Comparison of intra-articular tenoxicam and oral tenoxicam for pain and physical functioning in osteoarthritis of the knee

Abstract

This study was designed to compare efficacy of local administration of a nonsteroidal anti-inflammatory drug with systemic administration in patients with osteoarthritis (OA) of the knee. For this purpose, intra-articular tenoxicam and oral tenoxicam therapies were applied and the improvement in control of pain and physical functioning were evaluated. A total of 69 patients with OA of the knee were randomized into three groups. Patients in the first group (41 knees of 23 patients) were treated for 1-3 weeks with once weekly intra-articular injection of tenoxicam 20 mg. Patients in the second group (45 knees of 26 patients) received 20 mg/day tenoxicam orally for 3 weeks and only physical exercises were applied to the third group (32 knees of 20 patients). Physical examination of the knee joint, Western Ontario and McMaster Universities Index and the Lequesne Algofunctional Index were used as outcome measurements at baseline, and the 1st, 3rd and 6th months. More significant improvement in pain and disability parameters was observed in groups 1 and 2 than group 3 compared with baseline measures. Among the patients' responses a few of the differences were statistically significant, more in favour of tenoxicam, and tenoxicam seemed to be superior to exercise alone especially at the final evaluation. There was no significant difference between the oral and intra-articular tenoxicam treatment regimens. The results of this study showed that treatment of OA of the knee with intra-articular tenoxicam is as effective as that with oral tenoxicam. It can be thought that intra-articular administration can be preferred to oral therapy due to minimal possibility of systemic side effects.

Comparison of Piroxicam Pharmacokinetics and Anti-Inflammatory Effect in Rats after Intra-Articular and Intramuscular Administration

“…Several studies comparing IA NSAIDs with systemic administration reported better pain relief after IA administration, indicating a peripheral analgesic effect in OA and/or in postoperative pain in the knee (Elhakim et al ., 1996; Colbert et al ., 1999; Unlu et al ., 2006). When administered locally, high concentrations of NSAIDs can be achieved at the site of cell injury, and local administration may lead to clinical benefits such as the use of lower doses, lower subsequent systemic exposure, and a reduced frequency of adverse events.…”

“…This finding is supported by the earlier report, which suggests that NSAIDs delivered via IA injection effectively inhibit the activation of peripheral nociceptors, by reducing the levels of arachidonic acid metabolites such as prostaglandins and thromboxanes in the joint tissue (Izdes et al ., 2003). NSAIDs injected intraarticularly may also reduce the pain by modifying the local inflammatory process (Unlu et al ., 2006). Actually, Oztuna et al .…”

“…Several clinical studies have demonstrated that IA administration of NSAIDs provides advantageous results with respect to the analgesic efficacy, by delivering higher drug concentration in local tissue (Unlu et al ., 2006; Oztuna et al ., 2007; Lee et al ., 2011). The weekly IA tenoxicam-treated group showed more rapid pain relief than the daily oral treatment group of OA patients (Oztuna et al ., 2007).…”

Ultrasound guided intra-articular ketorolac versus corticosteroid injection in osteoarthritis of the hip: a retrospective comparative study

“…After IA NSAID injection, high concentrations of these agents can be achieved at the point of origin of the inflammatory process with the potential for a more effective reduction of inflammation and fewer side effects if used in doses causing low plasma concentrations of the drug [10]. Also, previous studies demonstrated no detrimental effects of IA NSAID injection on the articular cartilage, ligaments and kinematic function of the native knee in an in vivo animal model [11][12][13].…”

“…Multiple studies demonstrated the efficacy of IA NSAID injection for pain after arthroscopic procedures [15,16]. In addition, Unlu et al [10] reported that IA tenoxicam injection seems to be effective and safe for reducing pain and functional disability in patients with knee OA until the 6-month follow-up. However, there is no report on the effects and safety of IA NASID injection for hip OA, and the number of comparison studies of treatment effects between NSAIDs and corticosteroids is still very limited.…”