Comparison between Hyalgan and Indomethacin in the treatment of osteoarthritis

Aim & purposes: Osteoarthritis (OA) is a disease with significant morbidity in patients. Knee joint is commonly involved in the OA. There is several treatment modalities, such as medical and surgical treatment. Many of patients interested to medical treatment and avoid surgical procedure. One of this treatment, treatment via indomethacin and hyaluronic preparation. This study was carried out in order to evaluate effect of hyalgan and indomethacin in the treatment of OA.Patients and methods: Patients with advanced grade of OA were included in this study. For this purpose, every patients with severe knee pain, limited range of motion, cryptation, joint stiffness, and difficulty in daily activity, were selected. Upright knee x-ray (AP, Lat) were obtained and radiologic changes were recorded. Before treatment, all cases were asked about pain, joint stiffness, knee cryptation, and other and were recorded. All patients received recommendation about activity modification and physiotherapy for quadriceps muscle. Then this patients were divided in two Hyalgan and Indomethacin groups. This study was conducted in the orthopedy clinic of Imam Khomeini Hospital, Ahwaz, Iran. Patients in Hyalgan groups , were received intra-articular injection 20mg weekly for 5 weeks. Patients in indomethacin group, were treated with dosage 25mg three times daily. All patients were evaluated post treatment.Results: in this study 39 patients (60 joints, 32 right and 28 left) underwent hyalgan and 27 patients( 50 joints, 25 right and 25 left) treated by indomethacin. From Hyalgan group 54 knee joint had grade IV and 6 have grade III radiology of OA. In the indomethacin group, 43 knee joints had grade IV and 7 joints had grade III. There is significant difference between two group for post treatment score(HA: 38.45�57.77 vs Indomethacin:32.16�67.29, P=0.00007). In the patients treated with HA, 56.67%, and 28.33% had excellent and good prognosis respectively. In indomethacin group 24.00%, and 34.00% had excellent and good prognosis respectively. Patients treated with HA had better outcome than patients treated with indomethacin( P-value=0.001475). In HA group, satisfaction about treatment was significantly higher than indomethacin group(P-value=0.003045). Pain in resting, morning stiffness, limitation in range of motion, and crypation was significantly lower in patients treated with HA compared to another (P 30yrs. About half of the people aged >65 had evidence of OA.2 In addition to age, sex can also incidence and prevalence of OA. In the aged<50, OA predominately seen in male. After that, incidence and prevalence of OA was higher in female.3 Many patients are interested to non surgical treatment. There are several non surgical treatment modalities for treatment of OA. These treatments include lifestyle modification, NSAIDs, intraarticular injection of corticosteroid, and intraarticular hyalgan.4 Hyalgan has less adverse effect than intraarticular injection of corticosteroid.5 Hyalgan is a poly saccharide chain which seen in connective tissue in high quantity and prevents chondral damage.6 In OA, concentration and molecular weight of hyaluronate was reduced as 33-50%.7 The aim of this study was to compare of indomethacin and hyaluronic acid preparation for treatment of OA. PATIENTS AND METHODS Patients with advanced grade of OA were included in this study. For this purpose, every patients with severe knee pain, limited range of motion, cryptation, joint stiffness, and difficulty in daily activity, were selected. Upright knee x-ray Comparison between Hyalgan and Indomethacin in the treatment of osteoarthritis 2 of 5 (AP, Lat) were obtained and radiologic changes were recorded. Before treatment, all cases were asked about pain, joint stiffness, knee cryptation, and other and were recorded. All patients received recommendation about activity modification and physiotherapy for quadriceps muscle. Then this patients were divided in two Hyalgan and Indomethacin groups. In the Hyalgan group, 6 joint has grade III OA and 54 had grade IV OA. In the indomethacin group, 7 joints had grade III, and 43 joints had grade IV. This study was conducted in the orthopedy clinic of Imam Khomeini Hospital, Ahwaz, Iran. Patients in Hyalgan groups , were received intra-articular injection with dosage 20mg weekly for 5 weeks. Patients in indomethacin group, were treated with dosage 25mg three times daily. All patients were evaluated post treatment. Thirtynine patients were treated with Hyalgan. These patients had 60 joints involved with osteoarthritis. Twenty-seven cases were treated with indomethacin, and these cases had 50 knee joints involved with osteoarthritis. We evaluated effect of HA and indomethacin by using this proposed criteria. The criteria were as follows: Figure 1 If patient has score 30-50, there is satisfactory from treatment. If patients score was less than 30, there is unsatisfactory treatment. We compared two groups of patients for cryptation, limitation in range of motion, pain at activity, resting pain, satisfaction during treatment, total outcome, total score, and morning stiffness after treatment. Spss and Epiinfo ver 6.0 were used for analysis. We define Comparison between Hyalgan and Indomethacin in the treatment of osteoarthritis 3 of 5 the criteria for evaluation these patients.