Background Inside the therapeutic algorithm of knee osteoarthritis (OA) it is included the Non-Arthroscopic Joint Lavage (NAJL) since around 1934 Burman reported that arthroscopies improved the symptoms. Current medical treatment strategies are aimed at pain reduction and symptom control rather than disease modification (1). The large variety of potentially interventions available has raised the need to assess their effectiveness.
Objectives To compare the short-term effectiveness among five treatment strategies in patients with symptomatic knee OA.
Methods An open, controlled, randomized prospective study involving 150 patients of whom 76.7% were females. The average age was 65.37±8.35. Patients had knee OA according to American College of Rheumatology criteria, with Kellgren-Lawrence radiographic grades II-III. They were randomly assigned to five groups of treatment, 1)NAJL (n=30), 2)NAJL+hyaluronic acid (HA) (n=32), 3)NAJL+ corticosteroid (CS) (n=32), 4)HA (n=31), and 5)CS (n=25). Evaluations took place at baseline, one and three months. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lequesne scores were recorded. Statistical analysis included mixed analysis of variance, with post-hoc comparisons with Sidak's adjustment, and multiple linear regression (MLR) to identify those possible factors associated to WOMAC total at 3 months.
Results Regarding WOMAC pain, significative differences were found in NAJL, at one month and at 3 months; and in NAJL+CS at one month. For WOMAC stiffness, there were significative differences in NAJL at one month and at 3 months; in NAJL+HA after one month and 3 months versus one month; and in NAJL+CS, at one month. For WOMAC function, significative differences were found in NAJL at one month and at three months; in NAJL+CS at one month; and in HA at 3 months. Regarding WOMAC total, significative differences were found in NAJL at one month (p<0.001) and at 3 months (p<0.001); and in NAJL+CS at one month (p=0.018). For Lequesne, significative differences were found in HA at one month (p=0.003) and at 3 months (p=0.019) versus baseline; and in CS, at one month (p<0.001). The WOMAC function at baseline, NAJL+HA, and infiltration with CS are the variables that show a significant association with WOMAC total at 3 months. The group that received NAJL+HA had poorer outcomes.
Conclusions One month after treatment, best outcomes were obtained with HA due to the results found in Lequesne scale when comparing HA versus NAJL+HA, and NAJL+CS. Three months after the treatment, the most effective modality treatment was NAJL; since we did find significant differences regarding articular stiffness, physical function and Lequesne scale. The treatment with NAJL+HA appears to be less effective than the other modalities.
Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J et al. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research Vol. 64, No.4, April 2012,pp 465–474.
Disclosure of Interest None declared