Objective: To assess the effects of dextrose prolotherapy in patients with knee osteoarthritis on the levels of serum cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen, and on the Western Ontario McMaster Universities Index and numerical rating scale score for pain. Methods: A randomized controlled trial, in which participants were randomly allocated into 2 groups, receiving injections of either hyaluronic acid or dextrose prolotherapy. The hyaluronic acid group received 5 injections, 1 each on weeks 1, 2, 3, 4 and 5, and the dextrose prolotherapy group received 3 injections, 1 each on weeks 1, 5 and 9. Serum cartilage oligomeric proteinase, urinary C-terminal telopeptide of type II collagen, Western Ontario McMaster Universities Index score, and numerical rating scale score for pain were measured at baseline and 3 weeks after the last injection. Comparative analysis was conducted using Wilcoxon test within groups and analysis of covariance (ANCOVA) test between groups. Results: A total of 47 participants (21 allocated to hyaluronic acid, 26 allocated to dextrose prolotherapy) completed the protocol. Both interventions resulted in significant improvements in numerical rating scale scores for pain, total Western Ontario McMaster Universities Index scores, and its subscales score. However, the dextrose prolotherapy outperformed hyaluronic acid in numerical rating scale score for pain and level of urinary C-terminal telopeptide of type II collagen, with score changes differences of 0.93 (p?=?0.042) and 0.34 (p?=?0.048), respectively. No significant changes in level of serum cartilage oligomeric proteinase were found in either group. Conclusion: Dextrose prolotherapy is an alternative injection therapy for knee osteoarthritis, which was found to be associated with a significant reduction in urinary C-terminal telopeptide of type II collagen compared with hyaluronic acid injection. Neither injection method resulted in reduced serum cartilage oligomeric proteinase.
Background:The clinical utility of cartilage oligomeric matrix protein (COMP) as a diagnostic and prognostic biomarker is currently under intense study. COMP has been associated primarily with musculoskeletal disorders such as rheumatoid and osteoarthritis (OA) or muscular and ligament trauma. Aside from its established role as a biomarker of arthritis, an increasing number of studies have also suggested the role of COMP in tumorigenesis, based on findings of its expression in breast, prostate, and colon cancers. Case Presentation: We described the case of a 61-year-old man with knee osteoarthritis and was prescribed physical therapy and a course of prolotherapy injection. We found elevated sCOMP levels in our patient (twice higher than average). After a month of followup, he was diagnosed with colorectal cancer. Conclusion:It makes us wonder about other conditions of the patients. There is no standard COMP parameter to differentiate OA patients from colorectal cancer patients, but it considers the increase is higher in colorectal cancer patients. We suggest to clinicians who use the COMP level to monitor OA condition to be aware of other conditions when the level is much higher than average OA patients.
Objective: Current treatments for osteoarthritis do not resolve the underlying cause. Dextrose prolotherapy is an alternative method that has been proposed for treatment of osteoarthritis, due to its ability to aid tissue regeneration, improve clinical manifestations, and repair damaged tissue structures, which are pathological conditions in osteoarthritis. The aim of this systematic review was to evaluate the efficacy of dextrose prolotherapy compared with other interventions in the management of osteoarthritis.Methods: Electronic databases PubMed, Google Scholar, Cochrane, and BioMed Central were searched from inception to October 2021. Search terms included [(prolotherapy) OR (prolotherapies) OR (dextrose prolotherapy)] AND [(osteoarthritis) OR (osteoarthritides) OR (knee osteoarthritis) OR (hip osteoarthritis) OR (hand osteoarthritis) OR (shoulder osteoarthritis)]. Randomized controlled trials that compared the use of dextrose prolotherapy with other interventions (injection, placebo, therapy, or conservative treatment) in the treatment of osteoarthritis were included. Potential articles were screened for eligibility, and data were extracted by all authors. Risk of bias was assessed using the Cochrane Risk of Bias tool. Study population, methods, and results data were extracted and tabulated by 3 authors.Results: 12 studies reported that DPT was as effective or even more effective in improving functional outcomes compared with other interventions whilst others found that HA, PRP, EP, and ACS were more effective. 14 studies assessed the effectiveness of DPT and ten of them reported that DPT was more effective in reducing pain compared with other interventions.Conclusion: Dextrose prolotherapy in osteoarthritis confers potential benefits for pain and functional outcomes, but this systematic review found that the studies to date are at high risk of bias. LAY ABSTRACTOsteoarthritis is a long-term chronic illness defined by the degeneration of cartilage in joints, causing bones to rub together and causing stiffness, discomfort, and decreased movement. Current treatment options for osteoarthritis do not address the fundamental cause. Dextrose prolotherapy is a potential alternative approach for OA, due to its capacity to help tissue regeneration, improve clinical symptoms, and repair damaged tissue structures, which are pathogenic in osteoarthritis. Despite several comparison studies, the superiority of dextrose prolotherapy in osteoarthritis remains equivocal due to contradictory outcomes. Based on this review, dextrose prolotherapy should be considered as a possible treatment for osteoarthritis.
AbstrakLatar Belakang: Terus meningkatnya prevalensi ruptur tendon dan belum adanya metode penanganan yang diunggulkan dalam menangani ruptur tendon achilles, sehingga pengembangan terapi alternatif banyak dikembangkan, salah satunya adalah proloterapi. Tujuan: mengetahui adakah perbedaan efektivitas proloterapi dan steroid terhadap kepadatan fibroblast pada terapi ruptur parsial tendon achilles tikus .Metodologi: Dua puluh tikus wistar dengan desain randomized post test only control group design, dibagi 4 kelompok, kelompok kontrol tanpa diberikan injeksi apapun, kelompok saline diberi injeksi saline, kelompok steroid diberi injeksi steroid, kelompok dekstrosa diberi injeksi dekstrosa. Terapi ini dilakukan pada tikus dengan memberikan injeksi sebanyak enam kali dengan interval pemberian tiap lima hari.Hasil penelitian: Nilai rerata kepadatan fibroblast paling rendah didapatkan pada kelompok steroid dengan nilai 1.00, sedangkan nilai rerata paling tinggi didapatkan pada kelompok dextrosa dengan nilai 2.00. Didapatkan adanya perbedaan yang bermakna antara injeksi steroid dibandingkan kontrol dan dextrose (nilai p masing-masing 0.014; 0.003)Kesimpulan: Injeksi dextrose intratendon lebih efektif dalam meningkatkan kepadatan fibroblast dibandingkan dengan injeksi steroid pada model ruptur tendon Achilles.
Background: Knee osteoarthritis (KOA) is a degenerative joint disease with relatively high prevalence globally and is one of the leading causes of disability in the elderly population. Dextrose prolotherapy (DPT) has been proven effective in improving functional outcomes in knee osteoarthritis. The effect of hypertonic dextrose on cartilage biomarkers has not been evaluated. Purpose: To evaluate the association between a cartilage biomarker and changes in clinical outcomes among patients with KOA who received dextrose prolotherapy (DPT). Patients and methods: This study was conducted with a cross-sectional design. Twenty-six participants received DPT at weeks 1, 5, and 9. Our primary measures were urinary c-terminal telopeptides of type II collagen (uCTX-II), measured by an enzyme-linked immunosorbent assay (ELISA), and the WOMAC score, measured at baseline and week 12. Results: There were significant improvements in all WOMAC subscales and uCTX-II levels after DPT. There is no significant correlation between biomarker levels with the WOMAC score as a functional outcome indicator in KOA after DPT (p > 0.05), but there are positive correlations between pain, functional, total WOMAC score, and uCTX-II. Conclusion: DPT may reduce cartilage degradation and improve functional outcomes in osteoarthritic knees. Significant drops in uCTX-II levels can affect functional outcomes, especially pain, functional and total WOMAC scores.
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