Pharmacological Use of Gamma-Aminobutyric Acid Derivatives in Osteoarthritis Pain Management: A Systematic Review

Abstract Background Pain is the major complication of osteoarthritis (OA) patients and is a decisive symptom for medical intervention. Gamma-aminobutyric acid (GABA) derivatives are optional painkillers but not widely used in pain management of OA patients. We synthesized the efficacy and safety of GABA derivatives for OA pain management. Methods We searched Medline, Cochrane CENTRAL, Embase, and ClinicalTrals.gov from inception to 13 October 2021 and included randomized controlled trials (RCTs) comparing the efficacy and safety of GABA derivatives with placebo or standard control in OA pain management. Two independent reviewers extracted data and assessed these studies for risk of bias using Cochrane Collaboration’s tool for RCT. Results In total, three eligible RCTs (n=3) meeting the eligibility criteria were included. Among these RCTs, one focused on hand OA pain management, while two RCTs focused on knee OA. In hand OA, pregabalin reduced numerical rating scale (NRS) score and the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain score significantly compared with placebo, and caused 55 AEs. In knee OA, pregabalin reduced visual analogue scale (VAS) score and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score significantly with no recorded adverse event (AE). Meanwhile, in knee OA, gabapentin reduced both VAS score and WOMAC pain score compared with acetaminophen and caused 9 AEs. Conclusions GABA derivates are effective and safe in OA pain management. However, future researches with large sample size are needed to further prove the efficacy of GABA derivates in OA pain control. Trial registration: CRD42021240225.

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T2 mapping evaluation of changes in cartilage matrix after PRP and HA injection therapy in knee osteoarthritis: a prospective, randomized, double blind, placebo controlled study

10.21203/rs.3.rs-36493/v1 ◽

2020 ◽

Author(s):

Matjaz Vogrin ◽

Jakob Naranda ◽

Mario Gorenjak ◽

Tomaz Bajec ◽

Domen Mongus ◽

...

Keyword(s):

Placebo Group ◽

Knee Osteoarthritis ◽

Pain Score ◽

T2 Mapping ◽

Womac Score ◽

Controlled Study ◽

Womac Pain ◽

Womac Pain Score ◽

Knee Oa

Abstract BackgroundIn this study we focused on evaluating the effect of intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) on the qualitative and quantitative properties of the articular cartilage in patients with knee osteoarthritis (OA).MethodsWe evaluated 264 patients undergoing treatment of moderate knee OA. Patients aged between 40 and 70 years were included with articular K-L stage ≤ 2. Patients were randomized into three groups and treated with three doses of intra-articular PRP, HA, or placebo injection. Patients were evaluated clinically and by using T2 mapping.ResultsBoth PRP (619.05 ± 243 ms; p = 2.7 × 10− 5) and HA (637.12 ± 273 ms; p = 1.×10− 4) group showed statistically significant lower post-application T2 relaxation times in comparison to the placebo group (859.80 ± 406 ms).Cartilage thickness increased significantly after PRP (2.41±0.87 vs. 2.58±0.97 mm, p=0.033) and HA (2.28±0.81 vs. 2.80±1.00 mm, p=1.8×10) applications. There was a significant decrease in WOMAC pain score by 30% (p=0,001) and the overall WOMAC score by 27 p=1.9×10-4%) in PRP group. The decrease in WOMAC pain score and the overall WOMAC score in the placebo group was similar to the results observed in the PRP group. In the HA group a significant decrease in WOMAC pain score by 14% (p=0,005) was observed only at the first follow-up, whereas no difference was observed at the second follow-up. ConclusionsT2 mapping of cartilage tissue may aid to monitor its properties after the intra-articular therapies in knee OA. However, there is a discrepancy between clinical findings and the results of T2 mapping, suggesting questionable grounds for applying intra-articular therapy.

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Efficacy and safety of 12 weeks of osteoarthritic pain therapy with once-daily tramadol (Tramadol Contramid® OAD)

Journal of Opioid Management ◽

10.5055/jom.2007.0015 ◽

2007 ◽

Vol 3 (5) ◽

pp. 273 ◽

Cited By ~ 24

Author(s):

Ritchard L. Fishman, MD ◽

Charles James Kistler, DO ◽

Michael T. Ellerbusch, MD ◽

Raul Tomas Aparicio, MD ◽

Sharad S. Swami, MD ◽

...

Keyword(s):

Pain Relief ◽

Pain Score ◽

Severe Pain ◽

Womac Pain ◽

Global Rating ◽

Efficacy And Safety ◽

Once Daily ◽

Womac Pain Score ◽

Responder Analysis ◽

Percent Improvement

This placebo-controlled study examined the analgesic efficacy, safety, and clinical benefit of Tramadol Contramid OAD, a once-daily formulation with both immediate- and extended-release components. Five hundred and fifty-two patients with moderate to severe pain due to osteoarthritis (OA) of the knee were randomized into this multicenter, double-blind, parallel arm study. After randomization to Tramadol Contramid OAD 100, 200, or 300 mg, or to placebo, patients’ dose was titrated to the fixed randomized dose and maintained for 12 weeks. Efficacy was evaluated with the Patients’ Global Rating of Pain Relief (median ratings at maintenance visits), and the Western Ontario and McMaster University (WOMAC) Pain and Physical Function subscales (percent difference, baseline to end of study) as coprimary endpoints. A responder analysis was conducted (percentage of patients who achieved a 30 percent improvement on their baseline WOMAC pain score). The difference from placebo on the median Patient Global Rating of Pain Relief at the four maintenance visits was statistically significant (200 and 300 mg: p ≤ 0.001). Treatment was rated effective or very effective by 75 percent and 80 percent of patients randomized to Tramadol Contramid OAD 200 mg and 300 mg, respectively. There was a 46 percent (300-mg dose; p = 0.016) and 43 percent (200-mg dose; p = 0.05) improvement on the WOMAC pain score (baseline to the end of the study) with Tramadol Contramid OAD compared with 32 percent for placebo. The responder analysis demonstrated a statistically significant difference in the percentage of patients who achieved a 30 percent improvement in their baseline WOMAC pain score for both Tramadol Contramid OAD 200 mg (65 percent; p = 0.0095) and 300 mg (65 percent; p = 0.0104) compared with placebo (50 percent). The type and incidence of adverse events were typical of tramadol (nausea, dizziness/vertigo, vomiting, somnolence, and constipation) and the intensity was mild to moderate in 87 percent of patients who experienced them regardless of dose. This study shows the efficacy and safety of Tramadol Contramid OAD 200 mg and 300 mg in patients with moderate or severe pain of the knee due to OA.

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Efficacy and Safety of Hylan versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis

The Journal of Knee Surgery ◽

10.1055/s-0038-1641142 ◽

2018 ◽

Vol 32 (03) ◽

pp. 259-268 ◽

Cited By ~ 2

Author(s):

Wen-Li Dai ◽

Ze-Ming Lin ◽

Dong-Hong Guo ◽

Zhan-Jun Shi ◽

Jian Wang

Keyword(s):

Meta Analysis ◽

Womac Pain ◽

Efficacy And Safety ◽

Function Score ◽

Womac Pain Score ◽

Knee Oa ◽

Womac Function ◽

The Difference ◽

Level I ◽

And Function

AbstractThe purpose of this study was to use meta-analytic approach to compare the efficacy and safety of intraarticular hylan and hyaluronic acid (HA) for knee osteoarthritis (OA) treatment. We searched PubMed, Embase, and the Cochrane databases through July 2017 to identify Level I randomized controlled trials (RCTs) that evaluated clinical efficacy and safety of hylan compared with HA for knee OA. The primary outcomes were Visual Analogue Scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, and WOMAC function scores. In each study and for the outcome measures (VAS for pain, WOMAC pain, function and stiffness scores, and Lequesne score), we calculated the treatment effect from the difference between the preintervention and postintervention changes in the hylan and HA groups. Twenty-one RCTs involving 3,058 patients were included. Pooled analysis suggested that compared with HA, hylan was associated with similar pain relief and function improvement in patients with knee OA (VAS for pain: mean difference [MD], –3.04; 95% confidence interval [CI], –9.13 to 3.04; p = 0.33; I 2 = 76%. WOMAC pain score: MD, 0.23; 95% CI, –0.25 to 0.70; p = 0.35; I 2 = 0%. WOMAC function score: MD, –0.47; 95% CI, –6.81 to 5.88; p = 0.88; I 2 = 84%). No significant difference was found comparing the patients with treatment-related adverse events. The relationship was robust in sensitivity analysis and consistent in most of the subgroup analyses. As to the primary outcomes (WOMAC pain, function scores, VAS for pain), the difference between hylan and HA did not reach the previously reported minimum clinically important difference (MCID) values (–13.4 for VAS for pain, –2.0 for WOMAC pain score, –7.7 for WOMAC function score). Our meta-analysis showed that there were no statistically and clinically significant differences in pain relief and function improvement between hylan and HA injections for knee OA treatment. In view of its higher costs, we discourage the use of hylan in patients with knee OA in clinical practice. The level of evidence is I, meta-analysis of Level I studies.

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Acupotomy Therapy for Knee Osteoarthritis Pain: Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/2168283 ◽

2020 ◽

Vol 2020 ◽

pp. 1-17

Author(s):

Jigao Sun ◽

Yan Zhao ◽

Ruizheng Zhu ◽

Qianglong Chen ◽

Mengge Song ◽

...

Keyword(s):

Systematic Review ◽

Knee Osteoarthritis ◽

Pain Score ◽

Meta Analysis ◽

Cochrane Library ◽

Womac Pain ◽

Womac Pain Score ◽

Knee Oa ◽

Effectiveness Rate ◽

And Function

Background and Purpose. Knee osteoarthritis (OA) is a major public health problem, and currently, few effective medical treatments exist. Chinese acupotomy therapy has been widely used for the treatment of knee OA in China. We conducted this systematic review and meta-analysis to evaluate the efficacy of Chinese acupotomy in treating knee OA to inform clinical practice. Methods. We performed a comprehensive search on PubMed, the Cochrane Library, EMBASE, and four Chinese databases for articles published prior to June 2020. We included only randomized controlled trials (RCTs) that used acupotomy therapy as the major intervention in adults with knee OA, were published in either Chinese and English, included more than 20 subjects in each group, and included pain and function in the outcome measures. Knee OA was defined by the American College of Rheumatology or Chinese Orthopedic Association criteria in all studies. We extracted the visual analogue scale (VAS) pain score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total effectiveness rate, the modified Japanese Orthopedic Association (JOA) activities of daily living score, and Lysholm’s score. We calculated the mean difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were conducted using random-effects models when appropriate. Results. We identified 1317 potentially relevant studies, thirty-two of which met the eligibility criteria and were conducted in China between 2007 and 2020. A total of 3021 knee OA patients (62.96% female, median age: 57 years, and median disease duration: 33 months) were included. The treatment duration ranged from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment involved releasing soft tissue adhesions and was performed once a week for 1–5 weeks until the pain was relieved. The control group treatments included acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 studies), radiofrequency electrotherapy (1 study), and nonsteroidal anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis showed that acupotomy led to superior improvements in the VAS pain score (MD = −1.11; 95% confidence interval (CI), −1.51 to −0.71; p < 0.00001) and WOMAC pain score (MD = −2.32; 95% CI, −2.94 to −1.69; p < 0.00001), a higher total effectiveness rate (RR = 1.15; 95% CI, 1.09–1.21; p < 0.00001), and superior improvements in the JOA score (MD = 6.39; 95% CI, 4.11–9.76; p < 0.00001) and Lysholm’s score (MD = 12.75; 95% CI, 2.61–22.89; p = 0.01) for overall pain and function. No serious adverse events were reported. Conclusion. Chinese acupotomy therapy may relieve pain and improve function in patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs are warranted.

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An international, multicentre, double-blind, randomized study (DISSCO): effect of diacerein vs celecoxib on symptoms in knee osteoarthritis

Rheumatology ◽

10.1093/rheumatology/keaa072 ◽

2020 ◽

Vol 59 (12) ◽

pp. 3858-3868

Author(s):

Jean-Pierre Pelletier ◽

Jean-Pierre Raynauld ◽

Marc Dorais ◽

Louis Bessette ◽

Eva Dokoupilova ◽

...

Keyword(s):

Pain Score ◽

Phase Iii ◽

Comparable Efficacy ◽

Womac Pain ◽

Double Blind ◽

Once Daily ◽

Womac Pain Score ◽

Knee Oa ◽

Symptomatic Knee ◽

Significant Difference

Abstract Objective The objective of this study was to investigate whether diacerein has comparable efficacy with celecoxib in pain reduction for treatment in symptomatic knee OA patients. Methods This randomized double-blind multicentre non-inferiority trial evaluated diacerein vs celecoxib treatment in patients with Kellgren–Lawrence grade 2–3 and pain scoring ≥4 (10-cm VAS). Patients were randomized to 6 months of treatment with diacerein 50 mg (n = 187) once daily for 1 month and twice daily thereafter, or celecoxib 200 mg (n = 193) once daily. The primary outcome was the change in WOMAC pain score (0–50 cm) at 6 months, and the secondary outcomes were WOMAC sub-scores, VAS pain score, and the OMERACT–OARSI responder rate. Results In the per protocol population, the adjusted mean change from baseline in the WOMAC pain score was –11.1 ( 0.9) with diacerein (n = 140) and –11.8 (0.9) with celecoxib (n = 148). The intergroup difference was 0.7 (95% CI: −1.8, 3.2; P = 0.597), meeting the non-inferiority margin. Supportive analysis of the intention-to-treat population gave similar results. Other outcomes showed no significant difference between treatment groups. The incidence of treatment-related adverse events was low and balanced between groups, but a greater incidence of diarrhoea occurred with diacerein (10.2% vs 3.7%). Diarrhoea was considered mild-to-moderate in all but one case with complete resolution. Conclusions Diacerein was non-inferior to celecoxib in reducing knee OA pain and improving physical function. Diacerein also demonstrated a good safety profile. Trial registration A multicentre study on the effect of DIacerein on Structure and Symptoms vs Celecoxib in Osteoarthritis is a National Institutes of Health (NCT02688400) and European Clinical Trial Database (2015–002933-23) registered phase III (Canada) or IV (Europe) study.

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Monitoring the Clinical Response to an Innovative Transdermal Delivery System for Ibuprofen

Pharmaceutics ◽

10.3390/pharmaceutics11120664 ◽

2019 ◽

Vol 11 (12) ◽

pp. 664 ◽

Cited By ~ 1

Author(s):

Anthony Wright ◽

Heather A. E. Benson ◽

Penny Moss ◽

Rob Will

Keyword(s):

Transdermal Delivery ◽

Controlled Trial ◽

Phase 1 ◽

Womac Pain ◽

Number Needed To Treat ◽

Womac Pain Score ◽

Patch Application ◽

Knee Oa ◽

Randomised Controlled ◽

And Function

We present a phase 1 study that utilizes a crossover design that provides a rapid and relatively inexpensive methodology for evaluating a new transdermal product. The treatment for osteoarthritis (OA) aims to reduce pain and improve function. An innovative magnetophoresis technology has been developed that facilitates transdermal delivery of ibuprofen. The study used measures that were taken over a relatively short time period to monitor the pharmacodynamic response to ibuprofen. Each participant received magnetophoresis-enhanced transdermal ibuprofen or placebo in randomised order, with a five-day washout period. The participants were 24 volunteers with medically diagnosed, painful knee OA. The primary outcome measures were VAS rating of pain on movement and Western Ontario and McMaster Universities (WOMAC) pain and function scores. VAS for pain on movement (p < 0.001), WOMAC pain score (p = 0.004), and WOMAC function score (p = 0.004) were all significantly improved. There was a significant reduction in movement-related pain (p < 0.05) during the first patch application and for the remainder of the study period. The number needed to treat for a 50% reduction in movement related pain was 2.2. The study showed a rapid and significant analgesic effect in response to transdermal ibuprofen. A short trial of this nature can be used for informing the parameters that are required for a major randomised controlled trial.

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Influence of Posterior Condylar Offset on Maximal Flexion and Outcome Scales Following TKA in Asian Patients

Reconstructive Review ◽

10.15438/rr.4.4.82 ◽

2015 ◽

Vol 4 (4) ◽

pp. 15-21

Author(s):

Sae Kwang Kwon ◽

Nimesh Prakash Jain ◽

Jong Yeal Kang ◽

Yeon Gwi Kang ◽

Tae Kyun Kim

Keyword(s):

Clinical Outcome ◽

Pain Score ◽

Functional Outcomes ◽

Mobile Bearing ◽

Womac Pain ◽

Level Of Evidence ◽

Womac Pain Score ◽

Posterior Condylar Offset ◽

Postoperative Flexion ◽

Posterior Condylar

Background: Infection complicates traditional joint reconstruction prostheses in up to 7% of cases, witBackground: Alteration in femoral posterior condylar offset (PCO) after total knee arthroplasty (TKA) has been reported to influence maximal flexion angle after TKA. However, there are contradictory reports about its influence on clinical outcome, and the effects of PCO alterations may vary with implant type.Question / purposes: The purpose of this study was to determine whether PCO alterations affect maximal flexion after TKA and other functional outcomes, and whether the effects of PCO alterations differ by implant type.Patients and Methods: Fifty consecutive cases of TKAs in each of four implant types, namely, fixed bearing (FB) cruciate retaining (CR) or posterior stabilized (PS), mobile bearing (MB) CR or PS were included in the study. Patients were evaluated for maximal flexion and clinical outcome scales. The PCO alteration was measured using pre- and postoperative true lateral knee radiographs. Correlations between PCO alterations and functional outcomes including maximal flexion were compared among the four implant types. Results: No significant correlation was found between PCO alterations and maximal flexion achieved in any of the four implant groups (Correlation Coefficient [CC]=-0.03, 0.14, -0.14, 0.04; p> 0.05). The mean maximal postoperative flexion was greater in PS implants than in CR implants (p <0.05). In MB-CR implanted knees, a greater PCO alteration was correlated with worse anterior knee pain score as measured by the PF scoring system (CC=-0.44, p=0.003) and worse WOMAC pain score (CC=-0.41, p=0.007). Conclusions: Our findings indicate that PCO alterations have no effect on maximal postoperative flexion after TKA regardless of the implant type. Whether the implant is of PS or CR type is a better predictor of the final flexion achieved. However, increased PCO is correlated with worse pain score in MB-CR implants. Level of Evidence: Level III, Retrospective comparative study

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Efficacy and Safety of Tongning Gel for Knee Osteoarthritis: A Multicentre, Randomized, Double-Blinded, Parallel, Placebo-Controlled, Clinical Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/8707256 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Ye Zhao ◽

Zhi Bi Shen ◽

Ji Rong Ge ◽

Wen Gang Liu ◽

Jun Xing Yang ◽

...

Keyword(s):

Clinical Trial ◽

Adverse Events ◽

Knee Osteoarthritis ◽

Physical Function ◽

Pain Score ◽

Adverse Reactions ◽

Control Group ◽

Womac Pain ◽

Womac Pain Score ◽

Experimental Group

Objective. To evaluate the efficacy and safety of Tongning Gel (TNG) compared to placebo-controlled (PC) for knee osteoarthritis (KOA). Methods. A multicentre, randomized, double-blinded, parallel, placebo-controlled, clinical trial was performed in 576 patients (432 patients in the TNG group, 144 patients in the PC group), and 1 in the experimental group withdrew due to nonuse of drug. Patients were randomized to receive TNG or PC applied to knee skin at 3g per time, 2 times per day, which lasted for 3 weeks. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score was used to evaluate the primary efficacy of TNG and WOMAC stiffness and physical function and total scores were used to evaluate the secondary efficacy of TNG. All participants who received at least one dose of study drug were included in the safety analysis. This trial has been registered in Chinese Clinical Trial Registry (no. CTR20131276). Results. Primary efficiency outcome: there were significant differences in the decreased value of WOMAC pain score between two groups (P<0.05), and the decreased value of WOMAC pain score in the TNG group were better than those in the PC group (P<0.05). Secondary efficiency outcome: the WOMAC total score, WOMAC stiffness score, WOMAC physical function score, and the decrease of the above indexes of the two groups of patients after treatment were statistically significant (P<0.05), and the improvement of the above indexes in the TNG group was better than that of the PC group (P<0.05). Safety Evaluation. A total of 42 adverse events were reported by 29 patients: 25 adverse events reported by 16 patients (3.71%) in the experimental group and 17 adverse events were reported by 13 patients (9.03%) in the control group. And 8 adverse reactions were reported by 6 patients including 2 adverse reactions by 2 patients (0.46%) in the experimental group and 6 adverse reactions by 4 patients (2.78%) in the control group. Two cases of significant adverse events occurred in the experimental group. Both groups had one serious adverse event, respectively, which were not relevant to the intervention. Conclusion. These results of the trial demonstrate that TNG is superior to placebo in the treatment of patients with KOA, and TNG can improve other symptoms of KOA, such as stiffness and physical function. TNG is safe for the treatment of knee osteoarthritis as a whole.

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TO COMPARE THE EFFICACY OF GENICULAR NERVE BLOCK AND INJECTION OF HYLAN G-F 20 VERSUS GENICULAR NERVE BLOCK ONLY FOR IMPROVING PAIN AND FUNCTION OF GRADE-II AND GRADE-III OSTEOARTHRITIS KNEE

10.36106/ijsr/6704648 ◽

2021 ◽

pp. 57-62

Author(s):

Nabarun Gupta ◽

Saumen Kumar De ◽

Rathindra Nath Haldar

Keyword(s):

Nerve Block ◽

Combined Therapy ◽

Womac Score ◽

Womac Pain ◽

Womac Pain Score ◽

Vas Score ◽

Osteoarthritis Knee ◽

Grade Ii ◽

Group 2 ◽

Group 1

Introduction: Osteoarthritis (OA) of knee joint is a degenerative joint disease; heterogeneous and progressive in nature. Clinically presented with stiffness, swelling and pain which leads to a decrease in the quality of life. The presence of chronic knee pain has been found to be a strong predictor of future disability and dependency in older adults. Usually managed conservatively but if conservative treatment fails, Total Knee Replacement (TKR) is traditionally considered. This is associated with multiple perioperative morbidities. On the contrary, many patients are not suitable for surgical procedure and some do not want to go for surgical intervention. As many patients are not surgical candidates due to co-morbidities or unwillingness; other treatment options available are being sought for. The genicular nerve block (GNB) reduces pain and improves patient functions by blocking pain transmission of the sensory nerves. Combining this genicular nerve block with viscosupplementation (Injection Hylan G-F 20) appears to play a role and can be tried in patients suffering in grade II and grade III (radiological grading) osteo arthritis. There is paucity of information so as to compare the efcacy of genicular nerve block and injection of Hylan G-F 20 versus genicular nerve block only. Material And Methods: This Parallel group open label randomized controlled trial was done between July, 2018 to December, 2019 (Eighteen months). Patients with knee pain in grade II and III, OA knee attending the PMR OPD in IPGME&R, Kolkata in the specied tenure was considered for the study. The selected patients were allotted by random table. All the procedures were performed by single person. A total number of 60 patients with knee osteoarthritis of grade II and III, who did not respond with conservative management were included. Combined therapy of intra-articular injection of Hylan G-F 20 and genicular nerve block in Group 1 (Genicular Nerve Block and Injection Hylan G-F 20) and Genicular Nerve Block only in Group 2, performed to 30 patients in each arm. The three branches of the genicular nerve [superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves] were selected. Patients were evaluated initially (0 week) and at the 4th and 12th week followed up after intervention using VAS and WOMAC scale. Ultrasound guided genicular nerve block conducted under strict asepsis after proper dressing and draping with the visualization of genicular nerves (upper medial, upper lateral and lower medial quadrant) by musculoskeletal probe of Ultrasound machine (SAMSUNG/ Model PT60A/Musculoskeletal probe 12MHz). Injection Hylan G-F 20 (6 ml) intra-articular injection was given under strict asepsis. Results: 47% patients in group 1 and 67% patients in group 2 were in between 60-69 years. There is female preponderance in both the groups. WOMAC-pain score for dual intervention at 4th week was statistically signicantly lower compared to WOMAC-pain score obtained at any time of observation and any type of intervention. WOMAC- stiffness score for dual intervention at 4th week was statistically signicantly lower compared to WOMAC- stiffness score obtained at any time of observation. WOMAC SCORE: The changes in each intervention group at 0-week, 4th week and 12th week were statistically signicant. Statistically signicant difference of two groups were lost during 4th and 12th weeks observation. VAS: During 4th and 12th weeks observation, statistically signicantly different VAS score was observed among the two interventions; Genicular nerve block with injection consistently had a lower VAS score. This nding imply that Genicular nerve block alone did reduce the pain; however, reduction was greater in case of Genicular nerve block with Injection Hylan G-F 20 in both 4th and 12th week of observation. Conclusion: Genicular Nerve Block with injection HYLAN GF 20 (Combined Therapy Group) and Genicular Nerve Block alone are effective method of pain reduction in osteoarthritis knee. Combined Therapy doesn't have an added advantage as per WOMAC Score. But Combined therapy has a denite advantage over Genicular Nerve Block alone as per VAS Score.

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Efficacy and safety of adalimumab by intra-articular injection for moderate to severe knee osteoarthritis: An open-label randomized controlled trial

Journal of International Medical Research ◽

10.1177/0300060517723182 ◽

2017 ◽

Vol 46 (1) ◽

pp. 326-334 ◽

Cited By ~ 17

Author(s):

Jianping Wang

Keyword(s):

Knee Osteoarthritis ◽

Global Assessment ◽

Controlled Trial ◽

Womac Pain ◽

Physician Global Assessment ◽

Efficacy And Safety ◽

Open Label ◽

Womac Pain Score ◽

Physical Function Score ◽

Pain Visual Analog Scale

Objective To evaluate the efficacy and safety of adalimumab (ADA) versus hyaluronic acid (HA) by intra-articular injection for moderate to severe knee osteoarthritis. Methods Fifty-six consecutive patients with moderate to severe knee osteoarthritis were randomly allocated to either the ADA group or HA group. On day 0, patients in the ADA group received 10 mg of ADA by intra-articular injection, while those in the HA group received 25 mg of HA. All patients received celecoxib at 200 mg/day for 4 weeks. The pain visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Patient Global Assessment (PGA), and Physician Global Assessment (PhGA) scores were assessed. Results At baseline, the pain VAS, WOMAC, PGA, and PhGA scores were similar between the two groups. The decrease in the pain VAS score, WOMAC pain score, WOMAC physical function score, and WOMAC total score from baseline to week 4 were greater in the ADA than HA group. A greater decrease in the PGA and PhGA scores from baseline to week 4 was noted in the ADA than HA group. No difference in adverse events was observed between the two groups. Conclusion ADA by intra-articular injection was effective and tolerated for moderate to severe knee osteoarthritis.

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