Does the Presence of Neuropathic Pain Influence the Response to Hyaluronic Acid in Patients with Knee Osteoarthritis?

Cartilage ◽  
2020 ◽  
pp. 194760352095450
Author(s):  
Evarice Tiendrebeogo ◽  
Magda Choueiri ◽  
Xavier Chevalier ◽  
Thierry Conrozier ◽  
Florent Eymard
Keyword(s):  
Neuropathic Pain ◽  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Symptomatic Improvement ◽  
Pain Patient ◽  
Womac Pain ◽  
Double Blind ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
The Impact

Objectives Up to 50% of patients with symptomatic knee osteoarthritis (OA) present with neuropathic pain (NP) features. We assessed the impact of NP according to DN4 (Douleurs Neuropathiques 4 questions) score on the response to intra-articular (IA) hyaluronic acid (HA) injections and the effects of HA injections on NP. Materials and Methods We conducted a post hoc analysis from a multicenter, randomized, double-blind, noninferiority trial comparing the efficacy of 2 HA in symptomatic knee OA at 24 weeks. At baseline, demographic, anthropometric, radiologic data, and symptoms were recorded. The symptomatic effect of HA was assessed by VAS pain, patient global assessment (PGA), WOMAC, DN4, and OMERACT-OARSI response. Results A total of 187 patients were included. NP according to DN4 score was present in 20 patients (10.7%) at baseline. Most common positive DN4 items were tingling (36.9%) and burning (36.4%). NP was associated with WOMAC pain score ( P = 0.02). The presence of NP at baseline did not affect the symptomatic improvement after HA injections according to the VAS pain ( P = 0.71), PGA ( P = 050), WOMAC pain ( P = 0.89), WOMAC function ( P = 0.52), and rate of OMERACT-OARSI responders ( P = 0.21). The prevalence of patients with NP decreased by 50% ( n = 10) at 24 weeks after HA injections. Most improved DN4 items were itching (90%), hypoesthesia to pinprick (88%), and burning (50%). Conclusion In our study, NP was associated with pain severity, but did not influence the response to IA HA. On the other hand, HA injections reduced some NP features, especially itching, sting hypoesthesia, and burning.

scholarly journals Standardized Follow-up of Patients with Symptomatic Knee Osteoarthritis Treated with a Single Intra-articular Injection of a Combination of Cross-Linked Hyaluronic Acid and Mannitol

2016 ◽  
Vol 9 ◽  
pp. CMAMD.S39432 ◽  
Author(s):  
Thierry Conrozier ◽  
Ana-Maria Bozgan ◽  
Marie Bossert ◽  
Maxime Sondag ◽  
Anne Lohse-Walliser ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Safety Concern ◽  
Daily Practice ◽  
Womac Pain ◽  
Pilot Data ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Intent To Treat

Objectives The objective of this study is to obtain pilot data from daily practice conditions of a viscosupplement made of a cross-linked high-molecular-weight hyaluronic acid (HA) combined with mannitol in patients with knee osteoarthritis (KOA). Methods The data of 40 consecutive patients, 29 women and 11 men, who were prospectively followed up for 6 months, using a standardized procedure, were retrospectively analyzed. All patients have received a single intra-articular injection of H Anox-M-XL (4.4 mL), viscosupplement made of a cross-linked HA (16 mg/mL) + mannitol (35 mg/mL), in the target knee. The primary outcome was safety. The secondary end points included 3- and 6-month change in the WOMAC pain (0–50) and WOMAC total (0–240) and patient's global assessment (PGA). Patient's self-assessment of treatment efficacy (0–3) and analgesic consumption were obtained at months 3 and 6. An intent-to-treat analysis was performed. Results Mean (SD) age was 60.7 (13.9) years, and mean BMI was 28.6 (5.0). Kellgren–Lawrence radiological grade was I/II and III/IV in 13 and 27 of the subjects, respectively. The average WOMAC pain and WOMAC total scores at baseline were 21.5 (9.8) and 89.9 (42.8), respectively. Thirty-nine patients completed the follow-up. HAnox-M-XL was well tolerated; two patients experienced knee pain after injection, which resolved within three days. No treatment-related severe adverse event was reported. Mean (SD) variations in WOMAC pain and WOMAC total scores were –8.2 (8.9) and –38.4 (35.6), respectively, at month 6 ( P = 0.001). PGA decreased from 5.5 (2.0) to 3.0 (2.2) ( P = 0.006). Efficacy was rated as good or very good in 76.9% of the cases. Most of the regular analgesics users decreased their consumption. Conclusion Treatment with one injection of 4.4 mL HAnox-M-XL is effective to alleviate KOA symptoms over six months, without safety concern. Controlled trials are needed to confirm these pilot data.

Clinical Efficacy of Platelet-Rich Plasma Injection and Its Association With Growth Factors in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized Double-Blind Controlled Clinical Trial As Compared With Hyaluronic Acid

2021 ◽  
Vol 49 (2) ◽  
pp. 487-496
Author(s):  
Yong-Beom Park ◽  
Jun-Ho Kim ◽  
Chul-Won Ha ◽  
Dong-Hyun Lee
Keyword(s):  
Hyaluronic Acid ◽  
Growth Factors ◽  
Knee Osteoarthritis ◽  
Clinical Outcomes ◽  
Clinical Efficacy ◽  
Global Assessment ◽  
Platelet Rich Plasma ◽  
Patient Global Assessment ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

Background: Although platelet-rich plasma (PRP) has potential as a regenerative treatment for knee osteoarthritis, its efficacy varies. Compositional differences among types of PRP could affect clinical outcomes, but the biological characterization of PRP is lacking. Purpose: To assess the efficacy of intra-articular PRP injection in knee osteoarthritis as compared with hyaluronic acid (HA) injection and to determine whether the clinical efficacy of PRP is associated with its biological characteristics. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 110 patients with symptomatic knee osteoarthritis received a single injection of leukocyte-rich PRP (1 commercial kit) or HA. Clinical data were assessed at baseline and at 6 weeks and 3 and 6 months after injection. The primary endpoint was an improvement in the International Knee Documentation Committee (IKDC) subjective score at 6 months, and the secondary endpoints were improvements in scores based on the Patient Global Assessment, the visual analog scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Samsung Medical Center patellofemoral score. Cell counts and concentrations of growth factors and cytokines in the injected PRP were assessed to determine their association with clinical outcomes. Results: PRP showed significantly improvement in IKDC subjective scores at 6 months (11.5 in the PRP group vs 6.3 in the HA group; P = .029). There were no significant differences between groups in other clinical outcomes. The Patient Global Assessment score at 6 months was better in the PRP group ( P = .035). The proportion of patients who scored above the minimal clinically important difference (MCID) for VAS at 6 months was significantly higher in the PRP group ( P = .044). Within the PRP group, the concentrations of platelet-derived growth factors were high in patients with a score above the MCID for VAS at 6 months. The incidence of adverse events did not differ between the groups ( P > .05). Conclusion: PRP had better clinical efficacy than HA. High concentrations of growth factors were observed in patients who scored above the MCID for clinical outcomes in the PRP group. These findings indicate that concentration of growth factors needs to be taken into consideration for future investigations of PRP in knee osteoarthritis. Registration: NCT02211521 (ClinicalTrials.gov identifier).

scholarly journals AB0876 THE BENEFIT AND SAFETY OF DIACEREIN IN AGED AND OBESE PATIENTS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS: DATA FROM THE DISSCO CLINICAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1744.1-1744
Author(s):  
J. P. Pelletier ◽  
J. P. Raynauld ◽  
M. Dorais ◽  
P. Paiement ◽  
J. Martel-Pelletier
Keyword(s):  
Knee Osteoarthritis ◽  
Physical Function ◽  
Safety Profile ◽  
Age Groups ◽  
Womac Pain ◽  
Research Support ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Time To Onset ◽  
Two Age Groups

Background:The DISSCO trial (6-month international, multicentre, double-blind, randomised study on the effect of diacerein vs celecoxib in symptomatic knee osteoarthritis [OA] patients) showed that diacerein had comparable efficacy to celecoxib at reducing the level of pain (WOMAC pain).Objectives:To assess the effect of age, body mass index (BMI), and gender on the efficacy/safety profile of diacerein following 6 months of treatment.Methods:Of the patients (n=380) that were randomised, 186 received treatment with 50 mg diacerein once daily for the first month and twice daily thereafter. This study was done on the intent-to-treat population (n=183). Efficacy outcome assessments which included absolute change in WOMAC pain (score 0-50) and function (score 0-170), and VAS (score 0-10) were analysed following stratification based on age (< 65 vs ≥ 65 years old) and BMI (< 30 vs ≥ 30 kg/m2) at time of randomisation. Treatment effects on continuous efficacy outcomes were performed using covariance analysis (ANCOVA). For gastrointestinal (GI) safety outcomes, the adverse events (AEs), including diarrhoea, soft faeces, abdominal pain and dyspepsia, and the time-to-onset from baseline were stratified according to age of patients at randomisation. Treatment-related GI AEs were also assessed according to the gender. The independent variables were treatment, stratification variable, interaction between both, and the outcome measure at baseline. Comparisons between groups were carried out using Chi-square.Results:No significant differences were found between the two age groups (<65 years old [n=105], ≥65 years old [n=78]) in the level of reduction in WOMAC pain (-10.3 ± 1.1, -8.6 ± 1.3, respectively; p=0.30), VAS (-2.3 ± 0.2, -2.2 ± 0.3, p=0.73) or improved physical function (-29.7 ± 3.7, -22.1 ± 4.2, p=0.18). The reported incidences of treatment-related GI AEs were also similar between the two age groups; more specifically for diarrhoea, incidence for patients <65 years old [n=12] 11.3% and for those ≥65 years old [n=7] 8.8% (p=0.63) with a mean time-to-onset (day 43 ± 49, 61 ±51, respectively; p=0.11). Moreover, gender had no influence on treatment-related GI AEs (p=0.42).In regard to treatment response of obese (n=101) vs. non-obese (n=82) patients in terms of pain reduction (WOMAC: -10.1 ± 1.2, -9.1 ± 1.1, respectively; p=0.58; VAS: -2.6 ± 0.3, -2.0 ± 0.3; p=0.15), or improved WOMAC physical function (-29.8 ± 4.2, -23.5 ± 3.8; p=0.26), there were also no significant differences.Conclusion:In symptomatic knee OA patients, the level of effectiveness and safety profile of treatment with diacerein were found not to be influenced by age, BMI or gender.Disclosure of Interests:Jean-Pierre Pelletier Shareholder of: ArthroLab Inc., Grant/research support from: TRB Chemedica, Speakers bureau: TRB Chemedica and Mylan, Jean-Pierre Raynauld Consultant of: ArthroLab Inc., Marc Dorais Consultant of: ArthroLab Inc., Patrice Paiement Employee of: ArthroLab Inc., Johanne Martel-Pelletier Shareholder of: ArthroLab Inc., Grant/research support from: TRB Chemedica

scholarly journals US-Approved Intra-Articular Hyaluronic Acid Injections are Safe and Effective in Patients with Knee Osteoarthritis: Systematic Review and Meta-Analysis of Randomized, Saline-Controlled Trials

2013 ◽  
Vol 6 ◽  
pp. CMAMD.S12743 ◽  
Author(s):  
Larry E. Miller ◽  
Jon E. Block
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Serious Adverse Events ◽  
Safety Outcome ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

We conducted a systematic review and meta-analysis of randomized saline-controlled trials to determine the safety and efficacy of US-approved intra-articular hyaluronic acid (IAHA) injections for symptomatic knee osteoarthritis. A total of 29 studies representing 4,866 unique subjects (IAHA: 2,673, saline: 2,193) were included. IAHA injection resulted in very large treatment effects between 4 and 26 weeks for knee pain and function compared to pre-injection values, with standardized mean difference (SMD) values ranging from 1.07–1.37 (all P < 0.001). Compared to saline controls, SMDs with IAHA ranged from 0.38–0.43 for knee pain and 0.32–0.34 for knee function (all P < 0.001). There were no statistically significant differences between IAHA and saline controls for any safety outcome, including serious adverse events (SAEs) ( P = 0.12), treatment-related SAEs ( P = 1.0), study withdrawal ( P = 1.0), and AE-related study withdrawal ( P = 0.46). We conclude that intra-articular injection of US-approved HA products is safe and efficacious in patients with symptomatic knee osteoarthritis.

Safety and efficacy of intra-articular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis

The Knee ◽  
2016 ◽  
Vol 23 (5) ◽  
pp. 842-848 ◽  
Author(s):  
Thierry Conrozier ◽  
Florent Eymard ◽  
Naji Afif ◽  
Jean-Charles Balblanc ◽  
Virginie Legré-Boyer ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Safety And Efficacy ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee
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