Thu0426 effects of Sodium Succinate and Hyaluronic Acid in Knee Osteoarthritis Treatment

Abstract

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