15Mar 2020

EFFECTIVENESS OF INTRA-ARTICULAR HYALURONIC ACID ON PATIENTS SUFFERING FROM PAINFUL SHOULDER

  • Hospital Ortopedico Infantil de Caracas. Av. Andres Bello, Caracas 1050, Distrito Capital, Venezuela.
  • Meiji Pharma Spain S.A. Avda de Madrid 94, 28802 Alcala de Henares, Madrid, Spain.
  • Hospital Universitario Fundacion Alcorcon. Calle Budapest, 1, 28922 Alcorcon, Madrid, Spain.
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This work was a retrospective, observational study to analyse the effectiveness of viscosupplementation in terms of pain relief and function improvement in a cohort of patients suffering from shoulder pain and treated under usual clinical practice conditions. The population included patients with painful shoulder, stiffness grades I/II and intact rotator cuff or with partial thickness tear. Previous hyaluronic acid or corticosteroid injections, passive mobilization or shoulder infections were not permitted. Patients received 3-5 injections of medium molecular weight hyaluronic acid and efficacy was assessed at the end of treatment and at 3 and 6 months. Effectiveness was evaluated using the Constant scale, physician and patient global assessments. In total 180 patients were analysed with a mean age of 49.1 years and 52.2% were female. More than 50% presented 2 relevant symptoms, being pain present at baseline in 82.2% followed by stiffness (57.2%) and instability (5.6%). Mean Constant value was 53.8 points. A mean improvement of 14.3 points was observed at the end of treatment, 28.2 at 3 months and 37.9 at 6 months (p<0.001 versus baseline at all-time points). Constant condition at the end of treatment was excellent in 3.3% of patients, good in 70.6% and fair in 26.1% whereas at 6 months it was excellent in nearly 100% patients in agreement with patient and physician assessments. These results suggest that viscosupplementation constitute a conservative and minimally invasive approach to manage shoulder pain with effects lasting for at least 6 months.

  1. Andrews JR (2005): Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions. Arthroscopy. 21(3):333-47.
  2. Balazs EA, Delinger JL (1993): Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl. 39:3?9.
  3. Bannuru RR, Osani M, Vaysbrot EE, McAlindon TE (2016): Comparative safety profile of hyaluronic acid products for knee osteoarthritis: a systematic review and network meta-analysis.Osteoarthritis Cartilage. 24(12):2022-2041.
  4. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. (2015): Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: A systematic review and network meta-analysis. Ann Intern Med. 162(1):46-54.
  5. Becerril-Bautista P Negrete-Corona J, Chavez-Hinojosa E (2014): Functional results of type a botulinum toxin versus oral antiinflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion. Acta Ortopedica Mexicana. 28(5): 265-272.
  6. Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, Bombardier C,Cannon C,Farkouh ME,FitzGerald GA, et al (2013): Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials. Lancet. 382(9894):769-79.
  7. Blaine T, Moskowitz R, Udell J, Skyhar M, Levin R, Friedlander J, Daley M, Altman R (2008): Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am. 90(5):970-9.
  8. Bloom JE, Rischin A, Johnston RV, Buchbinder R (2012): Image-guided versus blind glucocorticoid injection for shoulder pain. Cochrane Database Syst Rev. (8):CD009147.
  9. Bruy?re O, Honvo G, Veronese N, Arden NK, Branco J, Curtis EM, Al-Daghri NM, Herrero-Beaumont G, Martel-Pelletier J, Pelletier JP, et al (2019): An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 9(3):337-350.
  10. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J (2008): Chronic shoulder pain: part I. Evaluation and diagnosis.Am Fam Physician. 15;77(4):453-60.
  11. Chou WY, Ko JY, Wang FS, Huang CC, Wong T, Wang CJ, Chang HE (2010): Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study.J Shoulder Elbow Surg. 19(4):557-63.
  12. Choudhry MN, Malik RA, Charalambous CP (2016): Blood glucose levels following intraarticular steroid injections in patients with diabetes: A systematic review. JBJS Rev.2016 Mar 22;4(3). pii: 01874474-201603000-00002
  13. Christiansen DH, Frost P, Falla D, Haahr JP, Frich LH, Svendsen SW (2015): Responsiveness and Minimal Clinically Important Change: A Comparison between 2 shoulder outcome measures. J Orthop Sports Phys Ther. 45(8):620-5.
  14. Conrozier T, Monfort J, Chevalier X, Raman R, Richette P, Dira?ogl? D, Bard H, Baron D, Jerosch J, Migliore A, Henrotin Y (2018): EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis.Cartilage.2020 Jan;11(1):47-59.
  15. Constant CR, Murley AH (1987): A clinical method of functional assessment of the shoulder. Clin OrthopRelat Res. (214):160-164.
  16. Daniels EW, Cole D, Jacobs B, Phillips SF (2018): Existing Evidence on Ultrasound-GuidedInjections in Sports Medicine.Orthop J Sports Med. 22;6(2):2325967118756576.
  17. De la Pe?a E, Gomis A, Ferrer-Montiel A, Belmonte C (2016): TRPV1 channel modulation by hyaluronan reduces pain. Channels (Austin). 10(2):81-82.
  18. Dean BJ, Franklin SL, Murphy RJ, Javaid MK, Carr AJ (2014): Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon: a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy?Br J Sports Med. 48(22):1620-6.
  19. Green S, Buchbinder R, Hetrick S (2003): Cochrane Database Syst Rev(2):CD004258.
  20. Gyftopoulos S, Abballe V, Virk MS, Koo J, Gold HT, Subhas N (2018):Comparison Between Image-Guided and Landmark-Based Glenohumeral Joint Injections for the Treatment of Adhesive Capsulitis: A Cost-Effectiveness Study. AJR Am J Roentgenol.210(6):1279-1287.
  21. Hershkovich O, Shapira S, Sela Y, Botser IB (2014): role of radiographs in shoulder pathology: a clinical review. Reports in Medical Imaging. 7: 75-80.
  22. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, TowheedT(2012): Recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 64:465-74.
  23. Itoi E, Arce G, Bain GI, Diercks RL, Guttmann D, Imhoff AB, Mazzocca AD, Sugaya H, Yoo Y (2016): Shoulder Stiffness: Current Concepts and Concerns. Arthroscopy. 32(7):1402-14.
  24. King LJ, Healy JC (1999): Imaging of the painful shoulder. Man Ther. 4(1):11-8.
  25. Kwon YW, Eisenberg G, Zuckerman JD (2013): Sodium hyaluronate for the treatment of chronic shoulder pain associated with glenohumeral osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled trial.J Shoulder Elbow Surg. May;22(5):584-94.
  26. Lee LC, Lieu FK, Lee HL, Tung TH (2015): Effectiveness of hyaluronic acid administration in treating adhesive capsulitis of the shoulder: a systematic review of randomized controlled trials.Biomed Res Int. 2015:314120.
  27. Lin I, Wiles LK, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O\'Sullivan PPB (2018): Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review.Br J Sports Med. Mar;52(5):337-343.
  28. Linaker CH, Walker-Bone K (2015): Shoulder disorders and occupation.Best Pract Res Clin Rheumatol. 29(3):405-23
  29. Metcalfe D, Achten J, Costa ML (2009): Glucocorticoid injections in lesions of the Achilles tendon.Foot Ankle Int. Jul;30(7):661-5
  30. Miller LE, Block JE (2013): US-Approved Intra-articular hyaluronic acid injections are safe and effective in patients with knee osteoarthritis: systematic review and meta-analysis of randomized, saline-controlled trials. Clin Med Insights Arthritis MusculoskeletDisord. 6:57-63.
  31. Peng H, Zhou JL, Liu SQ, Hu QJ, Ming JH, Qiu B (2010): Hyaluronic acid inhibits nitric oxide-induced apoptosis and dedifferentiation of articular chondrocytes in vitro. Inflamm Res. 59(7):519?530.
  32. Reeves B (1975): The natural history of the frozen shoulder syndrome. Scand J Rheumatol 4:193-196.
  33. Roy A, Adahan THM, Belair M, Dahan B (1018): Rotator cuff disease https://emedicine.medscape.com/article/328253-overview. Last accessed Feb 28, 2020.
  34. Saito S, Furuya T, Kotake S (2010): Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: a meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken). 62(7):1009-18.
  35. Salottolo K, Stahl E (2018): Minimal clinically important improvement response in patients with severe osteoarthritis of the knee: Short report from a survey of clinicians. J Orthop.15(2):424-425.
  36. Trojian TH, Concoff AL, Joy SM, Hatzenbuehler JR, Saulsberry WJ, Coleman CI (2016): AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis: importance for individual patient outcomes.Br J Sports Med. 50(2):84-92.
  37. TuiteMJ,SmallKM (2017):Imagingevaluationofnonacuteshoulderpain.AJRAm J Roentgenol.209(3):525-533.
  38. Waddell DD, Kolomytkin OV, Dunn S, Marino AA (2007): Hyaluronan suppresses IL-1beta-induced metalloproteinase activity from synovial tissue. Clin OrthopRelat Res. 465:241?248.
  39. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly.Aging Dis. 2018 Feb 1;9(1):143-150.
  40. Younes M, Neffati F, Touzi M, Hassen-Zrour S, Fendri Y, Bejia I, Ben Amor A, Bergaoui N, Najjar MF nes M, Neffati F, Touzi M, et al (2007): Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients. Joint Bone Spine. 74:472-6.
  41. Yu CJ, Ko CJ, Hsieh CH, Chien CT, Huang LH, Lee CW, Jiang CC (2014): Proteomic analysis of osteoarthritic chondrocytes reveals the hyaluronic acid-regulated proteins involved in chondroprotective effect under oxidative stress. J Proteomics. 99:40?53.

[Carolina Pisanti, Juan Valles, M Pilar Coronel and Carlos Gavin (2020); EFFECTIVENESS OF INTRA-ARTICULAR HYALURONIC ACID ON PATIENTS SUFFERING FROM PAINFUL SHOULDER Int. J. of Adv. Res. 8 (Mar). 337-344] (ISSN 2320-5407). www.journalijar.com

M Pilar Coronel
Meiji Pharma Spain S.A. Avda de Madrid 94, 28802 Alcalá de Henares, Madrid, Spain

DOI:

Article DOI: 10.21474/IJAR01/10633      
DOI URL: http://dx.doi.org/10.21474/IJAR01/10633

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