AB0585 COMPARISON OF THE EFFECTIVENESS OF HYALURONIC ACID PREPARATIONS WITH DIFFERENT MOLECULAR WEIGHTS AND IN COMBINATION WITH CHONDROITIN SULFATE DEPENDING ON THE STAGE OF OSTEOARTHRITIS OF THE KNEE JOINT
Authors: V. Bialik, M. Makarov, E. Bialik, S. Makarov, V. Nesterenko, M. Nurmukhametov
Journal: Annals of the Rheumatic Diseases (2021)

Background: intra-articular (IA) injections of hyaluronic acid (HA) preparations are one of conservative treatment of the knee osteoarthritis (OA). However, the results of this treatment are inconsistent. Objectives: to evaluate the effectiveness of HA preparations with different molecular weights and in combination with chondroitin sulfate (HS) for IA injections in the treatment of patients with stage I-III knee OA. Methods: IA HA injections were performed 160 patients with primary and post-traumatic knee OA of the I-III stages at the department of rheumoorthopaedic and rehabilitation, V. A. Nasonova Research Institute of Rheumatology for the period from September 2017 to June 2019. Patients were divided into 4 groups. Group 1 consisted of 80 patients treated with low molecular weight (LMW) HA, group 2 - 20 patients treated with medium molecular weight (MMW) HA, group 3 - 30 patients treated with high molecular weight (HMW) HA, and group 4 - 30 patients who were intraarticular introduced HA with HS. The course of IA injections was 2 for LMW, HMW, and HA with HS, and 3 for MMW HA. Injections were performed with an interval of 1 week. To evaluate the results of treatment, we studied the intensity of pain according to VAS and the total score of KOOS before treatment and on follow-up examinations 1, 3 and 6 months after the course of IA HA injections. Results: the maximum reduction in pain with IA HA injections at stage I of knee OA occurred by 3 months after the course of treatment. Moreover, improvement was detected by 1 month in 84.3% of cases, and remained until the end of the study in 71.1% of patients. All HA preparations used in stage I of knee OA were effective. At stage II of the knee OA after 3 months after the course of IA HA, different efficiencies of HA preparations were revealed. So, in the groups of LMW, MMW and HA with HS, the improvement persisted up to 3 months, and in the group of HMW HA - up to 1 month. After 3 months, the best results were shown by HA with HS, by 6 months the results were comparable. IA HA injections at the II stage of knee OA led to good and excellent results 1 month after the course of treatment in 53.9% of cases, but by the end of the study, improvement remained in only 30.8% of patients. In the case of the use of HA in stage III of the knee OA, the effectiveness of the studied drugs was comparable, and the maximum improvement was achieved by 1 month. The positive effect of IA HA injections in patients with stage III of the knee OA one month after the course of treatment was obtained in 40.6% of cases, by 3 months it decreased to 18.8%, and by 6 months - to 15.7% of patients. Conclusion: IA injections of HA at stage I of the knee OA is a highly effective method of conservative treatment, which allows to relieve pain and improve the condition of the knee joint for a period of 6 months or more. The use of HA preparations at stage II of the knee OA allows reducing pain up to 3 months with IA injections of LMW and MMW HA, as well as HA with HS. HMW HA helps reduce pain intensity for a period of 1 month. The use of HA preparations in stage III of the knee OA leads to a short-term relief of symptoms of OA. Disclosure of Interests: None declared.