title: Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis.
abstract: OBJECTIVE
  To assess the relation between knee osteoarthritis (KOA)-specific quality of life (QOL) and intra-articular cartilage volume (CV) in participants treated with prolotherapy. KOA is characterized by CV loss and multifactorial pain. Prolotherapy is an injection therapy reported to improve KOA-related QOL to a greater extent than blinded saline injections and at-home exercise, but its mechanism of action is unclear.
  
  
  METHODS
  Two-arm (prolotherapy, control), partially blinded, controlled trial.
  
  
  METHODS
  Outpatient.
  
  
  METHODS
  Adults with ≥3 months of symptomatic KOA (N=37).
  
  
  METHODS
  Prolotherapy: 5 monthly injection sessions;
  
  
  METHODS
  blinded saline injections or at-home exercise.
  
  
  METHODS
  Primary: KOA-specific QOL scores (baseline, 5, 9, 12, 26, and 52wk; Western Ontario and McMaster University Osteoarthritis Index). Secondary: KOA-specific pain, stiffness, function (Western Ontario McMaster University Osteoarthritis Index subscales), and magnetic resonance imaging-assessed CV (baseline, 52wk).
  
  
  RESULTS
  Knee-specific QOL improvement among prolotherapy participants exceeded that among controls (17.6±3.2 points vs 8.6±5.0 points; P=.05) at 52 weeks. Both groups lost CV over time (P<.05); no between-group differences were noted (P=.98). While prolotherapy participants lost CV at varying rates, those who lost the least CV ("stable CV") had the greatest improvement in pain scores. Among prolotherapy participants, but not control participants, the change in CV and the change in pain (but not stiffness or function) scores were correlated; each 1% CV loss was associated with 2.7% less improvement in pain score (P<.05).
  
  
  CONCLUSIONS
  Prolotherapy resulted in safe, substantial improvement in KOA-specific QOL compared with control over 52 weeks. Among prolotherapy participants, but not controls, magnetic resonance imaging-assessed CV change (CV stability) predicted pain severity score change, suggesting that prolotherapy may have a pain-specific disease-modifying effect. Further research is warranted.
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: david.rabago@fammed.wisc.edu.
authors.forename: David
authors.initials: D
authors.lastname: Rabago
authors.forename: Richard
authors.initials: R
authors.lastname: Kijowski
authors.forename: Michael
authors.initials: M
authors.lastname: Woods
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Patterson
authors.forename: Marlon
authors.initials: M
authors.lastname: Mundt
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zgierska
authors.forename: Jessica
authors.initials: J
authors.lastname: Grettie
authors.forename: John
authors.initials: J
authors.lastname: Lyftogt
authors.forename: Luke
authors.initials: L
authors.lastname: Fortney
mesh_terms: D000328:Adult; D000368:Aged; D002358:Cartilage, Articular / Q000473:pathology; D005081:Exercise Therapy; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D020370:Osteoarthritis, Knee / Q000473:pathology / Q000534:rehabilitation*; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000187:drug effects; D013549:Sweetening Agents / Q000008:administration & dosage*
chemical_list: D013549:Sweetening Agents; D005947:Glucose
keywords: BMI; CV; Cartilage; Dextrose; Injections; K-L; KOA; Kellgren-Lawrence; Knee osteoarthritis; MCII; MRI; Magnetic resonance imaging; QOL; RCT; Rehabilitation; WOMAC; Western Ontario McMaster University Osteoarthritis Index; body mass index; cartilage volume; knee osteoarthritis; magnetic resonance imaging; minimal clinically important improvement; quality of life; randomized controlled trial