ABSTRACT
Background: Osteoarthritis (OA) is the most common type of rheumatic disease and a leading cause of disability. Current treatments aim at alleviating these symptoms by several different methods: non-pharmacological and pharmacological treatments and invasive interventions. Among the regenerative methods, hyaluronic acid (HA) is popular now-a-days where differences exist in concentration, molecular weight, dosage, expected duration of effects and added formulations. Based on HA molecular weight, these products are classified in two groups (high and low). Due to cost effectiveness, low molecular weight HA is commonly used. To find out the outcome of single intra-articular injection of high-molecular- weight HA in patients with knee osteoarthritis.Material & Methods:This was a randomized clinical trial conducted among purposively selected 55 patients suffering from Knee OA attending at the Physical Medicine and Rehabilitation outpatient department, DMCH during July 2020 to June 2021. Patients were randomly allocated into two groups; group A received single dose of high molecular weight HA and designed exercise program and group B received same exercise program only. Pre-treatment and 3 weekly post treatment assessment were done up to 12 weeks in each group. In each follow up visit, pain, and functional status were measured in Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) respectively and compared between group A and group B where was considered as significant (p value <0.050.Results:The mean age of the participants in group A and group B were 56.8 (±9.8) and 53.3 (±7.4) years respectively where majority of the patients in both groups were female patients with overweight. In group A, VAS and WOMAC significantly decreased from base line to each follow up till 12th weeks after treatment with high-molecular-weight HA (P<0.001). In group B, VAS and WOMAC significantly decreased from base line to each follow up till 12th weeks after treatment with conservative management (P<0.001). After 6 weeks of intervention, the mean VAS scores of the patients became 4.9 ±1.1 and 6.0±1.0 in group A and group B respectively which showed significant statistical difference (P<0.001). At the end of 12 weeks, the VAS score was significantly decreased in group A (2.8±1.3) than group B (4.9±1.7) (P<0.001). After 3 weeks of intervention, the mean WOMAC scores of the patients became 71.2±6.6 and 75.0 ±4.9 in group A and group B respectively which showed significant statistical difference (P<0.001). At the end of 12 weeks, the WOMAC score was significantly decreased in group A (61.9±6.6) than group B (68.1±4.6) (P<0.001). Conclusion:Single intra-articular injection of high-molecular-weight Hyaluronic Acid is effective in patients with knee osteoarthritis in reducing pain and improving functional impairment. Long term and large scale research studies are needed to establish the effectiveness and safety of this procedure in patients with knee osteoarthritis.
ABSTRACT
OBJECTIVE: In this study, we aimed to assess the health-related quality of life (HRQOL), to evaluate the relationship between HRQOL, and various factors in Korean patients with osteoarthritis (OA). METHODS: The HRQOL and clinical and laboratory parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO) and standard gamble (SG) using computer software, Centers for Epidemiologic Studies Depression (CES-D), social support, self-efficacy scale, Western Ontario and McMaster Universities (WOMAC), functional class, and radiological grading, respectively, in 103 outpatients with OA. And the data of the SF-36 and EQ-5D in OA patients were compared with those in 228 healthy controls. RESULTS: Of the 103 subjects, 99 (96.1%) were women with a mean age of 61.1?6.7 years. The mean year of disease duration was 9.44+/-7.44. The mean scores of SF-36 global, mental component summary (MCS) and physical component summary (PCS) were 51.5?20.6, 61.6?26.6 and 47.1?24.1, respectively. The mean EQ-5D utility and visual analog scale (VAS) scores were 0.56+/-0.26 and 60.0+/-17.3, respectively. The mean scores of the TTO and SG were 0.74+/-0.22 and 0.60+/-0.31, respectively. The mean scores of CES-D, self-efficacy scale, social support and social network were 9.52+/-5.67, 60.6+/-16.0, 2.32+/-0.22, and 2.01+/-0.66, respectively. The mean scores of WOMAC pain, stiffness and function were 28.8+/-15.4, 6.08+/-3.79, and 2.17+/-1.92, respectively. In the correlations analysis among health-related quality of life and other variables, the cores of KWOMAC, CES-D, and self-efficacy showed the good correlation with the scores of SF-36 and EQ-5D. In multivariate models, the statistically significant variables of SF-36 global and PCS were KWOMAC, and the statistically significant variables of SF-36 MCS were marital status and KWOMAC. CONCLUSION: This study shows that HRQOL in Korean patients with osteoarthritis is significantly lower than healthy control. Among the variables, only the WOMAC was significantly correlated with HRQOL. Therefore, the efforts to improve HRQOL should be focused on controlling the disease activity and on improving the functional state.