Clinical comparison of oral administration and viscosupplementation of hyaluronic acid (HA) in early knee osteoarthritis.
OBJECTIVE
Osteoarthritis (OA) is a progressive, chronic and degenerative joint disease characterized by a loss of articular cartilage. Treatment of OA is largely palliative based on nonsteroidal anti-inflammatory drugs, opioids and injections of steroids. Regarding conservative treatment, intra-articular injections of hyaluronic acid (HA) can play a role in early symptomatic knee OA.


METHODS
Between August 2015 and September 2015, sixty patients (32 males and 28 females) between 40 and 70 years old were randomly allocated into two groups: Half were treated with three weekly intra-articular injections of hyaluronic acid 1.6 % (group A), while the others were treated with Syalox 300 Plus®(hyaluronic acid 300 mg + Boswellia serrata extract 100 mg) 1 tab/die for 20 days and afterward Syalox 150®(hyaluronic acid 150 mg) 1 tab/die for other 20 days (group B). All patients were evaluated clinically with American Knee Society Score (AKSS) and visual analogue scale (VAS) for the pain before the treatment and after 3 months.


RESULTS
AKSS of the patients in both groups was significantly increased by the treatment, and VAS score was significantly reduced. In both groups, two subgroups were created with patients older than 60 years and patients younger than 60 years. Better results are reported in younger patients of group A and older subjects in group B.


CONCLUSIONS
Despite several limitations, the results of the study have shown that HA injection and oral administration may have beneficial therapeutic effects on patients with early osteoarthritis. Different outcomes in younger and older subject suggested a combined therapy first with local infiltrations and then with oral composition.
Orthopedic and Traumatology Unit, Surgery Department, University of Verona, 37126, Polo Confortini, Verona, Italy.
M
M
Ricci
Orthopedic and Traumatology Unit, Surgery Department, University of Verona, 37126, Polo Confortini, Verona, Italy. gianmario.micheloni@libero.it.
G M
GM
Micheloni
Orthopedic and Traumatology Unit, Surgery Department, University of Verona, 37126, Polo Confortini, Verona, Italy.
M
M
Berti
Orthopedic and Traumatology Unit, Ospedale di Rovereto, Trento, Italy.
F
F
Perusi
Orthopedic and Traumatology Unit, Surgery Department, University of Verona, 37126, Polo Confortini, Verona, Italy.
E
E
Sambugaro
Orthopedic and Traumatology Unit, Surgery Department, University of Verona, 37126, Polo Confortini, Verona, Italy.
E
E
Vecchini
Orthopedic and Traumatology Unit, Surgery Department, University of Verona, 37126, Polo Confortini, Verona, Italy.
B
B
Magnan
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular / Q000379:methods; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage*
D055675:Viscosupplements; D006820:Hyaluronic Acid
Early knee osteoarthritis; Hyaluronic acid; Viscosupplementation
Ann Rheum Dis. 1957 Dec;16(4):494-502
13498604
J Agric Food Chem. 2008 Nov 26;56(22):10582-93
18959406
Arthritis Res Ther. 2008;10(4):R85
18667054
ScientificWorldJournal. 2012;2012:167928
23226979
Curr Opin Pharmacol. 2016 Jun;28:8-13
26921602
Exp Ther Med. 2010 Sep;1(5):817-827
22993606
Nutr J. 2016 Jan 05;15:1
26728196
J Orthop Res. 2008 Dec;26(12):1643-8
18524010
Mol Cell Biochem. 2011 Aug;354(1-2):189-97
21479939
Phytomedicine. 2003 Jan;10(1):3-7
12622457
J Bone Joint Surg Am. 2015 Dec 16;97(24):2047-60
26677239
Rheumatol Int. 2015 Jan;35(1):43-52
24899570
Osteoarthritis Cartilage. 2015 Jan;23(1):88-93
25246074
J Rheumatol Suppl. 1993 Aug;39:3-9
8410881
Rheum Dis Clin North Am. 2000 Aug;26(3):547-67
10989512
Int J Med Sci. 2011;8(7):615-22
22022214
Semin Arthritis Rheum. 2002 Aug;32(1):10-37
12219318
Arthritis Rheum. 2000 Sep;43(9):1905-15
11014340
Osteoarthritis Cartilage. 2005 Sep;13(9):769-81
15978850
Int J Med Sci. 2010 Nov 01;7(6):366-77
21060724