DOI: https://doi.org/10.15674/0030-59872020261-67

The influence of different concentration of proFLEX® INTRA on clinical progression and dynamics of laboratory test values in different age patients with knee osteoarthrosis

Stanislav Bondarenko, Frieda Leontyeva, Dmytro Morozenko

Abstract


Introduction: application of hyaluronic acid gel for intraarticular administration is actual topic of modern orthopaedic concerning to its therapeutical efficacy. Objective: to assess the influence of different concentrations of proFLEX® INTRA on the synovial fluid and biochemical blood markers in patients with the 2nd knee osteoarthritis stage in the different age groups. Materials and methods: 30 patients with Kellgren–Lawrence stage II knee osteoarthritis were examined. The first group consisted of 15 patients aged 40–50 years, in the second group the average age of patients was 50–70 years. Each group was divided into 3 subgroups (a, b, c) of 5 patients. In each group the first subgroup of patients received intra-articular 1 injection of proFLEX® INTRA 10 mg/ml 2.0 ml, І-b, ІІ-b — 12 mg/ml 2.5 ml, І-с, ІІ-с — 20 mg/ml 3.0 ml. Results: an inflammatory-dystrophic process in the knee joint of patients was found in both groups, which was more expressed in elderly patients. The dynamics of blood markers in patients of the 1st and 2nd groups after the treatment showed a decreasing the level of inflammatory and dystrophic processes in the knee joints. In the 1st group 1 month after intra-articular injection, the content of glycoproteins and chondroitin sulfates (CS) decreased, did not reach the normative values. In subgroup II-c the level of glycoproteins and CS decreased, the concentration of interleukin-6 (IL-6) remained elevated comparing to subgroups II-a and II-b. Conclusions: it was found that patients with stage II knee osteoarthritis had increased CS and lower levels of hyaluronic acid in their synovial fluid. Markers of inflammation (glycoproteins and IL-6) and destruction markers (CS) in the blood serum changed unidirectionally and indicated a decreasing in the activity of inflammatory process after the injection of hyaluronic acid gel, which was clinically confirmed 1 month after intra-articular injection. In this case, the results after the reexamination of blood biomarkers of patients aged 40–50 years indicated a higher efficiency of hyaluronic acid gel injection with a concentration of 10 and 12 mg/ml, aged 50–70 years — a concentration of 20 mg/ml was confirmed by a decrease in the level of glycoproteins, CS and IL-6 in the blood of patients.

Keywords


knee osteoarthritis; blood biomarkers; synovial fluid; hyaluronic acid gel; intraarticular injection; aged patients

References


Dai, W., Lin, Z., Guo, D., Shi, Z., & Wang, J. (2018). Efficacy and safety of Hylan versus Hyaluronic acid in the treatment of knee osteoarthritis. The Journal of Knee Surgery, 32(03), 259-268. doi: 10.1055/s-0038-1641142

He, W., Kuang, M., Zhao, J., Sun, L., Lu, B., Wang, Y., … Ma, X. (2017). Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis. International Journal of Surgery, 39, 95-103. doi: 10.1016/j.ijsu.2017.01.087

Abate, M., Vanni, D., Pantalone, A., & Salini, V. (2015). Hyaluronic acid in knee osteoarthritis: Preliminary results using a four months administration schedule. International Journal of Rheumatic Diseases, 20(2), 199-202. doi: 10.1111/1756-185x.12572

Vyrva, O. Ye., & Ashukina, N. O. (2018). Hyaluronic acid drugs in the treatment of pathology of the musculoskeletal system (literature review). Orthopedics, traumatology and prosthetics, 1(610), 117-124. doi: 10.15674/0030-598720181117-124. [in Ukrainian]

Cooper, C., Rannou, F., & Richette, P. (2017). Use of intraarticular hyaluronic acid in the management of knee osteoarthritis in clinical practice. Arthritis Care & Research, 69(9), 1287-1296. doi: 10.1002/acr.23204

Ong, K. L., Runa, M., Xiao, Z., Ngai, W., Lau, E., & Altman, R. D. (2020). Severe acute localized reactions following intra-articular Hyaluronic acid injections in knee osteoarthritis. CARTILAGE, 194760352090511. doi: 10.1177/1947603520905113

Sirin, D., Kaplan, N., Yilmaz, I., Karaarslan, N., Ozbek, H., Akyuva, Y., … Mahirogullari, M. (2018). The association between different molecular weights of hyaluronic acid and CHAD, HIF-1α, COL2A1 expression in chondrocyte cultures. Experimental and Therapeutic Medicine. doi: 10.3892/etm.2018.5943

Kamyshnikov, V. S. (2009). Handbook of clinical and biochemical studies in laboratory diagnostics. Moscow: Medpress-inform. [in Russian]

Morozenko, D. V., & Leontieva, F. S. (2016). Methods of research of metabolic markers connective tissue in modern clinical and experimental medicine. Young scientist. 2(29), 168-172. [in Ukrainian]

Petrie, A. (2019). Medical Statistics at a Glance (4th Edition). Wiley-Blackwell

Maruschak, O. P. (2019). Diagnosis of early periprosthetic infection after knee and hip arthroplasty joints (clinical study): dissertation of PhD in Medical Sciences. Kharkiv. [in Ukrainian]

Filipenko, V. A., Leontieva, F. S., Morozenko, D. V., & Korzh I. V. (2012). The content of cytokines in the serum of osteoarthritis. Orthopedics, traumatology and prosthetics, 3, 52-55. doi: 10.15674/0030-59872012352-55. [in Ukrainian]

Miltner, O., Schneider, U., Siebert, C., Niedhart, C., & Niethard, F. (2002). Efficacy of intraarticular hyaluronic acid in patients with osteoarthritis—a prospective clinical trial. Osteoarthritis and Cartilage, 10(9), 680-686. doi: 10.1053/joca.2002.0815

Petrella, R. J., & Petrella, M. (2006). Prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee. The Journal of Rheumatology, 33, 951-956

Bannuru, R., Natov, N., Dasi, U., Schmid, C., & McAlindon, T. (2011). Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis – meta-analysis. Osteoarthritis and Cartilage, 19(6), 611-619. doi: 10.1016/j.joca.2010.09.014

Rutjes, A. W., Jüni, P., da Costa, B. R., Trelle, S., Nüesch, E., & Reichenbach, S. (2012). Viscosupplementation for osteoarthritis of the knee. Annals of Internal Medicine, 157(3), 180. doi: 10.7326/0003-4819-157-3-201208070-00473

Sun, S., Hsu, C., Hwang, C., Hsu, P., Wang, J., Tsai, S., … Wang, Y. (2006). Hyaluronate improves pain, physical function and balance in the geriatric osteoarthritic knee: A 6-month follow-up study using clinical tests. Osteoarthritis and Cartilage, 14(7), 696-701. doi: 10.1016/j.joca.2006.01.010

Gigis, I., Fotiadis, E., Nenopoulos, A., Tsitas, K., & Hatzokos, I. (2016). Comparison of two different molecular weight intra-articular injections of hyaluronic acid for the treatment of knee osteoarthritis. Hippokratia, 20(1), 26-31

Uçar, D., Dıraçoğlu, D., Süleyman, T., & Çapan, N. (2013). Intra-articular hyaluronic acid as treatment in elderly and middle-aged patients with knee osteoarthritis. The Open Rheumatology Journal, 7(1), 38-41. doi: 10.2174/1874312901307010038




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