Kim Ji Yeong, Kim Yoo Na, Lee Yu Jung, Sim Sung Eun, Ko Yu Ri, Shim Jin Woo, Lee Ku Sang, Joo Mina, Park Hue Jung
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Mapo Hapjung Bone Orthopedics, Seoul 06591, Korea.
J Clin Med. 2021 Mar 9;10(5):1138. doi: 10.3390/jcm10051138.
Degenerative arthritis of the knee joint has become a major social problem worldwide due to population aging. There are several treatment options for knee osteoarthritis, and the intraarticular injection of sodium hyaluronate is commonly selected by many clinicians as a nonsurgical treatment. However, the efficacy of the treatment is controversial. In this pilot study, we aimed to compare polynucleotide sodium (Conjuran) with sodium hyaluronate (Hyruan Plus) and 1,4-butanediol diglycidyl ether-crosslinked sodium hyaluronate (Synovian) in terms of analgesic efficacy after intraarticular injection in patients with knee osteoarthritis. One of the three intraarticular agents was selected according to what agents were available for outpatients when each patient was enrolled in the study. The 15 enrolled patients were subdivided into 3 groups of 5 patients each. Three injections were performed under ultrasound guidance at a 1-week intervals over a total of 3 weeks. The visual analog scale (VAS) score, the Korean version of the Western Ontario and McMaster Universities Arthritis Index (K-WOMAC), the EuroQol five-dimension scale (EQ-5D) score, and the Korean version of the painDETECT Questionnaire (K-PDQ) score were evaluated before injection and at 1, 2, and 6 weeks after the start of the treatment protocol. The primary endpoint was the change in weight-bearing pain at 4 weeks after the last injection. Secondary endpoints included pain at rest and during walking and the K-WOMAC, EQ-5D, and K-PDQ scores. Weight-bearing pain decreased significantly more from pretreatment to 6 weeks after the start of the treatment protocol in the polynucleotide sodium-treated patients than in the patients who were treated with other agents ( = 0.006, one-way ANOVA). There were no significant between-group differences in the other secondary endpoints. No adverse events occurred. In conclusion, polynucleotide sodium could effectively reduce weight-bearing pain in the patients with knee osteoarthritis compared to standard hyaluronic acid viscosupplementation.
由于人口老龄化，膝关节退行性关节炎已成为全球主要的社会问题。膝关节骨关节炎有多种治疗选择，关节腔内注射透明质酸钠是许多临床医生常用的非手术治疗方法。然而，该治疗方法的疗效存在争议。在这项初步研究中，我们旨在比较多核苷酸钠（Conjuran）与透明质酸钠（Hyruan Plus）以及1,4 - 丁二醇二缩水甘油醚交联透明质酸钠（Synovian）在膝关节骨关节炎患者关节腔内注射后的镇痛效果。根据每位患者入组研究时门诊可获得的药物，从三种关节腔内用药中选择一种。15名入组患者被分为3组，每组5名患者。在超声引导下每隔1周进行一次注射，共注射3周。在注射前以及治疗方案开始后的第1、2和6周评估视觉模拟量表（VAS）评分、韩国版西安大略和麦克马斯特大学骨关节炎指数（K - WOMAC）、欧洲五维健康量表（EQ - 5D）评分以及韩国版疼痛DETECT问卷（K - PDQ）评分。主要终点是最后一次注射后4周时负重疼痛的变化。次要终点包括静息和行走时的疼痛以及K - WOMAC、EQ - 5D和K - PDQ评分。与接受其他药物治疗的患者相比，多核苷酸钠治疗的患者从治疗前到治疗方案开始后6周时负重疼痛的减轻更为显著（单向方差分析，P = 0.006）。在其他次要终点方面，组间差异不显著。未发生不良事件。总之，与标准的透明质酸黏弹性补充疗法相比，多核苷酸钠可有效减轻膝关节骨关节炎患者的负重疼痛。
