AB0981 Comparison of the efficacy of autologous conditioned serum and hyaluronic acid treatment in hip osteoarthritis

Abstract

Background In the synovial fluid of joints affected by osteoarthritis (OA),the concentration and molecular weight of hyaluronic acid (HA) is reduced,which negatively affects its viscoelastic properties and lubricity.In this regard,the possibility of stimulating β-cells of the synovial membrane of the joint in order to intensify production of own HA anabolic cytokines is of particular interest.At present two biotechnologies are used:autologous conditioned serum (ACS) and platelet-rich plasma (PRP),which reproduce the anabolic cytokines on the basis of platelet growth factors.In addition to platelet derived growth factors ACS consists of heigh levels of antiinflammatory cytokines IL-1Ra,IL-4,IL-10.IL-Ra may impede the implementation of pro-inflammatory and hondrodegenerative potential of IL-1b in OA Objectives The purpose of the study was a comparative assessment of the effectiveness of local therapy with ANS and HA of low molecular weight (synocrom forte) in patients with hip OA Methods 59 patients with hip OA at the age of 55,4±8,8 were included in the study.The basic group (ANS) accounted for 32 patients.The comparison group (HA) consisted of 27 patients.ACS made by the known method [1] and injected intra-articular 2.5 ml 2 times a week for 3 weeks.HA therapy consisted of 3 intra-articular injections of synocrom weekly.Efficacy of treatment was estimated after 1,3 and 6 months of treatment by the dynamics of the intensity of pain according to VAS,the section of “morning stiffness”, Womac and Lequesne Indexes. “Area under the curve” (AUC) with the assessement of the prolongation of effectiveness of treatment after 6 months (AUC6) was used to evaluate the prolongation of clinical effect Results Decrease in the intensity of pain in hip joints according to VAS after 1,3 and 6 months of treatment in both groups was fixed.However,more substantial regression of pain was observed after ACS treatment.After 1 month pain reduction according to VAS was comparable (9.1%,p=0.40),after 3 and 6 months pain intensity was higher in HA group vs ACS group (52.5%, p=0.009 and 33.1%, p=0.047,respectively).AUC6 after treatment with ACS was 309.2±80.8%*6 months,after the treatment with HA-199.1±219.8%*6 months (p=0.011). Prolongation of clinical effect in the section of “morning stiffness“ of Womac index of the AUC6 rate was better on ACS therapy-201.4±106.6%*6 months, than on HA therapy-88.7±168.1%*6 months (p=0.003).During ACS treatment functional scale of Womac index improved in all 3 control points (-23.1%,-28.5%,-39.1%, p=0.000).A similar dynamics was observed in HA group (-35.6%,-26.4%,P=0.000 and -20.4%, p=0.005).After 6 months of observation more significant improvement of joint function was fixed in ACS group vs HA group (18.3%,p=0.044).The overall clinical efficacy judging by Lequesne Index after six-month monitoring was comparable in both groups:201.8±114.9%*6 months in ACS group and 184.1±182.6%*6 months in HA group (p=0.65) Conclusions The severity of pain,stiffness,functional status and overall severity of clinical man...