Comparison between Hyalgan and Indomethacin in the treatment of osteoarthritis

摘要

Aim & purposes: Osteoarthritis (OA) is a disease with significant morbidity in patients. Knee joint is commonly involved in the OA. There is several treatment modalities, such as medical and surgical treatment. Many of patients interested to medical treatment and avoid surgical procedure. One of this treatment, treatment via indomethacin and hyaluronic preparation. This study was carried out in order to evaluate effect of hyalgan and indomethacin in the treatment of OA.Patients and methods: Patients with advanced grade of OA were included in this study. For this purpose, every patients with severe knee pain, limited range of motion, cryptation, joint stiffness, and difficulty in daily activity, were selected. Upright knee x-ray (AP, Lat) were obtained and radiologic changes were recorded. Before treatment, all cases were asked about pain, joint stiffness, knee cryptation, and other and were recorded. All patients received recommendation about activity modification and physiotherapy for quadriceps muscle. Then this patients were divided in two Hyalgan and Indomethacin groups. This study was conducted in the orthopedy clinic of Imam Khomeini Hospital, Ahwaz, Iran. Patients in Hyalgan groups , were received intra-articular injection 20mg weekly for 5 weeks. Patients in indomethacin group, were treated with dosage 25mg three times daily. All patients were evaluated post treatment.Results: in this study 39 patients (60 joints, 32 right and 28 left) underwent hyalgan and 27 patients( 50 joints, 25 right and 25 left) treated by indomethacin. From Hyalgan group 54 knee joint had grade IV and 6 have grade III radiology of OA. In the indomethacin group, 43 knee joints had grade IV and 7 joints had grade III. There is significant difference between two group for post treatment score(HA: 38.45?57.77 vs Indomethacin:32.16?67.29, P=0.00007). In the patients treated with HA, 56.67%, and 28.33% had excellent and good prognosis respectively. In indomethacin group 24.00%, and 34.00% had excellent and good prognosis respectively. Patients treated with HA had better outcome than patients treated with indomethacin( P-value=0.001475). In HA group, satisfaction about treatment was significantly higher than indomethacin group(P-value=0.003045). Pain in resting, morning stiffness, limitation in range of motion, and crypation was significantly lower in patients treated with HA compared to another (P<0.05). Pain at activity was significantly lower in indomethacin group(p<.05)Conclusion: this study showed significant effect of HA compared to indomethacin in reducing morning stiffness, pain during resting, limitation in ROM. This study support early administration of HA for treatment of OA. Introduction and aim Osteoarthritis (OA) is a disease with significant morbidity in the patients due its clinical manifestation and limited range of motion.1 Knee joint is one of the joint which is commonly involved. In the Framingham study, OA prevalence was reported 6% in the adults aged >30yrs. About half of the people aged >65 had evidence of OA.2 In addition to age, sex can also incidence and prevalence of OA. In the aged<50, OA predominately seen in male. After that, incidence and prevalence of OA was higher in female.3 Many patients are interested to non surgical treatment. There are several non surgical treatment modalities for treatment of OA. These treatments include lifestyle modification, NSAIDs, intraarticular injection of corticosteroid, and intra-articular hyalgan.4 Hyalgan has less adverse effect than intra-articular injection of corticosteroid.5 Hyalgan is a poly saccharide chain which seen in connective tissue in high quantity and prevents chondral damage.6 In OA, concentration and molecular weight of hyaluronate was reduced as 33-50%.7 The aim of this study was to compare of indomethacin and hyaluronic acid preparation for treatment of OA. Patients and methods Patients with advanced grade of OA were included in this study. For this purpose, every pat