Effectiveness of 3 Weekly Injections Compared With 5 Weekly Injections of Intra-Articular Sodium Hyaluronate on Pain Relief of Knee Osteoarthritis or 3 Weekly Injections of Other Hyaluronan Products: A Systematic Review and Meta-Analysis

Stitik, Todd P.; Issac, Sony M.; Modi, Simple; Nasir, Saad; Kulinets, Irina

doi:10.1016/j.apmr.2017.01.021

Cited by 24 publications

(16 citation statements)

References 24 publications

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“…Based on this information, a possible explanation of paininhibition by BoNT-A is that it reduces the release of neurotransmitters, such as substance P and others, thus blocking the pain signal pathway. Hyaluronate, which is a lubricant, may exert its effect by reducing bone friction and protecting cartilage tissues (32).…”

Section: Mechanism Of Effect Of Bont-a and Hyaluronatementioning

confidence: 99%

Effect of therapeutic exercise on knee osteoarthritis after intra-articular injection of botulinum toxin type A, hyaluronate or saline: A randomized controlled trial

Bao¹,

Tan²,

Flyzik³

et al. 2018

J Rehabil Med

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Section: Mechanism Of Effect Of Bont-a and Hyaluronatementioning

confidence: 99%

Effect of therapeutic exercise on knee osteoarthritis after intra-articular injection of botulinum toxin type A, hyaluronate or saline: A randomized controlled trial

Bao¹,

Tan²,

Flyzik³

et al. 2018

J Rehabil Med

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“…According to the ACR guidelines, acupuncture is conditionally recommended for KOA for its pain relief, affordability, and safety [15][16][17][18]. In addition, hyaluronic acid products, commonly used as alternative intraarticular injection and recommended by the Food and Drug Administration for treatment of KOA in 1997 [19], have the function of viscoinduction properties and increasing intraarticular lubrication, inhibiting inflammatory mediators and promoting repair of cartilage to delay the progression of KOA [20,21]. Altman et al [22] has reported that HA injections are generally well tolerated, provide a longer duration of symptomatic relief, and improve knee function for patients with knee OA.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture Therapy plus Hyaluronic Acid Injection for Knee Osteoarthritis: A Meta‐Analysis of Randomized Controlled Trials

Zheng

Duan

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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Objective. This meta-analysis aimed to investigate the effectiveness of acupuncture therapy plus hyaluronic acid injection versus hyaluronic acid injection alone for patients with knee osteoarthritis. Methods. Relevant randomized controlled trials that compared the combined effect of acupuncture therapy and hyaluronic acid injection with hyaluronic acid injection alone for knee osteoarthritis patients were included. 10 studies were included in this meta-analysis, and the relative risk (RR) and weight mean difference (MD) with 95% CI for the Lysholm knee score (LKSS), visual analogue scale (VAS), and effective rate (ER) were evaluated by using RevMan 5.3 software. Besides, the bias assessment of the included studies was evaluated using the Cochrane risk of bias tool, and the GRADE (Grading of Recommendations, Assessment Development, and Evaluation) system was applied to assess the overall quality of the evidence. Results. A total of 10 studies involving 998 participants were included in this study. Compared to hyaluronic acid injection alone, the combined therapy significantly reduced pain on the visual analogue scale (VAS) and improved the ER and knee function on the Lysholm knee score (LKSS). Of these, the pooled LKSS (MD = 8.09, 95% CI = [7.02, 9.16], p<0.00001, 7 studies) and ER (RR = 1.23, 95% CI 1.15 to 1.31, p<0.00001, 8 studies) suggested that combination therapy yielded a significantly higher ER and improved the LKSS scores to a greater degree than hyaluronic acid injection alone in patients with KOA. The VAS (MD = −1.39, 95% CI = [−1.99, −0.79], p<0.00001, 7 studies) showed that the combined therapy significantly reduced pain than hyaluronic acid injection alone. The quality of evidence for the main outcomes was from very low to low according to the GRADE system. Conclusion. Current evidence suggests that acupuncture therapy combined with hyaluronic acid injection is more effective in alleviating pain, improving the ER and knee function compared with hyaluronic acid injection alone. However, considering the low quality, small size, and high risk of the studies identified in this meta-analysis, more higher methodological quality, rigorously designed randomized controlled trials with large sample sizes are needed to confirm the results.

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“…Knee and hip OA are the two most prevalent types of OA in the elderly population [3]. OA is characterized by the disruption of articular cartilage and loss of viscoelastic properties of the synovial fluid [4]. OA has been classified as noninflammatory arthritis because of the presence of fewer leukocytes in the synovial fluid than that observed in rheumatoid arthritis, reactive arthritis, and septic arthritis [5].…”

Section: Introductionmentioning

confidence: 99%

Increased risk of knee osteoarthritis in patients using oral N-acetylcysteine: a nationwide cohort study

Yeh

Liang

Chang

et al. 2020

BMC Musculoskelet Disord

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Background: Knee osteoarthritis (OA) is known to be a progressive degenerative disorder; however, recent evidence suggests that inflammatory mediators contribute to cartilage degradation. Studies have reported that Nacetylcysteine (NAC) had a promising effect on the reduction of the synthesis of proinflammatory and structural mediators by synovial cells. Given the lack of relevant clinical trials, we conducted this study to determine the relationship between NAC use and risk of knee OA. Methods: We designed a retrospective cohort study from 2000 to 2013. Patients who received oral NAC over 28 days within 1 year after the first prescription were defined as the case group, whereas those without NAC use were considered as candidates of the control group. We adopted 1:4 propensity-score matching by age, sex, index year, and comorbidities to obtain the control group. The primary outcome was a new diagnosis of knee OA during the follow-up period. Results: Our study sample comprised 12,928 people who used NAC and 51,715 NAC nonusers. NAC users had a significantly higher incidence of osteoarthritis (adjusted hazard ratio: 1.42, P < .001) than did NAC nonusers. Also, in analyses stratified by age group and sex, all subgroups exhibited a significantly higher incidence of knee osteoarthritis (P < .0001) among NAC users than among NAC nonusers. The use of oral NAC was associated with nearly four-fold increased the risk of knee OA in the young age group. Conclusions: Long-term use of oral NAC is associated with a higher risk of knee OA.

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Effectiveness of 3 Weekly Injections Compared With 5 Weekly Injections of Intra-Articular Sodium Hyaluronate on Pain Relief of Knee Osteoarthritis or 3 Weekly Injections of Other Hyaluronan Products: A Systematic Review and Meta-Analysis

Cited by 24 publications

References 24 publications

Effect of therapeutic exercise on knee osteoarthritis after intra-articular injection of botulinum toxin type A, hyaluronate or saline: A randomized controlled trial

Effect of therapeutic exercise on knee osteoarthritis after intra-articular injection of botulinum toxin type A, hyaluronate or saline: A randomized controlled trial

Acupuncture Therapy plus Hyaluronic Acid Injection for Knee Osteoarthritis: A Meta‐Analysis of Randomized Controlled Trials

Increased risk of knee osteoarthritis in patients using oral N-acetylcysteine: a nationwide cohort study

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