hip injections of hybrid HA 15 days apart; a control group received a single ultrasound-guided infiltration with medium-high molecular weight hyaluronic acid (1500–2000 kDa). We assessed the pain, functional and cardiovascular capacity of the patients at baseline, after 3 months, and after 6 months of the infiltrative sessions. Results: The treatment group showed greater improvements in the scores on the NRS scale (5.4 ± 0.8 vs. 6.3 ± 0.8; p < 0.05) and in the Lequesne index (11.4 ± 2.6 vs. 13.6 ± 2.7; p < 0.05) and in the distance traveled at 6MWT (238.1 ± 53.9 m vs. 210.7 ± 46.2 m; p = 0.02) both at 3 months (T1) and at 6 months (T2). Conclusions: This study underlines the importance of exploiting the anti-inflammatory, analgesic, and chondrogenic properties of hybrid HA for the treatment of hip OA in overweight/obese patients.

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.

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.

Evaluation of arthrocentesis with corticosteroids versus arthrocentesis with hyaluronic acid in the management of Temporomandibular joint osteoarthritis

Aim: to evaluate the clinical results, radiographic results and levels of inflammatory mediators following arthrocentesis with intra-articular injection of steroids versus arthrocentesis with intra-articular injection of hyaluronic acid in temporomandibular joint osteoarthritis.Materials and Methods: Ten patients suffering from Osteoarthritis with pain and crepitation during jaw movements together with radiographic evidence of bony erosions were included in the study. The patients were divided into two groups, five patients in group A were treated with arthrocentesis followed by intra-articular injection of corticosteroid and five patients in group B were treated with arthrocentesis followed by intra-articular injection of Hyaluronic acid. Results: Patients in both groups showed significant reduction in pain and increase in maximum mouth opening; however, arthrocentesis with intra-articular injection of HA showed better clinical results compared to arthrocentesis with intra-articular injection of corticosteroids. Less inflammatory mediators were found in the Corticosteroid group patients compared to HA group patients. No evidence of new bone formation was seen in both groups after 4 months postoperatively.Conclusion: Better clinical results were achieved after Arthrocentesis followed by intra-articular injection of hyalurionic acid when compared to arthrocentesis with intra-articular injection of corticosteroids. Less inflammatory mediators were associated with arthrocentesis with corticosteroids injection compared to arthrocentesis with HA injection. Long term follow up is required to be able to assess new bone formation following arthrocentesis with intra-articular injection of HA or corticosteroid.

Shear-thinning hyaluronan-based fluid hydrogels to modulate viscoelastic properties of osteoarthritis synovial fluids.

Hyaluronan (hyaluronic acid, HA) has been extensively explored as an attractive biomaterial for biomedical and pharmaceutical applications due to its unique physiological properties. In particular, HA is a major component of synovial fluid in normal knee joints and provides viscoelastic properties to synovial fluid. In osteoarthritic joints, synovial fluid loses its unique viscoelastic and lubrication properties. Intra-articular injection of HA in osteoarthritic knee joints is believed to restore viscoelasticity and lubrication abilities to synovial fluid. However, the main drawback of HA is its rapid degradation in synovial fluid. In order to overcome the problem of rapid clearance of HA, a HA-based hydrogel (vinyl sulfone-modified HA crosslinked by dithiol-terminated poly(ethylene glycol), HA-VS/SH-2-PEG) was synthesized in this study. Injectable fluid hydrogels (viscosupplements) possessing tunable viscoelasticity and controllable degradation rates were then prepared by adding HA-VS/SH-2-PEG microgels to HA solutions. The resultant viscosupplements exhibit enhanced viscoelastic properties, lubrication effects, efficient triamcinolone acetonide payload capacity, and high resistance to enzymatic degradation along with good biocompatibility and the capability to inhibit the progression of osteoarthritis in vivo. Overall, the results provide support for the use of injectable fluid hydrogels as a strategy for the treatment of osteoarthritis and potential for the clinical translation.

The efficacy of multiple versus single hyaluronic acid injections: a systematic review and meta-analysis

BackgroundIntra-articular hyaluronic acid (IA-HA) is a common therapy used to treat knee pain and suppress knee inflammation in knee osteoarthritis (OA), typically prescribed in regimens ranging from a single injection to 5 weekly injections given once weekly. We conducted a systematic review to determine the efficacy of IA-HA, with subgroup analyses to explore the differences in knee pain and adverse events (AEs) across different dosing regimens.MethodsWe conducted a systematic search of the literature to identify studies evaluating IA-HA for the management of knee OA compared to IA-saline. Primary outcome measure was the mean knee pain score at 13 Weeks (3 months) or 26 weeks (6 months). Secondary outcome was the number of treatment-related AEs and treatment-related serious adverse events (SAEs). We evaluated differences in levels of pain and AEs/SAEs between dosing regimens compared to IA-Saline.ResultsThirty articles were included. Overall, IA-HA injections were associated with less knee pain compared to IA-Saline injections for all dosing regimens. 2–4 injections of IA-HA vs. IA-Saline produced the largest effect size at both 3-months and 6-months (Standard mean difference [SMD] = −0.76; −0.98 to −0.53, 95% CI, P < 0.00001, and SMD = −0.36; −0.63 to −0.09 95% CI, P = 0.008, respectively). Additionally, single injection studies yielded a non-significant treatment effect at 3 and 6 months, while ≥5 5 injections demonstrated a significant improvement in pain only at 6 months. Five or more injections of IA-HA were associated with a higher risk of treatment-related AEs compared to IA-Saline (Risk ratio [RR] = 1.67; 1.09 to 2.56 95% CI, p = 0.02), which was a result not seen within the 1 and 2–4 injection subgroups.ConclusionOverall, 2–4 and ≥5 injection regimens provided pain relief over IA-Saline, while single injection did not. Intra-articular injections of HA used in a 2–4 injection treatment regimen provided the greatest benefit when compared to IA-Saline with respect to pain improvement in patients with knee OA, and was generally deemed safe with few to no treatment-related AEs reported across studies. Future research is needed to directly compare these treatment regimens.

INTRA ARTICULAR INJECTION OF HYALURONIC ACID ALONE IN COMPARISON WITH HYALURONIC ACID AND PRP IN THE TREATMENT OF INTERNAL DERANGEMENT OF TEMPOROMANDIBULAR JOINT

Objectives: This study aimed to compare the efficacy of intrarticular injection of HA alone versus HA and PRP in the treatment of internal derangement of the temporomandibular joint. Patients and Methods: Twenty patients were involved in our study, divided into two equal groups, group (1), treated with intraarticular injection of HA alone and group (2) treated with intraarticular injection of HA and PRP. All patients were diagnosed with internal derangement of the TMJ. The patients were evaluated clinically and radiographically preoperatively and postoperatively: clinically for evaluation of pain intensity, maximal mouth opening and lateral movements. Radiographically by panoramic and MRI images for detection of the condyle disc relationship and detection of any pathological changes. Postoperatively the patient’s clinical data including pain intensity, maximal mouth opening and the lateral movements were evaluated at one week and 2, 3 weeks and one month and 2,3 and 6 months. Radigraphically using MRI images to determine any changes in the TMJ after injection at 6 months. Results: Twenty patients, nineteen females and one male, their ages ranged from18-55 years with a mean of 29.5 years. The results of the clinical data including pain intensity, maximal mouth opening and lateral movements presented with significant improvements of all outcomes from preoperative to 6 months postoperatively for group (2) when compared with group (1). Radigraphically MRI after 6 months presented with no changes in the disc condyle relationship. Conclusion: Intraarticular injection of HA and PRP considered to be strongly effective and optional treatment of internal derangement of TMJ when compared to HA alone by controlling pain, improving mouth opening and the lateral movements for up to 6 months.

Hyaluronic Acid Intra-Articular Injections in Patients Affected by Moderate to Severe Glenohumeral Osteoarthritis: A Prospective Randomized Study.

Purpose The aim of this study was to evaluate the efficacy and safety of intra-articular injection treatment with high molecular weight HA (Hyalubrix, 30 mg/2 mL, molecular weight > 1,500 kDa) in patients affected by moderate to severe glenohumeral osteoarthritis (OA). Methods Seventy-eight patients, affected by shoulder OA grade II–IV were randomized in two groups. Patients included in case group were treated with three intra-articular injections of HA and a specific physiotherapy program, whereas patients included in the control group received the only physical therapy. The follow-up examination was 6 months for both groups. The evaluation of functional status of treated shoulder, range of motion, and pain was performed before treatment and at the final follow-up examination by means of the Constant score. The safety evaluation of the treatment was also performed recording any adverse events. Results Statistical analysis revealed a significant difference ( p < 0.05) between the two groups in terms of pain reduction and improvement in the activities of daily living. In particular, case group subjects affected by grade III and IV OA had a significant improvement in the Constant score (18.2 ± 5.4 and 19.2 ± 5.9, respectively). Conclusion This study showed that the combination of intra-articular injection of hyaluronic acid (Hyalubrix, 30 mg/2 mL) with physical therapy program was more effective in comparison with the only physical therapy in reducing pain in patients affected by glenohumeral OA. Level of Evidence Level II, randomized controlled study.

Hyaluronan modulates TRPV1 channel opening, reducing peripheral nociceptor activity and pain.

Hyaluronan (HA) is present in the extracellular matrix of all body tissues, including synovial fluid in joints, in which it behaves as a filter that buffers transmission of mechanical forces to nociceptor nerve endings thereby reducing pain. Using recombinant systems, mouse-cultured dorsal root ganglia (DRG) neurons and in vivo experiments, we found that HA also modulates polymodal transient receptor potential vanilloid subtype 1 (TRPV1) channels. HA diminishes heat, pH and capsaicin (CAP) responses, thus reducing the opening probability of the channel by stabilizing its closed state. Accordingly, in DRG neurons, HA decreases TRPV1-mediated impulse firing and channel sensitization by bradykinin. Moreover, subcutaneous HA injection in mice reduces heat and capsaicin nocifensive responses, whereas the intra-articular injection of HA in rats decreases capsaicin joint nociceptor fibres discharge. Collectively, these results indicate that extracellular HA reduces the excitability of the ubiquitous TRPV1 channel, thereby lowering impulse activity in the peripheral nociceptor endings underlying pain.

Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial).

INTRODUCTIONKnee osteoarthritis (OA) is the most common articular disease. Different methods are used to alleviate the symptoms of patients with knee OA, including analgesics, physical therapy, exercise prescription, and intra-articular injections (glucocorticoids, hyaluronic acid [HA], etc). New studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage, including the use of platelet-rich plasma (PRP) as a complex of growth factors. Due to the high incidence of OA and its consequences, we decided to study the long-term effect of intraarticular injection of PRP and HA on clinical outcome and quality of life of patients with knee OA.METHODThis non-placebo-controlled randomized clinical trial involved 160 patients affected by knee OA, grade 1–4 of Kellgren–Lawrence scale. In the PRP group (n = 87), two intra-articular injections at 4-week interval were applied, and in the HA group (n = 73), three doses of intra-articular injection at 1-week interval were applied. All patients were prospectively evaluated before and at 12 months after the treatment by Western Ontario and McMaster Universities Arthritis Index (WOMAC) and SF-36 questionnaires. The results were analyzed using SPSS 16.1 software (RCT code: IRCT2014012113442N5).RESULTSAt the 12-month follow-up, WOMAC pain score and bodily pain significantly improved in both groups; however, better results were determined in the PRP group compared to the HA group (P < 0.001). Other WOMAC and SF-36 parameters improved only in the PRP group. More improvement (but not statistically significant) was achieved in patients with grade 2 OA in both the groups.CONCLUSIONThis study suggests that PRP injection is more efficacious than HA injection in reducing symptoms and improving quality of life and is a therapeutic option in select patients with knee OA who have not responded to conventional treatment.

Changes in synovial fluid biomarkers and clinical efficacy of intra-articular injections of hyaluronic acid for patients with knee osteoarthritis.

BackgroundThe changes in synovial fluid biomarkers after intra-articular injection of hyarulonic acid (IA HA) remain controversial. We investigate the changes in the properties of synovial fluid (SF) and clinical symptoms before the first and fifth IA HA.MethodsA total of 73 patients (73 knees) with symptomatic knee osteoarthritis were treated with five weekly intra-articular injections of HA and 55 patients (55 knees) were analyzed. The SF total volume, viscosity, and levels of HA, chondroitin 4-sulfate (C4S), chondroitin 6-sulfate (C6S), keratin sulfate, and interleukin (IL)-6 were measured before the first and fifth injections. Clinical evaluations were performed using the American Knee Society score for physician-based outcome measurements and Knee injury and Osteoarthritis Outcome Score for patient-based outcome measurements before the first and fifth injections.ResultsThe SF viscosity and levels of HA were significantly increased, and the total SF volume and levels of chondroitin 4-sulfate, chondroitin 6-sulfate, and interleukin-6 were significantly decreased. The physician-based and patient-based outcome scores were improved.ConclusionsOur findings speculate that HA injections significantly modulate levels of intra articular biomarkers which may indicate beneficial effect for articular cartilage and synovium membrane.

Effects of hyaluronic acid (HA) viscosupplementation on peripheral Th cells in knee and hip osteoarthritis

Determine Th lymphocytes concentration in patients with knee or hip osteoarthritis (OA). Evaluate their change after HA viscosupplementation. Patients with early primary knee or hip OA (ACR Criteria) were recruited in two groups: group A was only observed longitudinally, group B was treated with a course of three weekly intra-articular injections of HA. Ahealthy control group gender and age matched was enrolled too. All subjects were followed for 3months. Flow cytometry was performed from blood samples to assess T cells subpopulations (CD3, CD4, CD8, CCR6, CD38, CxCR3, HLA DR) at baseline and at 3-months visit. 86 patients were recruited with OA: 49 in Group A (35 knee OA, 14 hip OA), 37 in Group B (24 knee OA, 13 hip OA). 23 in Control Group. Activated CD4 T cells (CD4(+)CD38(+)DR(+), CD4(+)CD38(-)DR(+)), Th2 (CD4(+)CXCR3(-)CCR6(-)),Th1 (CD4(+)CXCR3(+)CCR6(-)) were higher at baseline in group A and B than in control group. After the HA course activated T cells were lower in group B than in group A (P=0.01). Th17 (CD4(+)CXCR3(-)CCR6(+)) at baseline were higher in groups A and B than in control group and decreased levels in Group B after the HA course were observed (P=0.03). The presence of activated T cells in patients with OA confirm that OA is a disease with an immunological/inflammatory involvement. Our preliminary results seems to show that HA injections could lower the levels of activated T cells, and so regulate the articular milieu.

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.

Anti‐inflammatory effects of hydrophilic and lipophilic statins with hyaluronic acid against LPS‐induced inflammation in porcine articular chondrocytes

The objective of the study is to understand the therapeutic effects of lipophilic (simvastatin) and hydrophilic statins (pravastatin) combined with/without hyaluronic acid for osteoarthritis by an in vitro LPS-induced inflammatory model of articular chondrocytes. HA in combination with different doses of simvastatin or pravastatin were used. Beside cytotoxicity, the influence of statins on NO production, pro-inflammatory cytokine, inflammatory mediators, and NF-κB p50 protein were analyzed. Finally, TUNEL assay was performed to detect DNA strand breakage. Two statins were less able to lower NF-κB activity when they were administrated along without HA. The gene expression demonstrates that simvastatin and pravastatin had the ability to decrease pro-inflammatory and inflammatory mediator levels. High dose simvastatin with or without HA down regulated inflammatory cytokines, but resulted in higher cytotoxicity. TUNEL assay confirms the regulatory effect of statins with or without HA over the apoptosis of chondrocytes, especially in hydrophilic statins. The significant down-regulation of inflammatory mediators suggests that intra-articular injection of HA in combination with statins might feasibly slow the progress of osteoarthritis. Administration of simvastatin or pravastatin with hyaluronic acid may produce beneficial effects for OA treatment, but with better results when hydrophilic statin was used.