Efficacy of Piroxicam Mesotherapy in Treatment of Knee Osteoarthritis: A Randomized Clinical Trial

Abstract

Introduction. Knee osteoarthritis (KOA) is one of the most common degenerative diseases that lead to pain and disability. Oral NSAIDs are effective drugs used to alleviate symptoms in patients with KOA, but they have several important complications, especially in the elderly. In this study, we evaluated the effectiveness of mesotherapy on pain reduction and improvement of functioning in patients with KOA. Methods. Sixty-two patients with KOA, grade 2-3 of the Kellgren–Lawrence scale, were randomized into two groups: the mesotherapy group, in which two injections were applied with piroxicam at a 10-day interval, and the oral group, in which piroxicam was prescribed for 10 days. The patients were evaluated before the treatment and 2, 4, and 8 weeks after it using the Visual Analogue Scale (VAS), Oxford Knee Scare (OKS), and Western Ontario McMaster University Osteoarthritis Index (WOMAC, Persian version). Results. There was no significant difference in demographic characteristics and baseline pain and function scores between the two groups. After 2, 4, and 8 weeks of follow-up, VAS, WOMAC, and OKS scores significantly improved in both groups (in the mesotherapy group: p value <0.001 in all three scores and in the oral group: p value <0.001 in the VAS scale and p value <0.05 in WOMAC and OKS scores). There was no significant difference between the two groups at any time in the VAS score, but improvement in WOMAC and OKS scales in the mesotherapy group was significantly better (p value <0.05 in both scales [p value <0.03 in OKS and p value <0.02 in WOMAC scales]). Side effects in both groups were not serious: limited heart burn in 32.2% of the total subjects in the oral group and pain at the injection site in 3.2% and bruises in 38.7% of the total subjects in the mesotherapy group. Conclusion. Mesotherapy is an effective and safe treatment modality in patients with mild-to-moderate KOA in the short term. This trial is registered with IRCT2017052434113N1.

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“…is is very true when we realize that OA is frequently associated with disturbed sleep, depression, increased sedentary behaviour, less physical activity, obesity, and polypharmacy, leading to decreased quality of life and overall physical and mental performance. Currently, treatment of OA varies widely from lifestyle changes (e.g., weight reduction with exercise and diet), physical aids (e.g., canes or braces), physical therapies, and medications including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and/or complementary and alternative medicines (CAMs) [4][5][6][7].…”

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“…OA management entails pharmacological and nonpharmacological approaches; traditional management of OA focused on the treatment of symptoms associated with the disease, such as pain and physical dysfunction, which focuses on short-term pain control [4][5][6][7]. Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to approximately 65% of patients because of their analgesic and anti-inflammatory effects; these drugs are typical options for knee OA treatments, but there is controversy about their role; these medications can be costly or carry substantial side effects, especially in older adults [8][9][10][11][12]. Using NSAIDs in patients with knee OA is associated with gastrointestinal, cardiovascular, and renal complications [13].…”

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“…Conservative treatment usually includes lifestyle modification, strengthening exercises and physical therapy, simple analgesics (nonsteroidal anti-inflammatory drugs), topical treatments [ 7 , 8 ], different intra-articular injections, and supplements such as chondroitin sulphate and glucosamine [ 9 , 10 ]. The current medical treatment strategies for OA aim at pain reduction and symptom control rather than disease modification [ 11 ].…”