Results of use of polyacrylamide gel Noltrexsin in patients with different grades of gonarthrosis in outpatient practice

Introduction. Osteoarthritis of the knee joints is the most common joint disease affecting more than 80% of people over 55 years of age. The priority method for the treatment of gonarthrosis is the use of local injection therapy with the introduction of synovial fluid endoprostheses based on hyaluronic acid, included in the Second Step of the ESCEO 2019 algorithm. Viscoelastic polyacrylamide gels for intra-articular administration since 2003 have also shown their high effciency in the symptomatic OA treatment. Since 2018, the new 3rd generation PAAG endoprosthesis of synovial fluid, Noltrexsin, has been actively used.Objective. To compare the efficacy and safety of Noltrexsin viscoprosthesis use with oral NSAIDs in patients with grade I-III of gonarthrosis.Materials and methods. 40 patients with gonarthrosis participated in a comparative study of the effcacy and safety of injection therapy Noltrexsin 4.0 ml No. 2 (study group, А) and oral administration of NSAIDs 200 mg per day (comparison group, В). NSAIDs were taken in groups A and B, the duration of therapy in both groups was 1 month. The results were evaluated by standard examination methods, including measuring the range of motion in the joint and scoring of physical signs, tests with walking up the stairs and at a distance, VAS, WOMAC, Lequesne Index.Results. In group А, a more signifcant reduction in pain according to VAS was revealed to 15–20 mm at the grade I–II of gonarthrosis and up to 25–30 mm in the grade III, a decrease in the Lequesne index to 1–2 and 3–4 points, respectively. In group В with a standard therapy, and then on-demand within 6 months, a decrease in VAS was revealed on the 8–9th day, and after 6 months the level of pain at the grade I–II did not exceed 20–25 mm, at the grade 3 it did not decrease below 40–45 mm. The Lequesne Index decreased to 2 points at the grade I–II and to 6–7 points at the grade III. Changes of WOMAC index correlated with VAS.Conclusions. 1. Noltrexsin can be used as a safe endoprosthesis of synovial fluid in the form of local injection therapy in patients with insufficient effect of chondroprotectors and NSAIDs. 2. Noltrexsin is recommended for use at all stages of arthrosis, as well as in comorbid patients.

Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review

Current non-surgical treatment for peripheral entrapment neuropathy is considered insignificant and unsustainable; thus, it is essential to find an alternative novel treatment. The technique of perineural injection therapy using 5% dextrose water has been progressively used to treat many peripheral entrapment neuropathies and has been proven to have outstanding effects in a few high-quality studies. Currently, the twentieth edition of Harrison’s Principles of Internal Medicine textbook recommends this novel injection therapy as an alternative local treatment for carpal tunnel syndrome (CTS). Hence, this novel approach has become the mainstream method for treating CTS, and other studies have revealed its clinical benefit for other peripheral entrapment neuropathies. In this narrative review, we aimed to provide an insight into this treatment method and summarize the current studies on cases of peripheral entrapment neuropathy treated by this method.