Therapeutic Effects of Intra-articular Botulinum Toxin Type A in Knee Osteoarthritis

Abstract

Knee OsteoarthritisKnee osteoarthritis (KOA) is an intractable and devastating consequence of degeneration that results in tremendous impact on daily activities. Painful disabling KOA occurs in more than 10% of people who are over 55 years old. Those who are severely disabled account for up to 25% of aging people and KOA is a major cause of total knee replacement [1][2][3]. Current osteoarthritis therapies largely rely on rest, weight loss, bracing and assistive devices, physical modalities, therapeutic exercises, and pharmacological interventions [4] which are unsatisfactory for the majority of severe disabled patients, who are left with ambulation deficit despite vigorous treatment intervention. Although numerous patients can be treated with surgery, some of them are not good candidates due to multiple co-morbidities. For these reasons, intra-articular (IA) treatments that reduce chronic joint pain and improve function is the long-term effective and safe alternative options. In a number of recent studies, pain intensity and functional performance resulted from osteoarthritis has been improved after IA injection of botulinum toxin type A (BoNT-A).The Botulinum neurotoxin has been comprehensively studied for its muscle-paralyzing effect by proteolysis of membrane-associated proteins inhibiting of the exocytotic release of acetylcholine, thereby blocking neurotransmission from motor nerve terminals. However, as the growing body of research has demonstrated, IA BoNT-A injection applied to the painful joints can successfully improve symptoms and function by anti-nociceptive effect [5][6][7][8][9]. The mechanism of pain modulation after IA BoNT-A injection by means of two very different strategies by direct inhibition of nociceptive neuropeptides release such as substance P, calcitonin gene related peptide (cGRP), glutamate and the expression of the transient receptor potential vanilloid 1 at the primary sensory fibers, leading to a reduction of peripheral sensitization; by indirect inhibition of central sensitization associated with neuropathic pain through the reduction of the se and blocked of substance P and cGRP secretion within central nerve system [10][11][12].The role of botulinum toxin type A in the clinical management is now considered as part of an established option for chronic advanced arthritis or osteoarthritis if a patient has been refractory to conservative treatments, failed to corticosteroid or hyaluronic acid IA injection and unable to undergo joint surgical intervention. As compared with conventional therapy, IA BoNT-A injection has significant therapeutic effect on pain processing and functional recovery [13]. The pilot study provides evidence that BoNT-A compared to IA corticosteroid achieves a significant and persistent pain modulating effect [6]. The following study further confirmed that the IA BoNT-A compared to education only yielded favorable outcomes that were of considerable longevity, at least 6-month period [14]. Another study demonstrates that IA BoNT-A in patients with chronic pain...

Efficacy of Intra Articular Botulinum Toxin Injection in Sickle Cell Patients’ Joints

“…BoNT/A is an effective treatment for painful movement disorders, spasticity, myofascial pain, and conditions with increased muscle tone, abnormal posturing, and pain and its safety also in repeating its injection in the joint according to Mahowald et-al. 20,21 The rationale of Botox injection intraarticularly for patients with chronic pain is to decrease the pain and improve functional capability. BTX was found to produce significant pain relief when injected into painful joints caused by inflammatory or noninflammatory disorders.…”