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Knee osteoarthritis combination therapy with hyaluronic acid, chondroitine sulfate and glucosamine after arthroscopic lavage: long-term results

      Purpose: Purpose to study the efficiency therapy of arthroscopic lavage in combination with subsequent intra articular injection of hyaluronic acid and combined drug of chondroitin sulfate and glucosamine hydrochloride at short- and long-term outcomes.
      Methods: One-hundred-forty-two patients with knee osteoarthritis (OA) were examined with accordance with the American College of Rheumatology criteria and randomized into 3 groups:
      1. Group 1 consisted of 40 patients only after arthroscopic lavage;
      2. Group 2 comprised 42 patients who were administered hyaluronic acid (RusVisc ®) after arthroscopic lavage;
      3. Group 3 comprised 40 patients who were administered combined drug of chondroitin sulfate and glucosamine hydrochloride (ARTRA®) and hyaluronic acid after arthroscopic lavage.
      Clinical evaluation encompassed pain while walking, resting, and moving (by a visual analogue scale), limited ability in covering 100 m (by a 5-point scale), general clinical evaluation (by a 5-point ordinal scale), the presence or absence of pain after 100-m walking, as well as resting pain (its presence or absence).
      Results: The treatment effect evaluated using different indicators was comparably positive in all 3 groups within 3 months. Following 3 months of therapy, its effect remained stable and even better in Group 2 and Group 3. Groups 2 and 3 showed a particularly noticeable superiority a year later. There were excellent and good results in 88 and 91% respectively, and 47.5% in Group 1. Moreover, excellent results were observed in 51% of patients in Group 3, and in 45% in Group 2. The clinical symptoms of the disease were absent in 66% of patients in Group 3, in 58% in Group 2 and in only 15% in Group 1. Moreover, Group 1 showed worsening and 20% of the patients had no effect. This trend was also seen while evaluating the therapeutic effectiveness in different periods. Thus, after therapy, no substantial difference was found in all groups, but 3 months later this difference was as many as 0.8 scores and a year later Group 2 and Group 3 had many points in its favor (1.2 and 1.6 scores).
      Conclusions: Arthroscopic lavage followed by the administration of hyaluronic acid makes it possible to prevent the negative effect of a washing liquid on the metabolism and structure of the articular cartilage. Complex therapy with hyaluronic acid and co-formulated drug of chondroitin sulfate and glucosamine hydrochloride allows to achieve a long-term effect against the major clinical symptoms (joint pain and function) affecting the quality of life. The effect depended on the magnitude of cartilage changes according to arthroscopic data and failed to be related to age and disease duration. The magnitude of cartilage changes may be a predictor of response to treatment.