Categories
Change Password!
Reset Password!
Knee osteoarthritis (OA) is a chronic inflammatory disorder.
Reliable
predictive determinants that can distinguish patients who could best benefit
from intra-articular hyaluronic acid (IAHA) treatment include severe knee pain,
younger age, and less severe structural damage. These could be implemented in
clinical practice as a useful guide for physicians to plan the treatment.
Knee
osteoarthritis (OA) is a chronic inflammatory disorder. Various types of
treatments are recommended nowadays that primarily focus on two strategies: 1) achieving
relief from the symptoms and 2) significant improvement in the body functions.
The number of drugs in a different dosage form such as oral, topical, and
intra-articular therapies including acetaminophen, nonsteroidal
anti-inflammatory drugs (NSAIDs) are used as first-line treatment for OA.
Previous
studies have reported that IAHA injections are the most commonly prescribed
intra articular drugs for the treatment of OA. However, unanimity concerning
the usefulness of IAHA injections for the symptomatic treatment of knee OA is
not yet established. This may be attributed to the fact that the current
literature provides inconsistent results and conclusions about this treatment.
The
present study aimed to identify the determinants that best correlate with the
level of response to IAHA in patients with symptomatic knee OA
Rationale behind the research:
To overcome the controversy behind the inconsistent results and
conclusion about the use of IAHA for the knee OA treatment.
Objective:
To identify the determinants that best correlate with the level of
response to IAHA in patients with symptomatic knee OA.
Study outcomes measures:
Time period: T0 and T1
(6 months).
Study Outcomes:
A significant increase in the
average WOMAC pain at from the low pain group to the hgh pain group T0 was
reported. This result showed that the level of pain had slightly increased over
time. On the other hand, when it was analyzed by the group, the low and
moderate group showed an increase in WOMAC score while the hight pain group
showed a reduction in the score. There were significant differences between the
low and high pain groups, and between the moderate and high pain groups.
The proportion of participants
with a decrease in pain level ≥ 20% was highest in the high pain group and that
this group also had a significantly smaller percentage of participants with an
increase in pain. The number of participants taking glucosamine and chondroitin
sulfate was markedly lower in the High pain group than in the other two groups;
however, the number receiving steroid injections was significantly higher than
in the low pain group. No differences were observed for non-steroidal
anti-nflammatory drugs (NSAIDs) with or without analgesics or bone
anti-remodeling agents.
The participants with high WOMAC pain score were identified
as most critical patients for at least two reasons: 1) the level of pain is
clinically meaningful, and 2) the highest improvement was seen with IAHA
treatment in this group of participants. These participants’ data was further
divided into responders and nonresponders. Based on the level of change in the
WOMAC score following treatment: responders had a WOMAC pain score decrease
≥ 20%, and nonresponders had a stable or increased WOMAC pain score.
Also, the participant characteristics at T0 were not
significantly different between responders and nonresponders when adjusted for
age, sex, and body mass index (BMI). About the change in WOMAC score, the
differences between responders and nonresponders were highly significant. In
responders, about 50% participants
showed the reduction in WOMAC pain score. The reductions in WOMAC function,
stiffness, and total scores were less pronounced than the WOMAC pain, with a
similar proportion experiencing a reduction > 40%. The changes in the WOMAC
scores in the nonresponder group were positive, indicating, as expected, a
worsening of symptoms. Overall, there were no significant differences in the
use of concomitant arthritis medication between the low, moderate, and high
pain groups and no significant differences in such use were observed between
responders and nonresponders.
The finding of the currents study revealed that IAHA injections
could be useful not only for the symptomatic treatment of knee OA, but also to improve
the joint functions. Data suggested that IAHA injections could be effective for
a subset of OA patients. To our knowledge, this is the first time that a
longitudinal study of predictive variables showed an excellent response to IAHA
injection therapy.
Another key finding was the need to select the
responders to IAHA therapy using a cutoff point of at least 20% improvement in
WOMAC pain in a population that had a pain score of at least 8 out of 20. T0
pain score ≥ 8 was chosen as it corresponds to a level of symptoms that is
perceived as clinically meaningful for patients and, accordingly, was a part of
the inclusion criteria for many previous clinical trials. Here, such
participants demonstrated clinically significant results of identifying
predictors of response and optimizing patient stratification based on a
relatively small population. Although the pain improvement cutoff point of 20%
might seem somewhat arbitrary, it is well explained by the OMERACT group
definition of what minimal pain improvement should be in a responder.
Interestingly, this subgroup representing 41% of the responders had > 40%
pain improvement, a particular landmark that yielded even more clinical
importance. This subgroup, however, was too small to further identify
predictors of such excellent response to IAHA therapy.
These results may help physicians in treating patients with IAHA. Some guidelines based on systematic review of the randomized controlled trials data on IAHA concluded that, despite mixed results, the overall data support the efficacy of IAHA injections and recommend such therapy.
This study supports the usefulness of IAHA therapy, especially for
the knee OA patients with high levels of knee pain, younger age, higher BMI,
and less severe structural damage.
Reliable predictive determinants that can distinguish patients who
could best benefit from IAHA treatment include high levels of knee pain,
younger age, and less severe structural damage.
Arthritis Res Ther. 2018 Mar 1;20(1):40.
Exploring determinants predicting response to intra-articular hyaluronic acid treatment in symptomatic knee osteoarthritis: 9-year follow-up data from the Osteoarthritis Initiative
Jean-Pierre Pelletier et al.
Comments (0)