Comparison between intra-articular Botulinum toxin type A, corticosteroid, and saline in knee osteoarthritis: a randomized controlled trial

Mendes, Jamille Godoy; Natour, Jamil; Nunes-Tamashiro, José Carlos; Toffolo, Sandra; Rosenfeld, André; Furtado, Rita Nely Vilar

doi:10.1177/0269215519827996

Cited by 33 publications

(25 citation statements)

References 28 publications

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“…It was also observable with different scores, as function or stiffness. Comparing TH to a saline injection, TH (40mg) had higher effectiveness than the placebo group in the four weeks in terms of pain in movement, pain scale, and ultra-sound measurement of synovial hypertrophy [70]. Treatment with 20mg or 40mg of TH produced equal relapse after six months in patients with chronic polyarthritis and when treating medium-sized joints.…”

Section: Plos Onementioning

confidence: 94%

The intra-articular administration of triamcinolone hexacetonide in the treatment of osteoarthritis. Its effects in a naturally occurring canine osteoarthritis model

Alves

Santos²,

Jorge³

et al. 2021

PLoS ONE

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Objective To evaluate the effect of an intra-articular (IA) administration of triamcinolone hexacetonide, compared with saline. Patients and methods Forty (N = 40) hip joints were randomly assigned to a treatment group (THG, n = 20, receiving IA triamcinolone hexacetonide) and a control group (CG, n = 20, receiving IA saline). On treatment day (T0), and at 8, 15, 30, 90 and 180 days post-treatment, weight distribution, joint range of motion, thigh girth, digital thermography, radiographic signs, synovial fluid interleukin-1 and C-reactive protein levels were evaluated. Data from four Clinical Metrology Instruments was also gathered. Results were compared Repeated Measures ANOVA, with a Huynh-Feldt correction, Paired Samples T-Test or Wilcoxon Signed Ranks Test. A Kaplan-Meier test was performed to compare both groups, with p<0.05. Results Joints were graded as mild (65%), moderate (20%) and severe (15%). Patients of both sexes, with a mean age of 6.5±2.4 years and bodyweight of 26.7±5.2kg, were included. No differences were found between groups at T0. Comparing THG to CG, weight distribution showed significant improvements in THG from 8 (p = 0.05) up to 90 days (p = 0.01). THG showed lower values during thermographic evaluation in the Lt view (p<0.01). Pain and function scores also improved from 30 to 180 days. Increasing body weight, age, and presence of caudolateral curvilinear osteophyte corresponded to worse response to treatment. Results of the Kaplan Meier test showed significant differences between groups, with THG performing better considering several evaluations and scores. Conclusion THG recorded significant improvements in weight-bearing and in with the considered CMIs, particularly pain scores. Lower thermographic values were registered in THG up to the last evaluation day. Age, sex, and radiographic findings did significantly influenced response to treatment.

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Section: Plos Onementioning

confidence: 94%

The intra-articular administration of triamcinolone hexacetonide in the treatment of osteoarthritis. Its effects in a naturally occurring canine osteoarthritis model

Alves

Santos²,

Jorge³

et al. 2021

PLoS ONE

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“…The analysis found that BoNT-A IA injection had a greater improvement than placebo in terms of the VAS pain scale and WOMAC questionnaire score in both the short-term and long-term treatment periods. Additionally, in the studies of Bao et al 16 and Mendes et al, 17 BoNT-A IA injection demonstrated an acceptable safety profile, with improvements in the Physical Component Summary-36, Mental Component Summary-36, and ultrasound measurement of synovial hypertrophy.…”

Section: Discussionmentioning

confidence: 93%

“…The intention-totreat analysis was shown in one study. 17 All of the included studies were of high quality, with a Jadad scores rating A ( Table 2). The plot was highly symmetrical and no evidence of bias was found ( Figure 2).…”

Section: Quality Of the Individual Studiesmentioning

confidence: 99%

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The efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis: a systematic review and meta-analysis

Zhai

Huang

2019

J Int Med Res

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Objective: A systematic review and meta-analysis was carried out to evaluate the efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis. Methods: The EMBASE and MEDLINE databases were searched to identify randomized controlled trials (RCTs) of Botulinum Toxin Type A in the treatment of painful knee osteoarthritis. The references of included literature were also searched. Results: Five articles involving 5 RCTs including 314 patients were included in this analysis. There was a significant difference between Botulinum Toxin Type A and placebo in the visual analog scale (VAS) pain scale and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) questionnaire score in both the short-term ( 4 weeks) and long-term (!8 weeks) treatment period. There were no serious adverse events in the Botulinum Toxin Type A groups. Conclusions: This meta-analysis suggests that Botulinum Toxin Type A is effective and safe in the painful knee OA treatment. However, high-quality randomized controlled studies are still needed to further confirm our findings.

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“…Although some primary studies showed some encouraging results for botulinum toxins, there were controversial results by other studies (17). Studies have shown better improvement in pain and function scores in short term, but there is a lack of evidence for long-term efficacy of BTX (18). According to different methods of physiotherapy interventions in KOA, modalities like local heat, TENS and pulsed ultrasound besides exercise therapy are effective in pain reduction and function of KOA patients (19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effects of Intra-articular Botulinum Neurotoxin Versus Physical Therapy in Knee Osteoarthritis

et al. 2021

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Background: Knee osteoarthritis (KOA) is the most common cause of chronic knee pain, and disability and different modalities have been used to improve pain and function. Botulinum toxin intra-articular injection is proposed to manage resistant joint pains. Objectives: This study was carried out to compare therapeutic effects of intra-articular botulinum neurotoxin (BTX) versus physical therapy (PT) in KOA. Methods: In this single-blind randomized clinical trial, patients with KOA attending to Imam-Reza Hospital, Tehran, Iran, from June 2018 to March 2019 were enrolled. Patients who met the inclusion criteria were randomly divided into BTX receiving a single intra-articular dose of 100 units (250 units from disport brand) and PT groups. The study was described for patients, and informed consent forms were received. For assessment of the pain and related severity, the VAS score and KOOS scales were used. Post-intervention assessment was done 1, 3, and 6 months after the intervention. The level of significance was set at α = 0.05. All data analyses were performed with SPSS version 26 for windows. Results: In this study, 50 patients were randomly divided into BTX and PT groups. All patients completed the study, and there was no loss to follow-up. There was no significant difference between demographic data of the two groups, including age and BMI. The VAS score was similar in the two groups at the beginning. KOOS subscales were not significantly different, but the quality of life was better in the BTX than the PT group (86.2 ± 15 vs. 72.1 ± 11.5, P < 0.001). One month after the intervention, all KOOS subscales were improved in the BTX group in comparison to the PT group (P < 0.001). This difference was statistically significant in the 3rd (P < 0.001 in all comparisons except Sport/Rec subscale in which P = 0.02) and 6th months (P < 0.001) after the intervention, and the improvement in all KOOS subscales and VAS score were higher in the BTX group than the PT group. The trend of KOOS subscales and VAS score was improved over time in the BTX (P < 0.001 in all tests), but the PT group showed no improvement (P > 0.05) except for Sport/Rec and VAS score (P < 0.001). Conclusions: Totally, it is concluded that the use of BTX can reduce pain and improve the function and quality of life in patients with KOA.

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Comparison between intra-articular Botulinum toxin type A, corticosteroid, and saline in knee osteoarthritis: a randomized controlled trial

Cited by 33 publications

References 28 publications

The intra-articular administration of triamcinolone hexacetonide in the treatment of osteoarthritis. Its effects in a naturally occurring canine osteoarthritis model

The intra-articular administration of triamcinolone hexacetonide in the treatment of osteoarthritis. Its effects in a naturally occurring canine osteoarthritis model

The efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis: a systematic review and meta-analysis

Therapeutic Effects of Intra-articular Botulinum Neurotoxin Versus Physical Therapy in Knee Osteoarthritis

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