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Background:At present hyaluronic acid (HA) is rather widely used in treatment of patients with osteoarthritis (OA). HA normalizes the properties of the synovial fluid; has a protective effects; promotes the cartilage nutrition and so improves the signs of OA and function of the joints. Sodium succinate (the salt of the succinic acid) helps to normalize intracellular metabolism and tissue respiration in hypoxic conditions via mitochondrial mechanism of action; normalizes acidic – alkaline balance; takes part in K+ and Ca2+ transportation and provides antioxidant defense, - so is a promising compound for cartilage treatmentObjectives:To investigate the clinical efficacy of combination of hyaluronate and sodium succinate in treatment of early OA stagesMethods:The study included 126 patients with knee OA (stages I-II, Kelgren and Lawrence), mean age (54.3 ± 2.7) years, among them - 75 women (60%) and 51 men - (40%). All enrolled patients had OA exacerbation (without clinically evident synovitis) and received standard OA treatment (NSAIDs, exercises, orthopedic devices) for 15 days; Gr.1 patients (58) also got 5 intra-articular injections of 1.1% hyaluronic acid, stabilized with sodium succinate (2 ml, once a week); patients of Gr.2 (68) in addition to standard treatment received 5 intra-articular injections of 1,1% solution of non-stabilized HA (2 ml, once a week). Clinical observation and evaluation of the results were performed at the beginning of the treatment, at 6th, 12th and 24th week after the study beginningResults:During the treatment period, patients in both groups showed the positive changes in clinical signs and symptoms of OA which led to the lowering of the general WOMAC index (from (78.3 ± 4.1) in Gr. 1 and (75.4 ± 3.8) in Gr. 2 at the beginning of the study to (27.9 ± 2.6) and (29 8 ± 1.9) accordingly at week 12 (p<0,05 for both groups). The VAS score in both groups indicated a significant pain reduction, but the stability and duration of the clinical effect in the groups was different. In patients of Gr.1, the pain syndrome continued to decrease after 12 weeks till 24th week, whereas in Gr.2 after the treatment course there was no significant changes in further pain regression after 6th week point. The changes in Lisholm score were also significantly better in Gr.1 than in Gr. 2 (before treatment (21.7 ± 4.6) and (22.6 ± 5.3), at week 6 - (86.4 ± 5.7) and (71.3 ± 4.8), at week 12 – (87.6 ± 6.2) and (63.8 ± 5.3), respectively, p<0,05 between groups at week 12th Conclusion:Combination of the hyaluronic acid and sodium succinate biochemical and physiologic properties in early stages of knee OA (as intra-articular injections) allows to increase the treatment efficacy, achieve better pain control, and more stable remission comparing to use of the hyaluronic acid aloneDisclosure of Interests:None declared

BackgroundThe investigations of the platelet-derived biologic agents in osteoarthritis treatment had shown promising but often controversial results.ObjectivesTo study the efficacy (in clinic & experiment) & safety (in clinic) of the platelet autologous plasma (PAP) in cartilage repair and treatment of early knee OA.MethodsThe study was conducted at the Department of Family Medicine and Traumatology and Orthopedic Department and consisted of 2 parts: experimental (20 rabbits with the traumatic damage of the knee cartilages) and clinical (included 146 patients with diagnosed knee OA (radiological stage I-II). Rabbits were randomly divided in 4 groups: in 1st and 2nd grs. 10 animals received 3 intra-articular injections of PAP (on 5th,7th,14th day after knee trauma) as a control (gr.3 and 4) 10 rabbits received 3 intra-articular injections of 0,9% NaCl at the same days after trauma; histopathology was performed at 45th (1st and 3rd gr.) & at 90th day (2nd and 4th gr.) after trauma. 146 patients - 58 men (39.7%) & 88 women (60.3%), were divided into 2 grs. Gr.1 included 68 patients who consented to receive standard OA treatment and 3 weekly intra-articular injections of PAP (total 2 courses in 12 months) (plasma volume 12–15ml/course, total platelets number per injection 1260,24±22,1x109); Gr.2 consisted of 78 patients with the same diagnosis who received only standard OA treatment (non-steroidal anti-inflammatory drugs, physiotherapy, exercises). Both groups were of comparable age, gender and initial WOMAC data (Gr.1 40,9±0,7 Gr.2 39,7±0,9, p>0,05). WOMAC scale parameters were analyzed before treatment and after 3 weeks; 6 & 12 months after course of treatment in both groups.ResultsIn animals histopathology has found better repair, ↓ inflammation, better structure of the knee cartilage after PAP injections comparing with the control groups animals; in addition in 3rd group of rabbits ↓ signs of early posttraumatic osteoarthritis were found (comparing to 4th gr.).Clinical study demonstrated better changes in pain, stiffness and function in 3 weeks after treatment in patients of Gr.1 comparing to Gr.2 (WOMAC had decreased by 35.8% in Gr.2 and by 74.1% in Gr.1), p<0,05.After 6 months of follow-up (before 2 course of PAP treatment), the mean number of OA exacerbations was (0,7±0,02) in Gr.1 & (1,6±0,04) in Gr.2 (p<0,05) and general WOMAC index in Gr.1 was significantly lower than in Gr.2 (accordingly (22,8±0,3) and (36,5±0,8); p<0,05).In the next 6 months again patients in Gr.1 had less exacerbations (0,51±0,03) then patients in Gr.2 (1,4±0,03),p<0,05; & better WOMAC performance (Gr.1-(17,5±0,6 & Gr.2–37,1±0,5 accordingly,p<0,05).ConclusionsHistopathology of the knee cartilage has shown promising results concerning possibility of cartilage repair after trauma and prophylaxis of the early posttraumatic OA after PAP injections in animal model.Repeating intra-artricular injections of PAP, added to the standard care in knee OA improves functional activity, reduces pain and number of OA exacerbations in 12 months of follow u...

BackgroundAt present hyaluronic acid (HA) is rather widely used in treatment of patients with osteoarthritis (OA). HA normalises the properties of the synovial fluid; has a protective effects; promotes the cartilage nutrition and so improves the signs of OA and function of the joints. To the contrary the effects of sodium succinate (the salt of the succinic acid) are not investigated but can be promising in OA treatment due to its known anti hypoxic and energetic properties.ObjectivesTo investigate the clinical efficacy of combination of hyaluronate and sodium succinate in OA treatment in early stages.MethodsThe study included 126 patients with knee OA (stages I-II, Kelgren and Lawrence), mean age (54.3±2.7) years, among them – 75 women(60%) and 51 men(40%). All enrolled patients had OA exacerbation (without clinically evident synivitis) and received standard OA treatment (NSAIDs, exercises, orthopaedic devices) for 15 days; Gr.1 patients (58) also got 5 intra-articular injections of 1.1% hyaluronic acid, stabilised with sodium succinate (2 ml, once a week); patients of Gr.2 (68) in addition to standard treatment received 5 intra-articular injections of 1,1% solution of non-stabilised HA (2 ml, once a week). Clinical observation and evaluation of the results were performed at the beginning of the treatment, at 6th, 12th and 24th week after the study beginningResultsDuring the treatment period, patients in both groups showed the positive changes in clinical signs and symptoms of OA. The VAS score in both groups indicated a significant pain reduction, but the stability and duration of the clinical effect in the groups was different. In patients of Gr.1, the pain syndrome continued to decrease after 12 weeks till 24th week, whereas in Gr.2 after the treatment course there was no significant changes in further pain regression after 6th week point. The general WOMAC index was decreased from (78.3±4.1) in Gr. 1 and (75.4±3.8) in Gr. 2 at the beginning of the study to (27.9±2.6) and (29.8±1.9) accordingly at week 12, p<0,05. The changes in Lisholm score were also significantly better in Gr.1 than in Gr. 2 (before treatment (21.7±4.6) and (22.6±5.3), at week 6 – (86.4±5.7) and (71.3±4.8), at week 12 – (87.6±6.2) and (63.8±5.3), respectively, p<0,05.ConclusionsCombination of the hyaluronic acide and sodium succinate in early stages of knee OA (as intra-articular injections) allows to increase the treatment efficacy. Add of sodium succinate to hyaluronic acide achieve better pain control and longer remission.Disclosure of InterestNone declared