ประสิทธิผลของยากลูโคซามีน ซัลเฟต ชนิดฉีดเข้ากล้ามเนื้อ และกรดไฮยาลูโรนิกชนิดฉีดเข้าข้อ เมื่อใช้เคี่ยวหรือใช้ร่วมกันในการรักษาผู้ป่วยโรคข้อเข่าเสื่อมที่โรงพยาบาลราชวิถี / ศิริพร เดชะ = Effectiveness of intramuscular glucosamine sulfate and intraarticular hyaluronic acid injection using either alone or in combination in the treatment of patient with knee osteoarthritis at Rajavithi hospital / Siriporn Decha
Objectives: To evaluate the effectiveness of intramuscular glucosamine sulfate and intraarticular hyaluronic acid injection using either alone or in combination in the treatment of patient with knee osteoarthritis (OA). Methods: A randomized, double-blind, placebo controlled was conducted at Rheumatology unit , Department of Medicine, Rajavithi hospital between February 2004-October 2004. The 64 out-patients with OA of the knee were randomized into three groups. Each group the patients were treated with glucosamine sulfate, hyaluronic acid, and glucosamine sulfate plus hyaluronic acid, respectively. The clinical assessments included 1) the Western Ontario and McMaster Universities (WOMAC) OA index ; 2) radiographic; 3) the presence of effusion; 4) the amount of paracetamol taken per week; 5) the global assessment by the patient; 6) the global assessment by the investigator; 7) 50 - feet walktime; 8) descending walktime; 9) ascending walktime. Results: From 64 patients, 80.33 percent was female, mean age was57.70 +- 7.70 years. Sixty-one patients completed the study (17 patients in glucosamine sulfate group, 22 patients in hyaluronic acid group, 22 patients in combination of glucosamine sulfate and hyaluronic acid). The improvement of symptoms in most outcome parameter was greatest in the combination group of glucosamine sulfate and hyaluronic acid according to OMERACT III. The improvement in all clinical assessment was significantly different between hyaluronic acid and glucosamine sulfate group as well as the combination and glucosamine sulfate group (p<0.05). However, there was no significant improvement in ascending walktime between groups. The adverse events, mainly local injection site reactions, occurred in 14 patients (3 patients in hyaluronic acid group,11 patients in placebo group). There was significant difference between hyaluronic acid and placebo group.(p<0.05) in terms of adverse event . Although the adverse event of glucosamine sulfate was mainly the reactions at the injection site, occurred in4 patients (1 patient in hyaluronic acid group, 3 patients in placebo group) but there was still no significant between groups. Conclusions: Hyaluronic acid and the combination of glucosamine sulfate with hyaluronic acid tends to be efficacious and safety in patient with osteoarthritis of the knee in the treatment over 25-week period.