Combination Therapy with Sodium Hyaluronate and Chondroitin Sulfate for Knee Osteoarthritis
Authors:   V.A. Nasonova Scientific and Research Institute of Rheumatology, Alekseeva L.I. ,   Moscow, Russian Federation,   Russian Medical Academy of Continuous Professional Education at the Ministry of Health of the Russian Federation; Moscow, Russian Federation, Kashevarova N.G. ,   V.A. Nasonova Scientific and Research Institute of Rheumatology; Moscow, Russian Federation, Taskina E.A. ,   V.A. Nasonova Scientific and Research Institute of Rheumatology; Moscow, Russian Federation, Strebkova E.A. ,   V.A. Nasonova Scientific and Research Institute of Rheumatology; Moscow, Russian Federation, Sharapova E.P. ,   V.A. Nasonova Scientific and Research Institute of Rheumatology; Moscow, Russian Federation, Anikin S.G. ,   V.A. Nasonova Scientific and Research Institute of Rheumatology; Moscow, Russian Federation, Lila A.M. ,   V.A. Nasonova Scientific and Research Institute of Rheumatology; Moscow, Russian Federation,   Russian Medical Academy of Continuous Professional Education at the Ministry of Health of the Russian Federation; Moscow, Russian Federation
Published: October 2021

Study Objective: To assess the efficiency and safety of intraarticular combination therapy with sodium hyaluronate and chondroitin sulfate (Hyalurom СS) in patients with knee osteoarthritis (OS). Materials and Methods. The 6-month study enrolled 79 patients with primary knee OA stage II–III (Kellgren и Lawrence), with pain intensity of at least 40 mm, using a visual analogue scale. Mean age was 60.3 ± 8.7 years; mean body mass index was 29.2 ± 4.7 kg/m2, and duration of disease of 6 (3–10) years. Therapy efficiency and safety were assessed on the basis of pain dynamics, constrained movements, joint functionality, patient health, quality of life, and daily need in non-steroidal anti-inflammatory drugs. Study Results. Initial pain was 62 (55–72) mm. After intraarticular injection of the drug, knee pain was statistically less severe, and in a week, it was 41 (32–51) mm, in a month — 28 (20–42) mm, in 3 months — 22 (14–37) mm, and in 6 months — 20 (14–42) mm (р < 0.0001). The same pattern was identified when the total knee functionality points were determined: 1,125 (899–1540) mm — initial value, 821 (556–1119) mm — in a week, 627 (401–874) mm — in a month, 554 (310–750) mm — in 3 months, and 552 (309–837) mm — in 6 months of follow-up (p < 0.0001). The same pattern was true for the assessment of all components of the index. Pain: 268 (189–312) mm, 161 (91–206) mm, 121 (63–165) mm, 102 (48–163) mm, 91 (48–171) mm, respectively (p < 0.0001); constrained movements: 101 (59–130) mm, 66 (30–92) mm, 51 (24-68) mm, 41 (18-60) mm, 40 (20-61) mm, respectively (p < 0.0001); impaired functionality: 802 (647–1095) mm, 587 (405-798) mm, 457 (277-683) mm, 396 (220-586) mm, 402 (191-638) mm, respectively (p < 0.0001). Statistically significant improvement in the quality of life and overall health condition was noted throughout the entire follow-up period: 0.52 (-0.02–0.59) mm and 0.69 (0.59–0.80) mm, р < 0.0001; 48 (30–60) mm and 72 (60–80) mm, р < 0.0001. The therapy led to reduction in the need for non-steroidal anti-inflammatory drugs: in a week, they were discontinued by 39.2% of patients; in a month — by 72.2% of patients, in 3 months — 73.4%, and in 6 months — 54.4% of patients. When the therapy efficiency was assessed by the patient and physician, “significant improvement” and “improvement” were recorded in a majority of cases. Adverse events associated with increased pain and/or swollen knee were noted in 8 (10.1%) patients. Conclusion. The results show good long-term effect from Hyalurom СS therapy. We recorded statistically significant reduction in pain, less constrained movements, rarer need in non-steroidal anti-inflammatory drugs, improved quality of life and joint functionality. The drug possesses a good safety profile and can be recommended for wide clinical application. Keywords: knee osteoarthritis, hyaluronic acid, chondroitin sulfate.