Effect of Sodium Hyaluronate on Inflammatory Cytokine Levels in Synovial Fluid of Patients with Knee Osteoarthritis
Department of Orthopaedics, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Hubei, PR China, 1Department of Spine, Characteristic Medical Center of the Chinese People’s Armed Police Force, PR China, 2Department of Orthopaedics, Yuyao Traditional Chinese Medicine Hospital of Zhejiang Province, Zhejiang, PR China, 3Central War Zone General Hospital of the Chinese People's Liberation Army, PR China
Department of Orthopaedics, Yuyao Traditional Chinese Medicine Hospital of Zhejiang Province, Zhejiang, PR China, E-mail: firstname.lastname@example.org
This study evaluated the efficacy of intraarticular injection of sodium hyaluronate in the treatment of knee osteoarthritis and its influence on the levels of stromal cell-derived factor-1 and matrix metalloproteinases 3, 9 and 13 in the synovial fluid of patients with knee osteoarthritis. A total of 180 patients with knee osteoarthritis treated in the orthopaedic outpatient department of the Hubei Provincial Hospital from April 2015 to April 2017 were selected as the research objects and all of them were given intraarticular injection of sodium hyaluronate with synovial fluid extracted before the injection, 1 and 3 mo after the injection, and the level of stromal cell-derived factor-1 and matrix metalloproteinases 3, 9, 13 were determined using a sandwich enzyme-linked immunosorbent assay method. After 3 mo of treatment, the effect on the efficacy of patient’s gender, age, body mass index, swollen joint degree, involved joint space, Kellgren and Lawrence grading as well as tibiofemoral angle were observed and studied. Among the 180 cases there were 132 cases with 73.3% effective rate and 48 cases of with ineffective rate of 26.7%. Significant differences were found in the levels of stromal cell-derived factor-1, matrix metalloproteinases 3, 9 and 13 in the synovial fluid before the treatment, 1 and 3 mo after the treatment (p<0.05) and the change of stromal cell-derived factor-1 was positively correlated with that of matrix metalloproteinases 3, 9 and 13 (r=0.462, p<0.05; r=0.407, p<0.05; r=0.378, p<0.05, respectively). Multivariate analysis showed that the influential factors included the joint graded more than II, knee osteoarthritis involving tibiofemoral joint space and X-ray Kellgren and Lawrence grading level more than 3 with RR>1.7 in joint effusion and osteoarthritis involving tibiofemoral joint gap. In the treatment of knee osteoarthritis, the intraarticular injection of sodium hyaluronate could effectively reduce the levels of stromal cell-derived factor-1, matrix metalloproteinases 3, 9 and 13 in synovial fluid and decrease inflammatory reaction. But it should be used with great caution for treating patients with moderate and severe knee osteoarthritis involving tibial and femoral joints with the joint effusion graded above II or bone contusion.