Background Osteoarthritis (OA) is a group of mechanical disorders leading to joint components degradation, including articular cartilage and subchondral bone. Incidence and prevalence of knee OA is rising by increasing average age of general population and increasing obesity (1). Treatment of knee effusion includes: rest, cold compresses, elevation, NSAIDS and aspiration (2). Spironolactone is a specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. (3).
Objectives Evaulation of low dose Spironolactone as a treatment for osteoarthritis related effusion using ultrasound and pain VAS.
Methods This study was carried out on 200 patients who aged 40 years or above with unilateral knee effusion related to osteoarthritis based on clinical examination, musculoskeletal ultrasonography (US) and synovial fluid analysis. Group 1 consisted of 50 patients received spironolactone 25 mg daily for 2 weeks, in group 2; 50 Patients took Ibuprofen 1200 mg daily for two weeks, in group 3; 50 patients used cold compresses two times daily for two weeks, and in group 4; 50 patients received placebo for the same time duration. Visual analog scale (VAS) for pain was done to the study participant at time 0 (baseline), after 2 weeks and after 4 weeks.
Results The mean age of the participants was 51.2±8.1 years. The mean duration of effusion was 16.5±3.6 days. In group 1, 66% had complete improvement, 20% partial improvement and 14% no response. In group 2, 24% had complete improvement, 12% partial improvement and 64% no response. In group 3, 28% had complete improvement, 14% partial improvement and 58% no response. In group 4, 6% had complete improvement, 10% partial improvement and 84% no response. VAS had a strong relation to fluid thickness as it decreased with the improvement of effusion and increased again among those patients who developed recurrence after 4 weeks.
Conclusions Low dose spironolactone is a safe and effective medical treatment for OA related knee effusion, especially in mild and moderate knee effusion.
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Acknowledgement We thank Professor Dr. Marina Backhaus for providing ultrasonography training course in the rheumatologic department at the Charité Universitätsmedizin, Berlin, Germany, and also Dr. May Hasan for recruiting patients for the study at the Sohag University in Egypt
Disclosure of Interest None declared