Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 3971-3979
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.3971
Comparison of intra-articular injection of parecoxib vs oral administration of celecoxib for the clinical efficacy in the treatment of early knee osteoarthritis
Lu Lu, Yu Xie, Ke Gan, Xiao-Wen Huang
Lu Lu, Yu Xie, Ke Gan, Department of Rheumatology, Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Nanjing 210029, Jiangsu Province, China
Xiao-Wen Huang, Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, Jiangsu Province, China
Author contributions: Lu L and Huang XW contributed to study conception and design; Lu L, Xie Y and Gan K contributed to data acquisition, data analysis and interpretation, and writing of article; all of authors contributed to editing, reviewing and final approval of article.
Supported by National Natural Science Foundation of China, NO. 81774274; and Project of Jiangsu Provincial Hospital of Traditional Chinese Medicine, NO. Y19058.
Institutional review board statement: The study was approved by the Ethics Committee of Affiliated Hospital of Nanjing University of Chinese Medicine.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: All authors have declared that no conflict of interest exists.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Wen Huang, MD, Professor, Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), No. 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. jiangsuaaa@aliyun.com
Telephone: +86-25-86624213 Fax: +86-25-86624213
Received: September 30, 2019
Peer-review started: September 30, 2019
First decision: October 23, 2019
Revised: November 5, 2019
Accepted: November 15, 2019
Article in press: November 15, 2019
Published online: December 6, 2019
Abstract
BACKGROUND

Non-steroid anti-inflammatory drugs (NSAIDs) have played a crucial role in the treatment of osteoarthritis, especially in the early stages. However, the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated. Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment. Parecoxib may be a suitable drug for intra-articular injection.

AIM

To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.

METHODS

Early knee osteoarthritis patients (n = 110) were retrospectively analyzed. These patients were divided into three groups: Basic treatment + oral glucosamine (group A, n = 37), oral celecoxib + basic treatment + oral glucosamine (group B, n = 37), and intra-articular injection of parecoxib + basic treatment + oral glucosamine (group C, n = 36). Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time, for three times total. The three groups were compared in terms of visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores and patient satisfaction before and after treatment. The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.

RESULTS

All patients were followed up for an average of 15.5 ± 2.7 mo. The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment. Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment. VAS and HSS scores were significantly improved in each group compared with before (P < 0.001). There were significant differences among the three groups in VAS and HSS scores (P < 0.001). The clinical efficacy of group C was superior to that of groups A and B (P < 0.001), while group B outperformed group A in this respect (P < 0.001). The patient satisfaction was the highest in group C (P < 0.001). After treatment, the levels of tumor necrosis factor α (TNF-α) and interleukin (IL)-6 in the synovial fluid decreased in each group compared with before (P < 0.001), while the levels of IL-10 increased (P < 0.001). The three groups differed significantly in the levels of TNF-a, IL-6 and IL-10 in the synovial fluid after treatment (P < 0.001).

CONCLUSION

For patients with early knee osteoarthritis, intra-articular injection of parecoxib could effectively improve clinical symptoms. This method may be a reliable alternative for early knee osteoarthritis.

Keywords: Knee osteoarthritis, Intra-articular injection, Parecoxib, Non-steroid anti-inflammatory drugs

Core tip: Among patients with early knee osteoarthritis, intra-articular injection of parecoxib can significantly improve clinical symptoms and avoid the adverse events associated with long-term oral use of non-steroid anti-inflammatory drugs. This treatment can be a suitable treatment alternative.