Changes in levels of cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen in subjects with knee osteoarthritis after dextrose prolotherapy: A randomized controlled trial

Abstract

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.

Hypertonic Dextrose Prolotherapy, an Alternative to Intra-Articular Injections With Hyaluronic Acid in the Treatment of Knee Osteoarthritis

“…Five clinical trials were included in the quantitative analysis. [24][25][26][27][28] The flowchart of the systematized search is shown in Figure 1.…”

“…HDP has also been reported to generate some adverse reactions such as pain, inflammation, and a stiffness feeling 9 . It was observed that in the studies that reported adverse reactions, 25,28,29 63.2% of individuals treated with HDP presented pain and inflammation vs. 46.0% of those treated with HA. Minor adverse reactions such as self-limiting pain and inflammation seem to be more common in individuals treated with HDP; no major adverse reactions or side effects occurred in any participant.…”

“…Only three studies reported adverse reactions. 25,28,29 Sanyal et al 25 reported self-limiting moderate pain in the 15 patients treated with HDP as well as in 5 of the 15 patients treated with HA. Erdem et al 29 reported self-limiting pain and inflammation in 2 of the 27 patients treated with HDP as well as in 3 of the 27 patients treated with HA.…”

“…Six studies [24][25][26][27][28][29] that compared HDP vs. IAI with HA were included. In the analysis of risk of bias with the Cochrane tool, all included clinical trials [24][25][26][27][28] had high risk of bias (Fig. 2).…”

“…To analyze the efficacy of HDP in pain reduction, a metaanalysis was performed including all clinical trials [24][25][26][27][28] in short-term follow-up. In the pooled analysis, no statistically significant differences were found in pain reduction between the groups treated with HDP and the HA groups (d = −0.94; 95% CI, −1.91 to 0.04; P (z) = 0.06, I 2 = 94%) (Fig.…”