Efficacy of Intra-articular Hyaluronic Acid and Triamcinolone Acetonide Combination Versus Hyaluronic Acid Alone in Knee Osteoarthritis
Bibliographic record
Abstract
BACKGROUND: Osteoarthritis (OA) is a chronic debilitating joint pathology and a major cause of disability worldwide. Treatment of knee OA primarily focuses on pain control and improvement of the quality of life of the patient. With the continuous increase in elderly population worldwide and consequent rise in knee OA, there is the need for new treatment strategies and optimal combination therapies for the treatment of patients suffering from early knee OA. Intra-articular injection of hyaluronic acid and corticosteroids has been demonstrated to be individually efficacious in the treatment of knee OA; however, they are both limited in the extent and duration of symptom relief. OBJECTIVES: This study compared the efficacy of combined intra-articular injections of hyaluronic acid and triamcinolone versus hyaluronic acid alone in pain relief of Kellgren and Lawrence (K & L) grade 2 and 3 knee OA. METHODS: This was a hospital based randomized controlled double-blind study which included patients in attendance at the orthopaedic clinic, University of Benin Teaching Hospital (UBTH) with the diagnosis of Kellgren and Lawrence grade 2 and 3 Knee OA. The total sample size was 66, divided into two groups (A and B) of 33 respondents each. Patients in group A received combined hyaluronic acid, triamcinolone, lidocaine and sterile water intra-articularly into the affected knee, while those in group B received hyaluronic acid, lidocaine and sterile water only. Patients in both groups were evaluated using the 11 point numerical rating pain scale(NRS) and the short-form Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scale for pain and physical function status respectively at 0 week (prior to the injections) and 2, 4, 12 weeks after administration of the various agents. These were analyzed using the SPSS software, version 22 (IBM Corp., Armonk, NY). A p-value of <0.05 was considered to be statistically significant. RESULTS: Patients in both groups had progressive improvement in their pain scores and physical function following intra-articular injections. However, the pain and physical function scores decreased more rapidly and to a much lower levels in the group A patients who received the combined treatment than in the group B patients who received hyaluronic acid alone (p=0.001). CONCLUSIONS: The results from this study suggest a synergistic effect between hyaluronic acid and triamcinolone, thus making them a more efficacious treatment option compared to hyaluronic acid alone in the treatment of K & L grade 2 and 3 knee OA. The findings from this study were based on a 12-week follow-up, more studies are encouraged to validate the findings over a longer period.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".