Pain In Knee Osteoarthritis Patients Research Articles

A Systematic Review: Does Land based Exercise Improve the Quality of Life in Patient with Knee Osteoarthritis?

Quality of Life (QoL) is a crucial aspect of an individual's well-being, and Knee Osteoarthritis (OA) is a chronic degenerative disease that significantly impacts QoL. OA patients experience functional impairment, leading to difficulty and pain in activities such as standing, squatting, walking, and climbing stairs. Land-based exercise is a non-pharmacological intervention recommended for long-term knee pain, as it can improve muscle strength, relieve pain, and improve function. However, excessive exercise can worsen pain. This systematic review evaluates literature on land-based exercise interventions that show significant effects on QoL and decrease in knee pain for patients with knee OA. The review includes six publications with randomized controlled trials and experimental studies that examined the impact of land-based exercise on knee OA. The review focuses on exercises such as yoga, strengthening exercises, Tai Ji, and Wuxinqi Exercise. The review finds that land-based exercise has a positive impact on physical function, pain reduction, and quality of life for patients with knee OA. Three publications with yoga and Wuxinqi Exercise showed significant results in pain management, increasing knee strength, and reducing pain in knee OA patients. The review concludes that land-based exercise is an appropriate intervention for people with knee OA related to pain and functional impairment.

Evaluation of an Unloading Concept for Knee Osteoarthritis: A Pilot Study in a Small Patient Group.

Joint compressive forces have been identified as a risk factor for osteoarthritis disease progression. Therefore, unloader braces are a common treatment with the aim of relieving pain, but their effects are not clearly documented in the literature. A knee brace concept was tested with the aim of reducing joint loads and pain in knee osteoarthritis patients by applying an extension moment exclusively during the stance phase. The ideal effects were evaluated during gait based on musculoskeletal modeling of six patients, and experimental tests with a prototype brace were conducted on one patient. The effects were evaluated using electromyography measurements and musculoskeletal models to evaluate the muscle activation and knee compressive forces, respectively. The ideal brace simulations revealed a varying reduction of the first peak knee force between 3.5% and 33.8% across six patients whereas the second peak was unaffected. The prototype reduced the peak vasti muscle activation with 7.9% and musculoskeletal models showed a reduction of the first peak knee compressive force of up to 26.3%. However, the prototype brace increased the knee joint force impulse of up to 17.1% and no immediate pain reduction was observed. The reduction of the first peak knee compressive force, using a prototype on a single patient, indicates a promising effect from an applied knee extension moment for reducing knee joint loads during normal gait. However, further clinical experiments with this brace method are required to evaluate the long-term effects on both pain and disease progression in knee osteoarthritis patients.

CD39+CD55- Fb Subset Exhibits Myofibroblast-Like Phenotype and Is Associated with Pain in Osteoarthritis of the Knee.

Recent studies utilizing single-cell analysis have unveiled the presence of various fibroblast (Fb) subsets within the synovium under inflammatory conditions in osteoarthritis (OA), distinguishing them from those in rheumatoid arthritis (RA). Moreover, it has been reported that pain in knee OA patients is linked to specific fibroblast subsets. Single-cell expression profiling methods offer an incredibly detailed view of the molecular states of individual cells. However, one limitation of these methods is that they require the destruction of cells during the analysis process, rendering it impossible to directly assess cell function. In our study, we employ flow cytometric analysis, utilizing cell surface markers CD39 and CD55, in an attempt to isolate fibroblast subsets and investigate their relationship with OA pathology. Synovial tissues were obtained from 25 knee OA (KOA) patients. Of these, six samples were analyzed by RNA-seq (n = 3) and LC/MS analysis (n = 3). All 25 samples were analyzed to estimate the proportion of Fb (CD45-CD31-CD90+) subset by flow cytometry. The proportion of Fb subsets (CD39+CD55- and CD39-CD55+) and their association with osteoarthritis pathology were evaluated. CD39+CD55- Fb highly expressed myogenic markers such as CNN1, IGFBP7, MYH11, and TPM1 compared to CD39-CD55+ Fb. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis of upregulated differentially expressed genes (DEGs) in CD39+CD55- Fb identified the Apelin pathway and cGMP-PKC-signaling pathway as possibly contributing to pain. LC/MS analysis indicated that proteins encoded by myogenic marker genes, including CNN1, IGFBP7, and MYH11, were also significantly higher than in CD39-CD55+ Fb. CD39-CD55+ Fb highly expressed PRG4 genes and proteins. Upregulated DEGs were enriched for pathways associated with proinflammatory states ('RA', 'TNF signaling pathway', 'IL-17 signaling pathway'). The proportion of CD39+CD55- Fb in synovium significantly correlated with both resting and active pain levels in knee OA (KOA) patients (resting pain, ρ = 0.513, p = 0.009; active pain, ρ = 0.483, p = 0.015). There was no correlation between joint space width (JSW) and the proportion of CD39+CD55- Fb. In contrast, there was no correlation between the proportion of CD39-CD55+ Fb and resting pain, active pain, or JSW. In conclusion, CD39+CD55- cells exhibit a myofibroblast phenotype, and its proportion is associated with KOA pain. Our study sheds light on the potential significance of CD39+CD55- synovial fibroblasts in osteoarthritis, their myofibroblast-like phenotype, and their association with joint pain. These findings provide a foundation for further research into the mechanisms underlying fibrosis, the impact of altered gene expression on osteoarthritic joints, and potential therapeutic strategies.

Effectiveness and Safety of Glucosamine in Osteoarthritis: A Systematic Review.

Knee osteoarthritis is the most popular type of osteoarthritis that causes extreme pain in the elderly. Currently, there is no cure for osteoarthritis. To lessen clinical symptoms, glucosamine was suggested. The primary goal of our systematic review study is to evaluate the effectiveness and safety of glucosamine based on recent studies. Electronic databases such as PubMed, Scopus, and Cochrane were used to assess the randomized controlled trial (RCT). From the beginning through March 2023, the papers were checked, and if they fulfilled the inclusion criteria, they were then examined. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Visual Analog Scale (VAS) scales were considered the main outcome measures. A total of 15 studies were selected. Global pain was significantly decreased in comparison to placebo, as measured by the VAS index, with an overall effect size of standardized mean difference (SMD) of -7.41 ([95% CI] 14.31, 0.51). The WOMAC scale confirmed that pain, stiffness, and physical function had improved, however the effects were insufficient. A statistical update also revealed that there were no reports of serious medication interactions or significant adverse events. To summarize, glucosamine is more effective than a placebo at reducing pain in knee osteoarthritis patients. In long-term treatment, oral glucosamine sulfate 1500 mg/day is believed to be well tolerated.

Safety and effectiveness of intra-articular injection of a highly cross-linked hyaluronic acid, LBSA0103 (Synovian): Results from a post-marketing surveillance study in South Korea.

This study aimed to assess the safety and effectiveness of the highly cross-linked hyaluronic acid-LBSA0103-in patients with knee osteoarthritis (OA) as per the prescribing information (PI) in South Korea. A total of 3,140 subjects aged ≥19 years were enrolled in this post-marketing surveillance (PMS) study from 2013 to 2019. The subjects received one or two injections of LBSA0103. The median duration of follow-up was 308 days. Adverse events (AEs), adverse drug reactions (ADRs), and serious AEs (SAEs) were monitored. Effectiveness was evaluated based on an index of effectiveness in accordance with the guidelines established by the Ministry of Food and Drug Safety and using a 100-mm visual analog scale (VAS) for weight-bearing pain. Overall, 250 subjects (7.96%) experienced 292 AEs and of these, unexpected AEs occurred in 114 subjects (3.63% [95% CI: 3.00-4.35]). Injection site pain was the most frequent AE reported by 81 subjects (2.58% [95% confidence intervals (CI): 2.05-3.20]). One hundred subjects experienced 108 ADRs (3.18% [95% CI: 2.60, 3.86]) and 15 unexpected ADRs were experienced by 13 subjects (0.41% [95% CI: 0.22-0.71]). Seventeen subjects experienced 22 SAEs (0.54% [95% CI: 0.32-0.87]) during the entire PMS period, and all were considered "unlikely" related to the study drug. Most AEs were mild in terms of severity and resolved during the study period. LBSA0103 was also effective in relieving symptomatic pain in knee OA patients. The condition in more than 80% of the subjects was considered to be improved when assessed by the investigators. LBSA0103 resulted in a significant reduction in the mean VAS score at 12 weeks after the first and second injections (24.79 (± 20.55) mm and 17.63 (±12.31) mm, respectively; p<0.0001). In conclusion, LBSA0103, used for the treatment of knee OA in a real-world setting, was well tolerated, with an acceptable safety profile and consistent therapeutic effect.

Effect of Combinations of Quadriceps Exercise and Hip Abductor Exercise on Pain in Knee Osteoarthritis Patients in Orthopedic and Traumatology Outpatient Care

Background: Osteoarthritis is a disorder of the moving joints. Pain functioning are the main complaints of the disease osteoarthritis of the knee. The purpose of the study was to analyze the effect of a combination of quadricep exercise and hip abductor exercise on pain in knee among osteoarthritis patients.Subjects and Method: The study was carried out at the East Java Regional Hospital for the period of December 2022 to March 2023. The study population was knee joint osteoarthritis patients of degree 1 to degree 2. The sampling technique used in this study was purposive sampling, with inclusion and exclusion criteria. The number of samples in quantitative research was 60 respondents. The dependent variable is pain, while the independent variable is quadriceps exercise and hip abductor exercise. The instrument used is the WOMAC questionnaire. Analysis of the study was using the Wilcoxon test and the Mann Whitney test.Results: There was a significant difference in pain between the control and intervention groups after conducting a combination of quadriceps exercises and hip abductor exercises (p=0.043)Conclusion: The combination of quadriceps exercise and hip abductor exercise is effective on pain reduction in knee osteoarthritis patients.Keywords: quadriceps, hip abductor, osteoarthritis.Correspondence: Dia Metasari. Master of Nursing, Universitas Airlangga, Indonesia. Jl. Dr. Ir. H. Soekarno, Mulyorejo, Surabaya, East Java 60115. Email: dia.metasari-2021@fkp.unair.ac.id. Mobile: +628563040303.Indonesian Journal of Medicine (2023), 08(02): 186-193https://doi.org/10.26911/theijmed.2023.08.02.08

Pain Empathy and Its Association with the Clinical Pain in Knee Osteoarthritis Patients.

Knee osteoarthritis (KOA) is a painful chronic disorder. Evidence has shown that a history of chronic pain plays an important role in shaping empathy. Empathy, a valuable indicator of social functioning that refers to an individual's ability to share the experiences of others, however, has been overlooked in KOA patients. This study aimed to investigate empathy and its association with clinical pain in KOA patients. KOA patients (n=47) and healthy controls (HCs, n=44) completed two empathy-for-pain tasks: a pain judgment task in which participants judged whether a person in an image felt pain or not, and a pain rating task in which they estimated pain intensity for themselves and others. The Interpersonal Reactivity Index was used to measure participants' trait empathy, and clinical severity and psychological factors were assessed using relevant instruments. Compared to HCs, KOA patients showed higher accuracy when judging pain and non-pain images and reported overall higher pain intensity when rating for themselves and others. KOA patients also showed greater personal distress than HCs in terms of their self-reported empathy. Moreover, pain catastrophizing particularly mediated the relationship between pain severity and pain ratings for others, and depression, anxiety, and pain catastrophizing all mediated the association between pain severity and empathy-induced personal distress. These findings suggest that patients with KOA have increased empathy, demonstrated by elevated sensitivity to pain-related scenes and intense emotional responses.

The Effectiveness of Infrared and Retrowalking Exercise on Pain Reduction in Patients With Knee Osteoarthritis

Knee osteoarthritis is a condition that causes weak bone strength and poor bone formation. The main cause is musculoskeletal pain. Treatment of pain in knee osteoarthritis patients is usually through infrared and retrowalking. The mechanism of infrared in reducing pain is through mild heating which gives a sedative effect on sensory nerve endings, while retrowalking decreases pain through rehabilitation exercise techniques for the lower extremities. This research aimed to compare the effectiveness of infrared and retrowalking on pain reduction in knee osteoarthritis patients at Puskesmas Kendal Kerep. This was a quasi-experimental study with 30 participants from Puskesmas Kendalkerep, divided into 2 groups: Group I (with infrared, n = 15) and Group II (with retrowalking, n = 15). Participants in both groups were given their interventions for 5 weeks. The level of pain was measured using the VAS scale at baseline and after the intervention. The paired t-test analysis showed that there was an improvement in pain in both groups after being given the interventions, while the independent t-test showed that there was no significant difference between the groups in the level of pain reduction.&#x0D; Keywords: knee osteoarthritis, knee pain, infrared, retrowalking

Association between Metformin Use and Risk of Total Knee Arthroplasty and Degree of Knee Pain in Knee Osteoarthritis Patients with Diabetes and/or Obesity: A Retrospective Study.

Objectives: We aimed to examine whether metformin (MET) use is associated with a reduced risk of total knee arthroplasty (TKA) and low severity of knee pain in patients with knee osteoarthritis (OA) and diabetes and/or obesity. Methods: Participants diagnosed with knee OA and diabetes and/or obesity from June 2000 to July 2019 were selected from the information system of a local hospital. Regular MET users were defined as those with recorded prescriptions of MET or self-reported regular MET use for at least 6 months. TKA information was extracted from patients’ surgical records. Knee pain was assessed using the numeric rating scale. Log-binomial regression, linear regression, and propensity score weighting (PSW) were performed for statistical analyses. Results: A total of 862 participants were included in the analyses. After excluding missing data, there were 346 MET non-users and 362 MET users. MET use was significantly associated with a reduced risk of TKA (prevalence ratio: 0.26, 95% CI: 0.15 to 0.45, p < 0.001), after adjustment for age, gender, body mass index, various analgesics, and insurance status. MET use was significantly associated with a reduced degree of knee pain after being adjusted for the above covariates (β: −0.48, 95% CI: −0.91 to −0.05, p = 0.029). There was a significantly accumulative effect of MET use on the reduced risk of TKA. Conclusion: MET can be a potential therapeutic option for OA. Further clinical trials are needed to determine if MET can reduce the risk of TKA and the severity of knee pain in metabolic-associated OA patients.

Neuropathic pain in primary knee osteoarthritis patients: correlation with physical function, quality of life, disease severity, and serum beta nerve growth factor levels

BackgroundNeuropathic mechanisms are thought to play a role in knee osteoarthritis (KOA) pain. Neuropathic pain questionnaires can promote diagnosis of a neuropathic component. Thus, we aimed to assess the frequency of neuropathic pain in primary KOA patients (using clinical questionnaires) and to investigate its correlation with socio-demographic factors, physical function, quality of life, disease severity, and serum beta nerve growth factor (β-NGF) levels.ResultsSeventy primary KOA patients were included. Neuropathic pain was detected in 52.9% of patients based on Douleur Neuropathique en 4 Questions (DN4) questionnaire and in 38.6% of patients based on Leeds assessment neuropathic pain symptoms and signs questionnaire (LANSS). Serum β-NGF levels were significantly higher in KOA patients than controls (P<0.0001), and in KOA patients with neuropathic pain compared with patients with non-neuropathic pain. DN4 score was positively correlated with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and physical function, and it was also negatively correlated with Osteoarthritis knee hip quality of life questionnaire (OAKHQOL) pain scores (rs=0.459, P<0.001; rs= 0.258, P= 0.031; rs= 0.307, P= 0.010; rs = −0.337, P= 0.004, respectively), while LANSS scale was positively correlated with symptom duration, WOMAC stiffness, Lequesne pain, and Lequesne index (rs= 0.260, P= 0.020; rs= 0.343, P= 0.004; rs= 0.344, P= 0.004; rs= 0.322, P= 0.007) and negatively correlated with OAKHQOL physical, OAKHQOL mental health, OAKHQOL social support, and total OAKHQOL scores (rs= −0.258, P= 0.031;rs= −0.254, P= 0.034; rs= −0.283, P= 0.018; rs= −0.261, P= 0.029 respectively).ConclusionsNeuropathic pain symptoms are frequent in primary KOA patients. KOA patients with neuropathic pain have worse quality of life, extreme disability, and higher serum β-NGF levels. Nerve growth factor inhibitors could have a potential role for not only relieving pain in KOA patients but also improving functional disability and quality of life in these patients.

Synovial tissue from sites of joint pain in knee osteoarthritis patients exhibits a differential phenotype with distinct fibroblast subsets.

BackgroundSynovial inflammation is associated with pain severity in patients with knee osteoarthritis (OA). The aim here was to determine in a population with knee OA, whether synovial tissue from areas associated with pain exhibited different synovial fibroblast subsets, compared to synovial tissue from sites not associated with pain. A further aim was to compare differences between early and end-stage disease synovial fibroblast subsets.MethodsPatients with early knee OA (n = 29) and end-stage knee OA (n = 22) were recruited. Patient reported pain was recorded by questionnaire and using an anatomical knee pain map. Proton density fat suppressed MRI axial and sagittal sequences were analysed and scored for synovitis. Synovial tissue was obtained from the medial and lateral parapatellar and suprapatellar sites. Fibroblast single cell RNA sequencing was performed using Chromium 10X and analysed using Seurat. Transcriptomes were functionally characterised using Ingenuity Pathway Analysis and the effect of fibroblast secretome on neuronal growth assessed using rat DRGN.FindingsParapatellar synovitis was significantly associated with the pattern of patient-reported pain in knee OA patients. Synovial tissue from sites of patient-reported pain exhibited a differential transcriptomic phenotype, with distinct synovial fibroblast subsets in early OA and end-stage OA. Functional pathway analysis revealed that synovial tissue and fibroblast subsets from painful sites promoted fibrosis, inflammation and the growth and activity of neurons. The secretome of fibroblasts from early OA painful sites induced greater survival and neurite outgrowth in dissociated adult rodent dorsal root ganglion neurons.InterpretationSites of patient-reported pain in knee OA exhibit a different synovial tissue phenotype and distinct synovial fibroblast subsets. Further interrogation of these fibroblast pathotypes will increase our understanding of the role of synovitis in OA joint pain and provide a rationale for the therapeutic targeting of fibroblast subsets to alleviate pain in patients.FundingThis study was funded by Versus Arthritis, UK (21530; 21812)

Randomised, double-blind comparison of a fixed co-formulation of intra-articular polynucleotides and hyaluronic acid versus hyaluronic acid alone in the treatment of knee osteoarthritis: two-year follow-up

BackgroundA first-year interim analysis of this two-year study suggested that intra-articular injections of highly purified, natural-origin polynucleotides and hyaluronic acid (HA) as a fixed combination (PNHA) might improve knee function and joint pain more effectively than HA alone in patients with knee osteoarthritis (OA). The purpose of the second-year analysis herein described was to verify whether the first-year interim outcomes persist over the whole two-year period.MethodsRandomised, double-blind, HA-controlled clinical trial in 100 knee OA patients (98 randomised, 79 completing the study) in a high-specialisation tertiary care setting. The hypothesised difference of efficacy between PNHA and HA for the original sample size estimate is 20%. Treatment cycle: three intra-articular knee injections of either PNHA or HA, at baseline and weekly for two weeks. Evaluations: Western Ontario and McMaster Universities (WOMAC) score and Knee Society Score (KSS) as, respectively, primary and secondary endpoints, evaluated at baseline and after 2, 6, 12, and 24 months; synovial fluid levels of mediators (at baseline and the end of the treatment cycle). Adverse effects investigated at each control visit. Statistical analysis: Kruskal-Wallis test for independent samples (nonparametric one-way analysis of variance) after correction of means for age, Body Mass Index and Kellgren-Lawrence grade. If significant, pairwise post-hoc Sidak multiple comparisons.ResultsKSS total score and KSS pain item: significant improvement in both groups, with significantly more pain improvement in patients treated with PNHA (2-point reduction) than HA (1-point reduction). Both groups experienced significant long-term reductions in WOMAC total scores: significantly stronger in PNHA-treated patients after 24 months with a steady difference of 16% favouring PNHA in WOMAC pain subscore. No clinically significant adverse events in either group.ConclusionsThe outcomes of the 2-year study confirmed that a short cycle of intra-articular treatment (3 weekly double-blind injections) with polynucleotides (long-acting viscosupplementation properties, chondrocyte activation, pain-relieving properties) in fixed combination with high molecular weight hyaluronic acid is more effective in improving knee function and pain in knee OA patients than HA alone. PNHA may be elective for viscosupplementation in knee OA patients with fastidious and resistant pain and worsening disease.Trial registrationNCT02417610.Registration, 15/04/2015.ClinicalTrials.gov database link:

Effectiveness of knee acupressure along with herbal knee poultice for knee osteoarthritis treatment: A pilot pre-post clinical study

Background & objectiveAccording to the clinical practice guideline of the Traditional Thai Medicine hospital, the therapeutic procedure of knee osteoarthritis (KOA) has been improved. The purpose of this study was aimed to assess the effectiveness of the procedure for the relief of knee pain in KOA patients. MethodsA multi-center, open-label, pre-post clinical trial was performed in 39 patients with KOA. Patients were treated with seven points of knee acupressure for 14 min. along with 30 min. of herbal knee poultice (Zingiber cassumunar, Gloriosa superba, Aloe vera, and Cinnamomum camphora). The clinical assessments including WOMAC score, visual analog scale (VAS) for pain as well as knee physical examination were carried out to compare between day 0 and day 3 after the treatment. ResultsA total of 36 patients were analyzed at the end of the study. The result revealed that WOMAC and VAS significantly reduced (p < 0.05) after three times of the treatment with the KOA guideline when compared with day 0. Moreover, the physical examination of the knee was improved. Based on the criteria of the International Contact Dermatitis Research Group (ICDRG), there was no skin irritation observed in all patients. ConclusionThis study proved that the KOA guideline from Traditional Thai Medicine hospital could potentially be applied to relieve pain in KOA.

Synovial Tissue from Sites of Joint Pain in Knee Osteoarthritis Patients Exhibits a Differential Phenotype with Distinct Fibroblast Subsets

Background: Synovial inflammation is associated with pain severity in patients with knee osteoarthritis (OA). The aim here was to determine in a population with knee OA, whether synovial tissue from areas associated with pain exhibited different synovial fibroblast subsets, compared to synovial tissue from sites not associated with pain. A further aim was to compare differences between early and end-stage disease synovial fibroblast subsets. Methods: Patients with early knee OA (n=29) and end-stage knee OA (n=22) were recruited. Patient reported pain was recorded by questionnaire and using an anatomical knee pain map. Proton density fat suppressed MRI axial and sagittal sequences were analysed and scored for synovitis. Synovial tissue was obtained from the medial and lateral parapatellar and suprapatellar sites. Fibroblast single cell RNA sequencing was performed using Chromium 10X and analysed using Seurat. Transcriptomes were functionally characterised using Ingenuity Pathway Analysis and the effect of fibroblast secretome on neuronal growth assessed using rat DRG. Findings: Parapatellar synovitis was significantly associated with the pattern of patient-reported pain in knee OA patients. Synovial tissue from sites of patient-reported pain exhibited a differential transcriptomic phenotype, with distinct synovial fibroblast subsets in early OA and end-stage OA. Functional pathway analysis revealed that synovial tissue and fibroblast subsets from painful sites promoted fibrosis, inflammation and the growth and activity of neurons. The secretome of fibroblasts from early OA painful sites induced neurite outgrowth in dorsal root ganglion neurons. Interpretation: Sites of patient-reported pain in knee OA exhibit a different synovial tissue phenotype and distinct synovial fibroblast subsets. Further interrogation of these fibroblast pathotypes will increase our understanding of the role of synovitis in OA joint pain and provide a rationale for the therapeutic targeting of fibroblast subsets to alleviate pain in patients. Funding: This study was funded by Versus Arthritis (21530; 21812). Declaration of Interest: The authors declare no competing interests Ethical Approval: Ethical approval was granted by the UK National Research Ethics Committee (NRES 17/SC/0456). Consent was provided by all patients.

Effectiveness of Combined Treatment Using Physical Exercise and Ultrasound-Guided Radiofrequency Ablation of Genicular Nerves in Patients with Knee Osteoarthritis

Radiofrequency (RF) is a mini-invasive neuromodulation intervention that is commonly used in chronic pain conditions including general musculoskeletal pain related to several diseases, including knee osteoarthritis (KOA). However, to date, few studies investigated synergistic therapeutic approaches combining RF with rehabilitative physical exercise protocols in KOA patients. This prospective cohort study aimed at assessing the short-term effects on pain in KOA patients of a multimodal intervention consisting of ultrasound (US)-guided RF geniculate ablation and concomitant rehabilitative physical exercise. We included grade III KOA patients with knee pain (Numerical Pain Rating Scale, NPRS &gt;4) not responsive to conventional treatments. They underwent a combined intervention including US-guided RF geniculate ablation and a 2-week physical exercise program. At the baseline (T0) and 1 month after (T1) we assessed: NPRS, Knee Injury and Osteoarthritis Outcome Scale (KOOS), quality of life, exercise adherence, and safety. All the 47 KOA patients enrolled (68.8 ± 13.7 years old) showed a reduction of pain (NPRS: 7.48 ± 1.74; 3.63 ± 1.68; p &lt; 0.001). In addition, there was a significant improvement (p &lt; 0.05) also in the other functioning and HRQoL outcomes. Adherence to the exercise program was over 80% in more than half (28) of the patients. No major adverse events were reported. These findings suggested that US-guided RF ablation of genicular nerves combined with rehabilitative exercise therapy might be considered a safe and effective approach in the complex management of KOA patients.

Efficacy and Safety of Sahastara Remedy Extract Capsule in Primary Knee Osteoarthritis: A Randomized Double-Blinded Active-Controlled Trial.

Sahastara (SHT) remedy is a Thai traditional medicine described in the Thai National List of Essential Medicine (NLEM) for the relief of muscle pain. The purpose of this study was to investigate the efficacy and safety of SHT remedy extract capsule for treating primary OA. A phase 2, double-blind, randomized, and controlled trial study was used to determine the clinical efficacy and safety of SHT in comparison with diclofenac for the treatment of knee OA. The outcome of reduce pain was measured from VAS, 100 meter time walk, and the WOMAC score of day 14 and day 28 which should reduce significantly when compared with day 0 and should be equal with or better than diclofenac. Blood pressure and blood chemistry values at day 14 and day 28 did not change when compared with day 0. The results found that SHT remedy ethanolic extract capsule can reduce all OA knee scores at day 14 and day 28 significantly when compared with day 0 and also no significant difference with diclofenac (P > 0.05). The SHT also showed safety values on blood pressure and blood chemistry. The SHT was observed that it had no serious side effect. The results of this study are the first report of using the SHT ethanolic extract capsule in the treatment of primary osteoarthritis of the knee. It can be recommended as an anti-inflammatory herbal drug for reducing pain in knee osteoarthritis patients.

Comparative study between fluoroscopic-guided and ultrasound-guided genicular nerve pulsed radiofrequency neurotomy for painful knee osteoarthritis

Introduction: Knee osteoarthritis (OA) has become a worldwide health issue. Genicular nerve ablation has been used for the management of pain in knee osteoarthritis patients. This study aims to compare between fluoroscopy and ultrasound-guided genicular ablation.Patients and methods: A total of 30 cases were included, and they were divided into two groups, 15 cases underwent the fluoroscopic guided procedure, while the other 15 cases underwent the ultrasound-guided procedure. Both VAS and WOMAC scores were assessed and recorded in all cases after 1-, 3-, and 6-month follow-up visits.Results: Patient demographics and characters did not differ significantly between the two groups. Both groups showed a marked improvement of both scores when compared to their basal score. However, the ultrasound group showed a marked improvement compared to fluoroscopy.Conclusion: Based on our study findings, we believe that ultrasound-guided genicular verve ablation provides better results compared to the fluoroscopic guided procedure. However, fluoroscopy still provides an effective guidance method.

Long-term effects of intra-articular oxygen-ozone therapy versus hyaluronic acid in older people affected by knee osteoarthritis: A randomized single-blind extension study

There is little evidence on intra-articular (IA) treatment in knee osteoarthritis (KOA) and there is a lack of long-term follow-up studies. To assess the long-term effectiveness and safety of IA oxygen-ozone (O2O3) and hyaluronic acid (HA) in terms of functioning in KOA patients over a 31-week period. Patients aged ⩾ 60 years with KOA were randomly allocated to receive 4 IA knee injections (1/week) of O2O3 or HA (T0-T3) and a follow-up visit 4 weeks after the fourth injection (T4). In this extension study we assessed VAS and safety in patients with Visual Analogue Scale (VAS) ⩾ 4 at the at 6-month follow-up visit (T5), undergoing a second treatment cycle (T5-T8) and 1-month follow-up visit (T9). Forty-two patients (aged 70.5 ± 5.8 years) were randomly allocated to O2O3 (n= 22) or HA group (n= 20). Twenty-three underwent another IA cycle: 12 (54.6%) in the O2O3 group and 11 (55.0%) in the HA group. Both groups showed significant reduction in VAS (p< 0.013) compared to baseline during both cycles. At follow-up visits (T4 and T9), VAS was significantly lower in the HA group (p< 0.013). There were no differences in adverse events occurrence between groups. IA O2O3 might be comparable to HA in terms of effectiveness and safety in reducing pain in KOA patients, although at both follow-up visits (T4 and T9) VAS was significantly lower in the HA group.

Effects of Class IV Laser in Knee Osteoarthritis: A Randomized ControlTrial

Background: Knee osteoarthritis (KOA) is characterized by a gradual wearing away of the cartilage in the joint through strain originating from weight bearing, repeated injury, and/or damage and is one of the most associated causes of knee pain. Current options for pain management include medication or surgery. Consequently patients are alternatively seeking a non-invasive approach that can help manage their pain. Recently, Class IV laser has gained popularity due to its clinical efficacy in pain management and non-invasive application. Objective: The aim of this randomized control trial was to evaluate the effects of a 30W powered Class IV laser with 1064 nm wavelength on knee pain in the treatment of patients with KOA. Methods: Patients were randomly assigned into two groups. Each patient underwent 7 treatment sessions every other day. Group-I (Laser group): 30 patients were treated with a semi conductive Class IV Laser with Scanning System applicator (BTL Industries Ltd.) With a maximal power of 30 W and 1064 nm wavelength. Group-II (Control group): 30 patients were treated with the same device without emission from the laser diode, and only a visible navigation beam to act as a placebo. All patients perception of pain was evaluated prior to beginning treatment (baseline), following the first session, after the 7 therapies, and 1 month following the last treatment using the Visual Analogue Scale (VAS). Results: The Man-Whitney test revealed there was a significant (P=0.01) reduction in pain according to the VAS results for the laser group (44.24% improvement), whereas the control group displayed no significant difference (3.93% improvement) in pain perception following the treatment(s). Conclusion: Class IV laser treatment was found to be an effective modality in reducing knee pain in KOA patients.

Combined effect of laser acupuncture and electroacupuncture in knee osteoarthritis patients: A protocol for a randomized controlled trial.

Background:Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. The most common treatment for KOA is non-steroidal anti-inflammatory drug administration. However, the analgesic effect is limited and often accompanied by multiple side effects. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with great analgesic effect and minimal side effect. Electroacupuncture (EA) and laser acupuncture (LA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies.Methods:Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (EA plus LA) or control group (EA plus sham LA without laser output). All subjects in the treatment group will undergo a combined EA and LA treatment thrice a week for 4 weeks. The acupuncture will be performed on GB33, GB34, SP9, SP10, and ST36 sites. The treatment group will receive acupuncture with a transcutaneous electrical nerve stimulator at GB33, GB34, SP9, and SP10 sites and with LA at EX-LE5, ST35, and BL40 sites. The subjects in the control group will undergo the same treatment modality as the treatment group, except these subjects will not be exposed to laser output. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, one-leg standing with eyes open test, and the 30-s chair stand test before and after 4 weeks of intervention.Objectives:This protocol aims to investigate the combined effect of EA and LA in KOA patients.