Assessment of knee function and biochemical parameters of articular fluid and peripheral blood in gonarthrosis patients following intra-articular administration of hyaluronic acid.

BACKGROUND: The development of gonarthrosis (GA) involves inflammatory processes; the role of reactive oxygen species (ROS) is being increasingly mentioned. The body is protected from oxidative damage by the antioxidative barrier with fundamental role being played by antioxidative enzymes, such as superoxide dismutase (SOD), catalase (CAT) and enzymes involved in glutathione transformations, particularly glutathione peroxidase (GPx). The methods of treatment of cartilage depend on the disease advancement, patient's reactions to pain, disease-related impairment in daily activities, as well as the age and overall health of the patient. Viscosupplementation involving intra-articular injection of agents that increase the viscosity of the articular fluid is aimed at reducing the friction between articular surfaces and thus at reducing pain and excessive wear of the remaining articular cartilage. The objective of the study was to examine whether intra-articular administration of a hyaluronic acid agent has any effect on the function of the knee and on the selected biochemical parameters of the articular fluid and blood in gonarthrosis, as well as to demonstrate of correlation or no correlation between the effects of viscosupplementation and administration of hyaluronic acid into a knee containing articular fluid or a "dry" knee. MATERIAL AND METHODS: The study group consisted of 22 gonarthrosis patients who received hyaluronic acid into the knee containing the articular fluid (group PS) as per the study protocol and 27 gonarthrosis patients who received hyaluronic acid into the "dry" knee (group PPI). The study lasted about 40 weeks and involved 10 visits at the study site. Hyaluronic acid was administered intra-articularly upon the first three visits held in one-week intervals, as well as on visit 4 (12 weeks after visit 3). The study knee was assessed clinically at all visits using the osteoarthritis WOMAC scale, visual assessment scale (0-10) for the assessment of pain intensity and HHS questionnaire for clinical assessment of the knee function. Blood for study-related analyses was collected at study start and 12 weeks after administration of the third dose of hyaluronic acid. The activity of superoxide dismutase (SOD) within the articular fluid and plasma and plasma levels of MDA were determined. Results Worse WOMAC-scale quality of life was observed in patients with osteoarthrosis and "dry" knee, mostly due to higher joint stiffness. Following viscosupplementation treatment, improvement in all tested WOMAC scores was observed in both groups, and no significant differences between groups was observed. The SOD activity and the MDA levels in plasma did not differ between the study groups, both before the study and after viscosupplementation. No statistically significant changes were observed in the biochemical parameters following viscosupplementation in both groups other than for reduced articular fluid MDA levels in the PS group. CONCLUSIONS: Viscosupplementation with hyaluronic acid administration is an effective method of conservative treatment in patients with gonarthrosis. Its beneficial effect consists mostly of pain reduction and knee function improvement both in patients with articular fluid present within the knee joints as in patients with "dry" knee joints.

Protein metabolism in the synovial membrane in the hip osteoarthritis.

BACKGROUND: Osteoarthritis (OA), and particularly osteoarthritis of the hip (coxarthrosis), together with hypertension and diabetes, belong to the most common lifestyle diseases. Usually the determination of a clear reason for the degenerative changes is impossible. However, the role of reactive oxygen species (ROS) that can affect the protein metabolism and thus cause the degradation of the joint connective tissue structures has been recently frequently pointed out. The aim of this study was to compare the activity of selected enzymes and albumin and protein level in the synovial membrane obtained during hip replacement surgery due to coxarthrosis. MATERIAL/METHODS: The reference group consisted of patients after traumatic femoral neck fracture, without osteoarthritis in the medical record. Collected sections of the synovial membrane were prepared for biochemical tests according to the authors' methodology. RESULTS: In the synovial membrane of patients with hip osteoarthritis significantly higher activity of superoxide dismutase (SOD) and glutamate dehydrogenase (GLDH) was observed, as well as increased activity of prolidase and lower activity of acid phosphatase activity compared with the reference group. The concentration of total protein and albumin in the synovial membrane was similar in both groups. CONCLUSIONS: Increased SOD activity indirectly indicates ROS participation in OA pathogenesis. Coexisting protein metabolism disorders of the synovial membrane may contribute to the degradation of the articular cartilage.

Evaluation of hyaluronic acid intra-articular injections in the treatment of primary and secondary osteoarthritis of the knee.

BACKGROUND: Osteoarthritis is one of the most common locomotor conditions and the knee is the second most frequently affected articulation. One of therapeutic methods is viscosupplementation involving intra-articular injections of hyaluronic acid preparations. The aim of the study was to evaluate the clinical status and analyse selected biochemical blood parameters in patients with knee osteoarthritis after intra-articular injections of a hyaluronic acid preparation. MATERIAL/METHODS: Blood was taken from 113 patients, 60 patients with primary and 53 patients with secondary osteoarthritis, who were administered intra-articular injections of a hyaluronic acid preparation into the affected knee, according to the schedule established in the study protocol. Concentration of lipid hydroperoxides in blood plasma was determined, along with that of malondialdehyde in erythrocytes. Plasma concentrations of ceruloplasmin, TAC, albumin, total bilirubin, and uric acid were also determined. Clinical assessment was performed using a modified HHS scale and the WOMAC questionnaire. RESULTS: Intra-articular administration of a hyaluronic acid preparation significantly reduced pain in the knee and improved its functioning, regardless of the form of osteoarthritis. Not only clinical improvement was observed, but also beneficial changes in the blood antioxidant system. CONCLUSIONS: Comparable clinical improvement was observed in both forms of osteoarthritis of the knee. It was also beneficial changes in blood antioxidant system, especially in the group with secondary osteoarthritis.