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Clinical Improvement of osteoarthritic knee pain by adding intra-articular steroid Injection to viscosupplementation

Author: Ahmed Latteef Al-Shamari
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2015 Volume: 14 Issue: 1 Pages: 51-57
Publisher: Al-Mustansyriah University الجامعة المستنصرية


Background: Intra-articular injections have been used for many years to treat painful joint disorders, especially by means of injecting crystalline suspensions of long-duration corticosteroids. Viscosupplementation, which is a relatively new intervention, consists of injection of exogenous hyaluronic acid into joints in order to treat osteoarthritis of knee joint. Patients and Methods: A prospective cohort study was conducted in a private orthopedic clinic in Baghdad from March 2013 to the end of September 2014, where it enrolled a total of fifty six (56) patients of middle ages, ranging from 39 to 64 years, classified as either grade II or III according to Kellgren and Lawrence radiographic criteria. Intra-articular injection of two drugs (a long acting steroid drug, then hyaluronic acid) were given locally in one or both knee joints with one week apart. To evaluate the effect of therapy, current study group patients were assessed by Visual Analogue Scale (VAS) after 1 week, and after 4-8 weeks from the beginning of the therapeutic trial. Results: more than two-third of cases were women (a ratio of 2.1:1), with age group of 50- 59 years old. No statistical correlation was found between Visual analogue scale (VAS) and radiographic grading (i.e. Kellgren and Lawrence radiographic criteria). Significant statistical difference (P<0.05) was shown in patients receiving intra-articular corticosteroids after week "1" of therapy, and a slightly better effect after adding hyaluronic acid on week "4" regarding the VAS scale of pain for radiographic grade II patients. Radiographic grade III patients showed a significant statistical correlation in VAS after week (4) of therapy for both moderate and severe classes. Conclusion: Intra-articular injections of both corticosteroids and hyaluronic acid with one week apart appear to give clinical improvement better than using Intra-articular injection of hyaluronic acid alone.

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