Abstract
This randomized, double-blind clinical trial was conducted over 16 weeks to assess the efficacy and safety profile of intra-articular polynucleotides gel injections in the treatment of knee osteoarthritis associated with persistent knee pain. 60 patients were enrolled and randomized to receive intra-articular polynucleotides (n = 30) or hyaluronan (n = 30); patients received five weekly intra-articular knee injections and the follow-up period was 3 months after the end of treatment. Primary endpoint was to determine polynucleotides (PN) efficacy in reducing knee pain at the end of the study, over baseline value and over standard hyaluronan viscosupplementation (HA). Pain levels were measured using a 0–10 cm Visual Analogue Scale (VAS). Secondary endpoints included Knee Osteoarthritis Outcome Score (KOOS), NSAIDs consumption, crackling during movement and articular mobility limitation. The mean global VAS pain decreased from 5.7 ± 1.9 cm (T0) to 1.9 ± 1.5 cm (T16) in polynucleotide group and from 4.9 ± 2.0 cm (T0) to 2.1 ± 1.4 cm (T16) in hyaluronan group. The reduction in pain was statistically significant for both groups. KOOS increases from baseline values were statistically significant in both groups. No significant adverse events were reported. These findings suggest that intra-articular polynucleotides can be a valid alternative to traditional hyaluronan supplementation for the treatment of knee osteoarthritis.
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Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049
Altman RD, Aven A, Holmburg CE et al (1994) Capsaicin cream 0.025% as monotherapy for osteoarthritis: a double-blind study. Semin Arthritis Rheum 23:25–33
Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Müllner M (2005) Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. Can Med Assoc J 172:1039–1043
Bellamy N, Campbell J, Robinson V et al (2006) Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2:CD005321
De Aloe G, Rubegni P, Biagioli M, Taddeucci P, Fimiani M (2004) Skin graft donor site and use of PDRN as a treatment for skin regeneration: a randomized, controlled, double-blind, clinical trial. Wounds 16:258–263
Guizzardi S, Galli C, Govoni P, Boratto P, Cattarini G, Martini D, Belletti S, Scandroglio R (2003) Polydeoxyribonucleotide (PDRN) promotes human osteoblast proliferation: a new proposal for bone tissue repair. Life Sci 73:1973–1983
Karlsson J, Sjögren LS, Lohmander LS (2002) Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology 41:1240–1248
Knutsen G et al (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89:2105–2112
Lo GH, LaValley M, McAlindon T, Felson DT (2003) Intra-articular hyaluronic acid in treatment of knee osteoarthritis—a meta-analysis. JAMA 23:3115–3121
Muratore O, Cattarini G, Gianoglio S, Tonoli EL, Saccà SC, Ghiglione D, Venzano D, Ciurlo C, Lantieri PB, Schito GC (2003) A human placental polydeoxyribonucleotide (PDRN) may promote the growth of human corneal fibroblasts and iris pigment epithelial cells in primary cultures. New Microbiol 26:13–26
Muratore O, Pesce Schito A, Cattarini G, Tonoli EL, Gianoglio S, Schiappacasse S, Felli L, Picchetta F, Schito GC (1997) Evaluation of the trophic effect of human placental PDRN on human knee skin fibroblasts in primary cultures. Cell Mol Life Sci 53:279–285
Murray CJ, Lopez AD (1996) Evidence-based health policy—lessons from the Global Burden of Disease Study. Science 274:740–743
Newman RE, Yoo D, LeRoux MA, Danilkovitch-Miagkova A (2009) Treatment of inflammatory diseases with mesenchymal stem cells. Inflamm Allergy Drug Targets 8:110–123
Reichenbach S, Sterchi R, Scherer M et al (2007) Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med 146:580–590
Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to Osteoarthritis. Health Qual Life Outcomes 1:64
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96
Roos E, Toksvig-Larsen S (2003) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:17
Sini P, Denti A, Cattarini G, Daglio M, Tira ME, Balduini C (1999) Effect of polydeoxyribonucleotides on human fibroblasts in primary cultures. Cell Biochem Funct 17:107–114
Thellung S, Florio T, Maragliano A, Cattarini G, Schettini G (1999) Polydeoxyribonucleotides enhance the proliferation of human skin fibroblasts: involvment of A2 purinergic receptors subtypes. Life Sci 64:1661–1674
Valdatta L, Thione A, Mortarino C, Buoro M, Tuinder S (2004) Evaluation of the efficacy of polydeoxyribonucleotide in the healing process of autologous skin graft donor sites: a pilot study. Curr Med Res Opin 20:403–408
Van Assche D, Staes F, Van Caspel D, Vanlauwe J, Bellemans J, Saris DB, Luyten FP (2009) Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc
Woessner JF, Howell DS (1993) Joint cartilage degradation: basic and clinical aspects. Marcel Dekker, New York
Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656
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The study took place at the IRCCS Foundation, Orthopaedic and Traumatology Department, S. Matteo Hospital Institute, University of Pavia, Italy. This work was supported by Mastelli s.r.l., Sanremo Italy. Special thanks to Dr. Giulia Cattarini and Dr. Andrea Armando for their assistance with the study and manuscript. Authors would also like to thank Prof. Martino Recchia for the statistical analysis.
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Vanelli, R., Costa, P., Rossi, S.M.P. et al. Efficacy of intra-articular polynucleotides in the treatment of knee osteoarthritis: a randomized, double-blind clinical trial. Knee Surg Sports Traumatol Arthrosc 18, 901–907 (2010). https://doi.org/10.1007/s00167-009-1039-y
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DOI: https://doi.org/10.1007/s00167-009-1039-y