Background Osteoarthritis (OA), the most common form of arthritis, is a chronic disease characterized by slow degradation of cartilage, pain, and increasing disability. A local (as compared to a systemic) treatment for a painful osteoarthritic knee has obvious appeal.

Objectives The aim of this work was to compare the effect intra-articular Hyaluronate, bloodletting cupping, acupuncture and ultrasound when combined with static exercises in the treatment of primary OA of the knee.

Methods 80 patients with symptomatic primary OA of the knee participated in a randomized, blinded (outcome assessors), gender-matched prospective study involving clinical and radiologic assessment. They were diagnosed according to American College of Rheumatology criteria.

Exclusion criteria included: Severe OA, Secondary causes of OA, other causes of knee pain, OA with knee effusion, recent intra-articular steroid injection one month before the start of the study, intra-articular hyaluronate injection within six months before the start of the study. Degree of pain was assessed by Visual Analogue Scale (VAS) during walking and at rest and Lequesne's Pain Function Index (LPFI). Also, tenderness, jelling and medial Joint Space Width (JSW) were measured for all patients before, after treatment and after 3months follow up. Patients were not allowed to use any other medications during duration of the study.

Patients were classified into 4 groups according to the line of treatment: Group I: 20 patients received intra-articular Sodium hyaluronate (Hyalgan) single injection per week for 5 weeks. Group II: 20 patients received bloodletting cupping therapy single session/week for 5 weeks. Group III: 20 patients received acupuncture therapy every other day for 5 weeks. Group IV: 20 patients received continuous ultrasonic waves of 1 MHz frequency and 1 watt/cm² power, applied for 10 minutes to the knee every other day for 5 weeks. All patients practiced home exercise therapy (static) for the knee 5times/day.

Results Clinically, IA hyaluronate, cupping and acupuncture combined with exercises improved VAS during walking, at rest, tenderness, jelling and LPFI (P<0.001) after treatment and at the follow up compared with the results before treatment. Similarly, continuous ultrasound combined with exercises improved VAS during walking, at rest, tenderness, LPFI (P<0.05) and jelling (P<0.001) after treatment and at the follow up compared with the results before treatment.

It was observed that improvement in clinical parameters in hyaluronate group was higher than cupping, acupuncture and ultrasound groups after treatment and at follow up (P<0.05). On the other hand there was statistically insignificant difference between Cupping, acupuncture and ultrasound groups after treatment and at follow up (P>0.05).

Radiologically there was no statistically significant difference regarding the measurement of medial JSW in all groups (P>0.05). However there was statistically non-significant stoppage of progression of JS loss in patients who received hyaluronate, observed after treatment but not maintained after 3 months

Conclusions Our study demonstrated the efficacy of local therapy combined with exercises in improving pain and function in patients with mild to moderate knee OA. Both immediately after treatment and maintained for 3 months. Inter-group analysis showed superiority of IA hyaluronate

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.1130