Clinical outcomes are associated with changes in ultrasonographic structural appearance after platelet-rich plasma treatment for knee osteoarthritis.

BACKGROUND: Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two treatment options used for knee osteoarthritis (KOA) but studies comparing the efficacy of the two yield conflicting results. In addition, the association of clinical outcomes of PRP intra-articular injections with changes in the ultrasonography structural appearance of the knee has not been investigated. AIM: To compare the efficacy of PRP and HA intra-articular injections as mono-therapeutic options for primary KOA, and to determine whether the clinical outcomes are associated with changes in the ultrasonography structural appearance. SUBJECTS AND METHODS: A randomized clinical trial was conducted on 89 patients with KOA. The patients were given either PRP (n = 45) or HA (n = 44) intra-articular injections. The patients received three injections in the knee, which was more symptomatic at baseline evaluation, with a 2-week interval between injections. The outcome measures included visual analog score - pain, International Knee Documentation Committee Score, and assessment of synovial hypertrophy, synovial vascularity and knee effusion using ultrasonography. Outcome measures were assessed at baseline and at 3 and 6 months post-injection. RESULTS: While both PRP and HA injections resulted in the improvement of all outcome measures at 3 and 6 months follow up, they were significantly better in the PRP group than in the HA group. CONCLUSION: Intra-articular injection of PRP is an effective treatment that reduced pain and improved functional status in patients with KOA. The clinical outcomes of the intra-articular injections of PRP are associated with improved synovial hypertrophy and vascularity scores, and less effusion.

Depression in obese patients with primary fibromyalgia: the mediating role of poor sleep and eating disorder features.

Depression is a prominent feature in fibromyalgia syndrome. Patients with fibromyalgia syndrome who are obese, with poor sleep quality, and those who have recurrent episodes of binge eating are at greater risk to develop depression. The aim of this cross-sectional study was to examine the hypothesis that the relationship between obesity and depression in patients with primary fibromyalgia syndrome is mediated by poor sleep, binge eating disorder (BED), and weight and shape concern. This study included 131 patients with primary fibromyalgia syndrome. Participants completed the following questionnaires: Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, Eating Disorder questionnaire, and Fibromyalgia Impact Questionnaire. Body mass index (BMI) provided the primary indicator of obesity. Sobel test showed that the conditions for complete mediation were satisfied on the weight and shape concern as mediator between BMI and depression because the association between BMI and depression score became insignificant after controlling of weight and shape concern. However, since the association between BMI and depression remained significant after BED and poor sleep score were controlled, thus for both mediators, the conditions for partial mediation on the depression were satisfied. The findings suggest that in patients with primary fibromyalgia syndrome, weight and shape concern, BED, and poor sleep quality are important mediators of the relationship between obesity and depression. We suggest that a greater focus on these mediators in depression treatment may be indicated.