Inyección de plasma rico en plaquetas y hexadecilamida de hialuronato sódico, por separado y en combinación, para la osteoartritis de rodilla. Estudio controlado aleatorizado en condiciones de práctica clínica real

  1. Luis Miguel Torres Morera 1
  2. Tatiana Gómez Sánchez 2
  3. Francisco Arroyo 2
  4. Diego Benítez 2
  5. José Manuel Trinidad 2
  6. Rogelio Sánchez de la Mata 3
  7. Enrique Calderón 2
  1. 1 Universidad de Cádiz
    info

    Universidad de Cádiz

    Cádiz, España

    ROR https://ror.org/04mxxkb11

  2. 2 Hospital Puerta del Mar
  3. 3 Hospital Universitario de Puerto Real
    info

    Hospital Universitario de Puerto Real

    Puerto Real, España

    ROR https://ror.org/04fbqvq73

Revista:
MPJ Multidisciplinary Pain Journal

ISSN: 2697-2263

Año de publicación: 2022

Número: 1

Tipo: Artículo

Otras publicaciones en: MPJ Multidisciplinary Pain Journal

Resumen

Introduction: Osteoarthritis (OA) is a degenerative joint disease that often affects the knees. In Spain almost 5 million people have been diagnosed with knee OA. Hyaluronic acid (AH) injections are clinically used to mitigate decreased endogenous AI functions of OA patients, where condral degeneration predominates. Platelet Rich Plasma (PRP) considered as a drug, by the Spanish Medicines Agency, is the most commonly drug related to AH in the treatment of OA, which has been shown to recruit endogenous stem cells and allow the regeneration of de novo tissue. Method: The purpose of the study has been to first compare the therapeutic efficacy of autologous PRP, sodium hyaluronate hexadecilamide (Hymovis®), or a combination of both (PRP+AH) in knee OA, under real clinical conditions. Results: Patients suffering from knee OA with a pain intensity at the beginning of >40 were included on a visual analog scale (VAS) of 100 mm. 109 patients (62 women and 47 men) between the age of 35 and 81 were included, of whom 101 ended the 1-year follow-up. All were treated on an outpatient basis. The groups were homogeneous. The primary goal outcome measure was a change in pain intensity evaluated by VAS at 2, 6 and 12 months after treatment. Secondary results were the result of the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), Womac rigidity (0-10) Womac functional capacity (0-68) test. Measurements were performed double-blindly. In the 3 groups positive results were obtained, in the PRP+AH group the largest reductions in pain and the highest of functional capacity were obtained. Discussion: Our results indicate that intraarticular injections of PRP and hexadecilamide of sodium hyaluronate, alone or in combination, offer significant clinical improvement in knee OA patients with no relevant side effects. The benefit was significantly stable in all 3 groups during the 12 months of follow-up. The combination of PRP + AH led to the best results in pain and mobility.

Referencias bibliográficas

  • Berenbaum F. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthr Cartil. 2013;21(1):16-21. DOI: 10.1016/j.joca.2012.11.012.
  • Blanco FJ, Silva-Díaz M, Quevedo Vila V, Seoane-Mato D, Pérez Ruiz F, Juan-Mas A, et al; en representación del Grupo de Trabajo del Proyecto EPISER2016. Prevalence of symptomatic osteoarthritis in Spain: EPISER2016 study. Reumatol Clin (Engl Ed). 2020:S1699-258X(20)30023-1. DOI: 10.1016/j.reuma.2020.01.008. DOI: 10.1016/j.reuma.2020.01.008.
  • Moskowitz RW. The burden of osteoarthritis: clinical and quality- of-life issues. Am J Manag Care. 2009;15(8 Suppl):S223-S229.
  • Puig-Junoy J, Ruiz Zamora A. Socio-economic costs of osteo- arthritis: a systematic review of cost-of-illness studies. Semin Arthritis Rheum. 2015;44(5):531-41. DOI: 10.1016/j.semarthrit.2014.10.012.
  • Herrero-Beaumont G, Roman-Blas JA, Bruyère O, Cooper C, Kanis J, Maggi S, et al. Clinical settings in knee osteoarthritis: pathophysiology guides treatment. Maturitas. 2017; 96:54-7. DOI: 10.1016/j.maturitas.2016.11.013.
  • Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137-62. DOI: 10.1016/j.joca.2007.12.013.
  • Center for Disease Control and Prevention [Internet]. Fact Sheet; 2021. Disponible en:https://www.cdc.gov/arthritis/basics/osteoarthritis.htm. Accessed 24 May 2021
  • Bowman S, Awad ME, Hamrick MW, Hunter M, Fulzele S. Recent advances in hyaluronic acid based therapy for osteoarthritis. Clin Trans Med. 2018;7(1):6. DOI: 10.1186/s40169-017-0180-3.
  • Oe M, Tashiro T, Yoshida H, Nishiyama H, Masuda Y, Maruyama K, et al. Oral hyaluronan relieves knee pain: a review. Nutr J. 2015; 15:11. DOI: 10.1186/s12937-016-0128-2.
  • Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthri- tis Res Ther. 2003;5(2):54-67. DOI: 10.1186/ar623.
  • Cooper C, Rannou F, Richette P, Bruyère O, Al-Daghri N, Altman RD, et al. Use of intraarticular hyaluronic acid in the management of knee osteoarthritis in clinical practice. Arthritis Care Res (Hoboken). 2017;69(9):1287-96. DOI: 10.1002/acr.23204.
  • Priano F. Early Efficacy of Intra-Articular HYADD® 4 (Hymovis®) Injections for Symptomatic Knee Osteoarthritis. Joints. 2017;5(2):79-84. DOI: 10.1055/s-0037-1603677.
  • Nguyen C, Rannou F. The safety of intra-articular injections for the treatment of knee osteoarthritis: a critical narrative review. Expert Opin Drug Saf. 2017;16(8):897-902. DOI: 10.1080/14740338.2017.1344211.
  • Vad VB, Sakalkale D, Sculco TP, Wickiewicz TL. Role of hylan G-F 20 in treatment of osteoarthritis of the hip joint. Arch Phys Med Rehabil. 2003;84(2):1224-6. DOI: 10.1016/S0003-9993(03)00140-0.
  • Battaglia M, Guaraldi F, Vannini F, Rossi G, Timoncini A, Buda R, et al. Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoar- thritis. Orthopedics. 2013;36(12):e1501-e1508. DOI: 10.3928/01477447-20131120-13.
  • Dallari D, Stagni C, Rani N, Sabbioni G, Pelotti P, Torricelli P, et al. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a Randomized Controlled Study. Am J Sports Med. 2016;44(3):664-71. DOI: 10.1177/0363546515620383.
  • Han Y, Huang H, Pan J, Lin J, Zeng L, Liang G, et al. Meta-analysis. comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis. Pain Med. 2019;20(7):1418-29. DOI: 10.1093/pm/pnz011.
  • Di Martino A, Di Matteo B, Papio T, Tentoni F, Selleri F, Cenacchi A, et al. Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: results at 5 years of a double-blind, randomized controlled trial. Am J Sports Med. 2019;47(2):347-54. DOI: 10.1177/0363546518814532.
  • Zhao J, Huang H, Liang G, Zeng LF, Yang W, Liu J. Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2020;21(1):224. DOI: 10.1186/s12891-020-03262-w.
  • Bansal H, Leon J, Pont JL, Wilson DA, Bansal A, Agarwal D, et al. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Sci Rep. 2021;11(1):3971. DOI: 10.1038/s41598-021-83025-2. 21. Moussa M, Lajeunesse D, Hilal G, El Atat O, Haykal G, Serhal R, et al. Platelet-rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-Infammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Exp Cell Res. 2017;352(1):146-56. DOI: 10.1016/j.yexcr.2017.02.012.
  • 22. Torres LM, García-Palacios M, Benítez D, Eizaga R, López-López J, Sánchez de las Matas R, et al. Tratamiento con la administración intradiscal de plasma rico en plaquetas para dolor crónico discogénico cervical y lumbar. MPJ. 2021;1. DOI: 1020986/mpj20211001/2021.
  • 23. Raeissadat SA, Rayegani SM, Babaee M, Ghorbani E. The effect of platelet-rich plasma on pain, function, and quality of life of patients with knee osteoarthritis. Pain Res Treat. 2013;2013:165967. DOI: 10.1155/2013/165967.
  • 24. Cubukçu D, Ardiç F, Karabulut N, Topuz O. Hylan G-F 20 efficacy on articular cartilage quality in patients with knee osteoarthritis: clinical and MRI assessment. Clin Rheumatol. 2005;24(4):336-41. DOI: 10.1007/s10067-004-1043-z.
  • 25. Vad VB, Sakalkale D, Sculco TP, Wickiewicz TL. Role of hylan G-F 20 in treatment of osteoarthritis of the hip joint. Arch Phys Med Rehabil. 2003;84(8):1224-6. DOI: 10.1016/S0003-9993(03)00140-0.
  • 26. Piccirilli E, Oliva F, Murè MA, Mahmoud A, Foti C, Tarantino U, et al. Viscosupplementation with intra-articular hyaluronic acid for hip disorders. A systematic review and meta-analysis. Muscles Ligaments Tendons J. 2016;6(3):293-9. DOI: 10.32098/mltj.03.2016.04.
  • 27. Chang KV, Hsiao MY, Chen WS, Wang TG, Chien KL. Effectiveness of intra-articular hyaluronic acid for ankle osteoarthritis treatment: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94(5):951-60. DOI: 10.1016/j.apmr.2012.10.030.