title: Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain.
abstract: OBJECTIVE
  To assess the efficacy and safety of intra-articular injections of sodium hyaluronate combined with a home exercise program (HEP) in the management of pain associated with osteoarthritis (OA) of the knee.
  
  
  METHODS
  Single-blinded, parallel-design, 1-year clinical study with sequential enrollment.
  
  
  METHODS
  University-based outpatient physiatric practice.
  
  
  METHODS
  Sixty patients (18 men, 42 women; age, > or =50 y) with moderate-to-severe pain associated with OA of the knee.
  
  
  METHODS
  (1) Five weekly intra-articular hyaluronate injections (5-HYL); (2) 3 weekly intra-articular hyaluronate injections (3-HYL); or (3) a combination of an HEP with 3 weekly intra-articular hyaluronate injections (3-HYL+HEP).
  
  
  METHODS
  The primary outcome measure was a 100-mm visual analog scale for pain after a 50-foot walk (15.24 m). Secondary measures included the Western Ontario and McMaster Universities Osteoarthritis Index subscales.
  
  
  RESULTS
  The 3-HYL+HEP group had significantly faster onset of pain relief compared with the 3-HYL (P<.01) and 5-HYL groups (P=.01). All groups showed a mean symptomatic improvement from baseline (reduction in baseline pain at 3 mo was 59%, 49%, and 48% for the 3-HYL+HEP, 3-HYL, and 5-HYL groups, respectively) that was clinically and statistically significant. There were no between-group differences in the incidence or nature of adverse events.
  
  
  CONCLUSIONS
  The combined use of hyaluronate injections with HEP should be considered for management of moderate-to-severe pain in patients with knee OA.
authors.affiliation: Department of Physical Medicine & Rehabilitation, UMDNJ New Jersey Medical School, Newark, NJ 07103, USA. stitikto@umdnj.edu
authors.forename: Todd P
authors.initials: TP
authors.lastname: Stitik
authors.forename: Marcia F
authors.initials: MF
authors.lastname: Blacksin
authors.forename: Doreen M
authors.initials: DM
authors.lastname: Stiskal
authors.forename: Jong H
authors.initials: JH
authors.lastname: Kim
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Foye
authors.forename: Lisa
authors.initials: L
authors.lastname: Schoenherr
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Choi
authors.forename: Boqing
authors.initials: B
authors.lastname: Chen
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Saunders
authors.forename: Scott F
authors.initials: SF
authors.lastname: Nadler
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000368:Aged; D004334:Drug Administration Schedule; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010147:Pain Measurement; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid