Efficacy of Intra‐Articular Botulinum Toxin Type A in Painful Knee Osteoarthritis: A Pilot Study

Boon, Andrea J.; Smith, Jay; Dahm, Diane L.; Sorenson, Eric J.; Larson, Dirk R.; Fitz‐Gibbon, Patrick D.; Dykstra, Dennis D.; Singh, Jasvinder A.

doi:10.1016/j.pmrj.2010.02.011

Cited by 80 publications

(70 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Intra-articular BoNT A reduces joint pain in osteoarthritic dogs [30] and human patients [31–33]. However, the antinociceptive mechanism of action of IA BoNT A in the joint is currently not known.…”

Section: Discussionmentioning

confidence: 99%

The effect of intra-articular botulinum toxin A on substance P, prostaglandin E2, and tumor necrosis factor alpha in the canine osteoarthritic joint

et al. 2017

View full text Add to dashboard Cite

BackgroundRecently, intra-articular botulinum toxin A (IA BoNT A) has been shown to reduce joint pain in osteoarthritic dogs. Similar results have been reported in human patients with arthritis. However, the mechanism of the antinociceptive action of IA BoNT A is currently not known. The aim of this study was to explore this mechanism of action by investigating the effect of IA BoNT A on synovial fluid (SF) and serum substance P (SP), prostaglandin E2 (PGE2), and tumor necrosis factor alpha (TNF-α) in osteoarthritic dogs. Additionally, the aim was to compare SF SP and PGE2 between osteoarthritic and non-osteoarthritic joints, and investigate associations between SP, PGE2, osteoarthritic pain, and the signalment of dogs. Thirty-five dogs with chronic naturally occurring osteoarthritis and 13 non-osteoarthritic control dogs were included in the study. Osteoarthritic dogs received either IA BoNT A (n = 19) or IA placebo (n = 16). Serum and SF samples were collected and osteoarthritic pain was evaluated before (baseline) and 2 and 8 weeks after treatment. Osteoarthritic pain was assessed with force platform, Helsinki Chronic Pain Index, and joint palpation. Synovial fluid samples were obtained from control dogs after euthanasia. The change from baseline in SP and PGE2 concentration was compared between the IA BoNT A and placebo groups. The synovial fluid SP and PGE2 concentration was compared between osteoarthritic and control joints. Associations between SP, PGE2, osteoarthritic pain, and the signalment of dogs were evaluated.ResultsThere was no significant change from baseline in SP or PGE2 after IA BoNT A. Synovial fluid PGE2 was significantly higher in osteoarthritic compared to control joints. Synovial fluid PGE2 correlated with osteoarthritic pain. No associations were found between SP or PGE2 and the signalment of dogs. The concentration of TNF-α remained under the detection limit of the assay in all samples.ConclusionsThe results suggest that the antinociceptive effect of IA BoNT A in the joint might not be related to the inhibition of SP nor PGE2. Synovial fluid PGE2, but not SP, could be a marker for chronic osteoarthritis and pain in dogs.

show abstract

Section: Discussionmentioning

confidence: 99%

The effect of intra-articular botulinum toxin A on substance P, prostaglandin E2, and tumor necrosis factor alpha in the canine osteoarthritic joint

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Intra-articular analgesia is often used after joint surgery and occasionally in joints with OA. Lidocaine, bupivacaine, ropivacaine, opiates and have been evaluated as intra-articular analgesics, mostly for post-operative pain 12 , Botulinum toxin A has been evaluated as a therapy for chronic joint pain and OA 47 Chondrolysis associated with the use of intra-articular local anaesthetic ‘pain pumps’ has been described by several groups, 48–50 which has raised concern about the clinical use of intra-articular anaesthetics. Dose-dependent toxic effects of analgesics, including apoptosis, have been demonstrated in vitro .…”

Section: Intra-articular Therapeuticsmentioning

confidence: 99%

Progress in intra-articular therapy

2013

View full text Add to dashboard Cite

Diarthrodial joints are well suited to intra-articular injection, and the local delivery of therapeutics in this fashion brings several potential advantages to the treatment of a wide range of arthropathies. Possible benefits include increased bioavailability, reduced systemic exposure, fewer adverse events, and lower total drug costs. Nevertheless, intra-articular therapy is challenging because of the rapid egress of injected materials from the joint space; this elimination is true of both small molecules, which exit via synovial capillaries, and of macromolecules, which are cleared by the lymphatic system. In general, soluble materials have an intra-articular dwell time measured only in hours. Corticosteroids and hyaluronate preparations constitute the mainstay of FDA-approved intra-articular therapeutics. Recombinant proteins, autologous blood products and analgesics have also found clinical use via intra-articular delivery. Several alternative approaches, such as local delivery of cell and gene therapy, as well as the use of microparticles, liposomes, and modified drugs, are in various stages of preclinical development.

show abstract

“…Products of regenerative medicine, including mesenchymal stem/stromal cells , platelet rich plasma, and autologous conditioned serum (ACS), as well as other agents such as intra-articular morphine demonstrate promise in treating pain and joint damage in knee OA [8]. Additionally, botulinum toxin has been studied against corticosteroids in a prospective, double-blinded randomized controlled trial with results suggesting a possible role in treating this disease [9]. …”

Section: Theorymentioning

confidence: 99%

Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine

Richards

Maxwell

Weng

et al. 2016

The Physician and Sportsmedicine

147

117

View full text Add to dashboard Cite

Objectives Knee osteoarthritis (OA)1 is a debilitating condition that may ultimately require total knee arthroplasty (TKA)2. Non-operative treatments are bracing, oral analgesics, physical therapy, and intra-articular knee injection (IAKI)3. The objective of this paper is to provide a systematic literature review regarding intra-articular treatment of knee OA and insight into promising new products of regenerative medicine that may eventually have a substantial effect on treatment. Methods A literature search was executed using Medline, Cochrane, and Embase with keywords ”knee osteoarthritis” and “injection.” Specifically, articles discussing intra-articular knee injection using corticosteroids, hyaluronic acid, analgesics, local anesthetics, and newer products of regenerative medicine, such as platelet-rich plasma (PRP)4 and mesenchymal stem cells (MSC)5, were analyzed. Results Forty-five publications were scrutinized. Of these, eleven were level 1, three were level 2, twelve were level 3, two were level 4, and seventeen were level 5. Papers included animal models. Local anesthetics have potential side effects and may only be effective for four hours. Morphine and ketorolac may provide significant pain relief for 24 hours. Corticosteroids may give patients weeks to one months of effective analgesia, but complications may occur, such as systemic hyperglycemia, septic arthritis, and joint degradation. Hyaluronic acid is a natural component of synovial fluid, but efficacy with respect to analgesia is controversial. Platelet-rich plasma formulations, autologous conditioned serum, autologous protein solution, and mesenchymal stem cell injections contain anti-inflammatory molecules and have been proposed to attenuate joint destruction or potentially remodel the joint. Conclusions Currently, knee OA treatment does not address the progressively inflammatory environment of the joint. More investigation is needed regarding products of regenerative medicine, but they may ultimately have profound implications in the way knee OA is managed.

show abstract

Efficacy of Intra‐Articular Botulinum Toxin Type A in Painful Knee Osteoarthritis: A Pilot Study

Abstract: This pilot study supports a possible role for BoNT-A as a treatment option for symptomatic knee osteoarthritis; however, larger double-blind randomized studies are needed to determine whether BoNT-A is more effective than placebo in this patient population.

Cited by 80 publications

References 30 publications

The effect of intra-articular botulinum toxin A on substance P, prostaglandin E2, and tumor necrosis factor alpha in the canine osteoarthritic joint

The effect of intra-articular botulinum toxin A on substance P, prostaglandin E2, and tumor necrosis factor alpha in the canine osteoarthritic joint

Progress in intra-articular therapy

Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine

Contact Info

Product

Resources

About