DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192560

Effects of intra articular steroids, hyaluronic acid and combination of both among patients with knee osteoarthritis

Uganath Subash B., Sundaramoorthy M.

Abstract


Background: Osteoarthritis (OA) is a common degenerative disorder of articular cartilage accompanied by hypertrophic changes of the bone. In the management of OA, though use of intra articular (IA) injection of steroids, hyaluronic acid (HA) separately plays an important role, their effects in terms of reducing pain, joint stiffness and movement restriction when it is used in combination remains a question. Hence this study was planned to assess the effects of HA and steroids alone with combination of both Ha and steroids.

Methods: Prospective randomized comparative study, among patients with osteoarthritis knee attending the outpatient department of Orthopedics in a tertiary care hospital during January 2017 to May 2018, were included. Patients were randomized in three groups (steroids, HA and combination of both) and a total of 96 patients were included and the outcome was assessed by WOMAC scale. Statistical analysis was done using SPSS Version 20.

Results: Pain and movement restriction, at the end of fourth week and pain, joint stiffness and movement restriction, were found to be statistically improved in combined steroids and HA group than the group with steroids alone. Similarly at the end of third month, pain and movement restriction were found to be statistically improved in combined steroids and HA group than HA group alone.

Conclusions: This study demonstrates that HA together with corticosteroid provides pain relief, reduction of joint stiffness and helps in improving joint movements within three months after treatment.


Keywords


Osteoarthritis, Hyaluronic acid, Triamcinolone acetonide

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References


Holbrook AM. Chair for the Ontario Musculoskeletal therapy Review Panel. Ontario treat-ment guidelines for osteoarthritis, rheumatoid arthritis, and acute musculoskeletal injury. Toronto, Ont: Queen’s Printer of Ontario; 2000.

Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 1987;30:914–8.

American College of Rheumatology, Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum. 2000;43:1905-15.

Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with Hylan G-F 20: a 26 week controlled trial of efficacy and safety in the osteoarthritic knee. Clinerapeut. 1998;20(3):410-23.

George E. Intra-articular hyaluronan treatment for osteoarthritis. Ann Rheum Dis. 1999;57(11):637-40.

Raynauld J, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee. Arth Rheum. 2003;48:370-7.

American College of Rheumatology subcommittee on osteoarthritis guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee. Arth Rheum. 2000;43:1905-15.

Ayral X. Injections in the treatment of osteoarthritis. Best Pract Res Clin Rehumatol. 2001;15:609-26.

Scale D, Wobig M, Wolpert W. Viscosupple-mentation of osteoarthritic knees with Hylan, in the treatment schedule study. Curr Ther Res. 1994;55:220–32.

Ayral X. Injections in the treatment of osteoarthritis. Best Prac Res Clin Rheumatol. 2001;15(4):609–26.

Canale ST, James H. Beaty, Campbell’s Operative Orthopaedics, 12th edn. Philadelphia, Elsevier. 2013.

Bellamy N, Buchanan W, Goldsmith C, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833-40.

Ostergaard M, Halberg P. Intra-articular corticosteroids in arthritic disease: a guide to treatment. Bio Drugs. 1998;9:95-103.

Brockmeier SF, Shaffer BS. Viscosupplementation therapy for osteoarthritis. Sports Med Arthrosc. 2006;14:155-62.

Goa KL, Benfield P. Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing. Drugs. 1994;47:536-66.

Axe JM, Snyder-Mackler L, Axe MJ. The role of viscosupplementation. Sports Med Arthrosc. 2013;21:18-22.

Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl. 1993;39:3-9.

Listrat V, Ayral X, Patarnello F, Bonvarlet JP, Simonnet J, Amor B, et al. Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthritis Cartilage. 1997;5:153-60.

Bagga H, Burkhardt D, Sambrook P, March L. Long termeffects of intraarticular hyaluronan on synovial fluid in osteoarthritis of the knee. J Rheumatol. 2006;33:946-50.

Pozo MA, Balazs EA, Belmonte C. Reduction of sensory responses to passive movements of inflamed knee joints by hylan, a hyaluronan derivative. Exp Brain Res. 1997;116:3-9.

Ghosh P. The role of hyaluronic acid (hyaluronan) in health and disease: interactions with cells, cartilage and components of synovial fluid. Clin Exp Rheumatol. 1994;12:75-82.

Chhetri DK, Mendelsohn AH. Hyaluronic acid for the treatment of vocal fold scars. Curr Opin Otolaryngol Head Neck Surg. 2010;18:498-502

Schnüriger B, Barmparas G, Branco BC, Lustenberger T, Inaba K, Demetriades D. Prevention of postoperative peritoneal adhesions: a review of the literature. Am J Surg. 2011;201:111-21.

Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther. 2003;5:54-67.

Gomis A, Miralles A, Schmidt RF, Belmonte C. Intraarticular injections of hyaluronan solutions of different elastoviscosity reduce nociceptive nerve activity in a model of osteoarthritic knee joint of the guinea pig. Osteoarthritis Cartilage. 2009;17:798-804.

Grecomoro G, Piccione F, Letizia G. Therapeutic synergism between hyaluronic acid and dexamethasone in the intra-articular treatment of osteoarthritis of the knee: a preliminary open study. Curr Med Res Opin. 1992;13:49–55.

Gray RG, Gottiblieb NL. Intra-articular corticosteroids; an updated assessment. Clin Orthopaedics Relat Res. 1983;177:235–63.

Balch HW, Gibson JM, El-Ghobarey Af. Repeated corticosteroid injections into knee joints. Rheumatol Rehabil. 1977;16:137–40.

Pelletier JP, Mineau F, Raynauld JP, Woessner JF Jr, Gunja- Smith Z, Martel-Pelletier J. Intraarticular injections with methyl-prednisolone acetate reduce osteoarthritic lesions parallel with chondrocyte stromelysin synthesis in experimental osteoarthritis. Arthritis Rheum. 1994;37:414–23.

Young L, Katrib A, Cuello C, Vollmer-Conna U, Bertouch V, Roberts-Thomson PJ, et al. Effects of intraarticular glucocorticoids on macrophage infiltration and mediators of joint damage in osteoarthritis synovial membranes. Arthritis Rheum. 2001;44(2):343–50.

Raynauld JP, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee. Arthritis Rheum. 2003;48(2):370–7.