European Journal of Cardiovascular Medicine

The integrity of hyaline cartilage¹, essential for facilitating smooth joint movement and protecting underlying bone, is pivotal for overall joint health. However, its limited capacity for self-repair, attributed to avascularity and minimal mitotic activity, renders it vulnerable to degeneration and eventual onset of osteoarthritis (OA). OA is characterized by symptoms such as pain, stiffness, swelling, and impaired mobility.^2-3

The pathogenesis of OA involves intricate interactions between biomechanical and biochemical factors, including cytokines, growth factors, and cellular processes such as autophagy and senescence. These mechanisms contribute to the breakdown of cartilage matrix components and alterations in subchondral bone structure, ultimately leading to joint dysfunction. Moreover, aging-related changes in the musculoskeletal system and the prevalence of risk factors like obesity further exacerbate the incidence and severity of OA, particularly in weight-bearing joints such as the knee.1001

Osteoarthritis, affecting approximately 12.1% of individuals aged 25-74 and becoming a leading cause of physical disability in those over 65, highlights the pressing need for effective management strategies.

Early management of knee OA prioritizes non-invasive approaches like rest, oral medications, physical therapy, and intra-articular injections such as hyaluronic acid (HA), corticosteroids (CS), and platelet-rich plasma (PRP). PRP, enriched with growth factors and cytokines, fosters tissue regeneration, and alleviating symptoms^4-5

Glucosamine, an aminosaccharide, reinforces cartilage by enhancing glycosaminoglycan and proteoglycan production, mitigating matrix degradation, and activating anti-catabolic genes. Glucosamine notably attenuates cartilage destruction and suppresses inflammation markers .exerting chondroprotective effects.^6-7

PRP and glucosamine present promising options for OA management, addressing the escalating burden on aging populations. Our study directly compares glucosamine and PRP to determine the optimal treatment for OA, bridging gaps in existing literature and providing valuable insights for clinical practice. Through rigorous analysis, we aim to identify the preferred approach for effectively managing OA symptoms and improving patient outcomes.

AIMS AND OBJECTIVES

The aim is to compare intra-articular PRP injection versus oral glucosamine in grade 1, 2, 3 knee osteoarthritis. objectives include evaluating WOMAC & VAS scores in patients receiving PRP and oral glucosamine, then comparing outcomes between the two treatment groups.

Sri Amritsar from January 2023 to March 2024 in which patients fulfilling the inclusion criteria were be randomly divided in two groups.

Glucosamine group: 30 Patients with symptomatic knee OA of grade 1, 2, 3 as per Kellgren-Lawrence classification with X-ray findings were given glucosamine and followed up on 1,2, 4 months

PRP group :30 Patients with symptomatic knee OA of grade 1, 2, 3 as per Kellgren-Lawrence classification with X-ray findings were given prp and followed up on 1, 2, 4 months

Randomization: All Patients of age group 30-75 years with osteoarthritic knee withXray suggestive were included in the study after obtaining informed written consent for both the treatments i.e. PRP and glucosamine. To avoid the selection bias computer generated random numbers were obtained and sealed in an envelope. The slip was then taken out by office clerk not involved in the study and whether to give glucosamine or give prp injection was then decided according to the coded slip. The patients were blinded in the present study and were followed up till 4 months.

PATIENT INCLUSION CRITERIA:

• Patient of age group 35-75 years with osteoarthritic knee
• X-ray findings suggestive of osteoarthritis
• Patient complaint of pain secondary to osteoarthritic knee

EXCLUSION CRITERIA

• Patient with Grade 4 osteoarthritis knee
• Patient with neurological defect
• Patient with rheumatoid arthritis
• Patient with gout
• Patient with osteomyelitis
• Patient with septic arthritis

TECHNIQUE:

Glucosamine will be given daily for 3 months.

Daily dose of 1500 mg of glucosamine is given orally.

Tab glucomine 500 mg is given thrice daily to cover the appropriate dose

Follow up will be on end of 1^st, 2^nd and 4^th months.

Interventional Procedure

The patients were treated with 1 intra-articular injection of Autologous PRP. The patients were placed in a supine position with the knee in full extension. The affected side was painted and draped Under aseptic conditions,The skin at the site of injection was anesthetized with 2% lignocaine using a 26 Gauge needle.  10 ml of PRP was injected into the knee joint with an 18-gauge needle. At the end of procedure, the patients were encouraged to bend and extend the knee a few times, to allow the PRP to distribute itself throughout the joint before becoming gel. After the injection, the patients were sent home with instructions on limiting the use of the leg and not to use nonsteroidal medication but to use cold therapy for pain for at least 24 hours. Patients were followed up at 1, 2 and 4 months

Statistical Analysis of Data

 The data from the present study was systematically collected, compiled and statistically analyzed to draw relevant conclusions using SPSS Statistics-26 version. The observations were tabulated in the form of mean Standard Deviation (SD) and Number with percentage. In parametric data, unpaired student t test was used. Quantitative variables were correlated using chi square test. The data was analyzed and level of significance was determined as its ‘p’ value with p <0.05 is significant with p<0.001 is highly significant.

The study conducted at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, aimed to compare the effectiveness of Platelet-Rich Plasma (PRP) injection and oral glucosamine in treating knee osteoarthritis (OA). The study, approved by the institution's ethical review board (Document number: Ant/85/2021) and with informed consent from participants, included 30 patients in each group between January 2023 and March 2024. Out of 70 patients, 10 were lost to follow-up. The outcomes were evaluated based on radiological and functional parameters.

Demographics:

The age range of participants was 34 to 73 years, with an average age of 51.7 years. The majority fell between 40-60 years. In terms of knee involvement, the right side was more affected in both groups, with females outnumbering males presenting with knee OA in both groups (Group A: 20 females, 10 males; Group B: 18 females, 12 males).

Kellgren-Lawrence Grading for OA:

Participants were recruited based on Kellgren-Lawrence grades. In Group A, 6 (20.00%) had grade 1, 16 (53.33%) had grade 2, and 8 (26.67%) had grade 3 OA. In Group B, 4 (13.33%) had grade 1, 17 (56.67%) had grade 2, and 9 (30.00%) had grade 3 OA.

WOMAC Score:

The total WOMAC scores,(assessing pain, stiffness, and physical function), were recorded before treatment and at 1, 2, and 4 months post-treatment for both groups. Reduction in WOMAC scores indicated better pain relief. Group A showed a more significant reduction compared to Group B.

Group A:

  - Before treatment: mean WOMAC was 58.90±5.40.

  - At 1 month: mean WOMAC reduced to 16.73±8.14 (p=0.001).

  - At 2 months: mean WOMAC further decreased to 20.53±7.48 (p=0.001).

  - At 4 months: mean WOMAC was 25.20±4.75 (p=0.001).

- Group B:

  - Before treatment: mean WOMAC was 59.43±4.24.

  - At 1 month: mean WOMAC reduced to 58.60±4.056 (p=0.001).

  - At 2 months: mean WOMAC was 56.76±5.14 (p=0.001).

  - At 4 months: mean WOMAC was 42.90±4.38 (p=0.001).

VAS Score:

VAS scores, indicating pain severity, were recorded before treatment and at 1, 2, and 4 months post-treatment for both groups. Lower scores indicated better pain relief. Group A exhibited a more significant decrease compared to Group B.

- Group A:

  - Before treatment: mean VAS was 5.10±1.348.

  - At 1 month: mean VAS reduced to 1.60±0.814 (p=0.001).

  - At 2 months: mean VAS was 1.93±0.980 (p=0.001).

  - At 4 months: mean VAS was 2.63±0.928 (p=0.001).

- Group B:

  - Before treatment: mean VAS was 5.23±1.165.

  - At 1 month: mean VAS reduced to 4.87±0.973 (p=0.001).

  - At 2 months: mean VAS was 4.40±1.037 (p=0.001).

  - At 4 months: mean VAS was 3.70±1.208 (p=0.001).

The study aimed to compare the efficacy of intra-articular injection of platelet-rich plasma (PRP) versus oral glucosamine in the management of knee osteoarthritis (OA). Osteoarthritis is a prevalent cause of disability worldwide, particularly among the elderly population. By exploring the effectiveness of these treatments, the study contributes to optimizing OA management strategies.

The study population comprised individuals primarily aged between 40 to 60 years, consistent with the age range commonly affected by OA. The mean age of 51.7 years aligns with the typical onset of OA symptoms, which often manifest in middle to older age. This finding underscores the relevance of OA as a condition affecting individuals in their productive years, highlighting the need for effective treatment options.In terms of gender distribution, there was a higher proportion of females in both treatment groups.⁸ This observation resonates with existing literature, which suggests a higher prevalence of OA among women, particularly in the knee joints. The increased susceptibility of females to OA may be attributed to various factors, including hormonal influences, anatomical differences, and lifestyle factors.⁹

The distribution of knee involvement showed a slight predilection towards the right knee, although the difference was not statistically significant. This finding contradicts the common perception that OA predominantly affects the dominant side, indicating that OA development may be influenced by multifactorial factors beyond mechanical stress alone.

The majority of patients in both groups exhibited grade 2 OA according to the Kellgren-Lawrence grading system. This distribution reflects the predominance of mild to moderate OA severity among the study population. Grade 2 OA is characterized by moderate joint space narrowing and the presence of osteophytes, indicative of progressive cartilage degeneration. The inclusion of patients across different OA grades enhances the generalizability of the study findings and allows for a comprehensive assessment of treatment efficacy across various disease stages.

Both PRP and glucosamine demonstrated significant reductions in VAS and WOMAC scores, indicative of improvements in pain and functional outcomes. These findings align with previous research highlighting the efficacy of PRP and glucosamine in alleviating OA symptoms. Notably, PRP showed early and sustained improvements in pain scores compared to glucosamine, suggesting its prompt efficacy in providing symptomatic relief.¹⁰

The study findings are consistent with prior research investigating the efficacy of PRP and glucosamine in OA management. Studies have reported favorable outcomes with PRP, attributing its therapeutic effects to the release of growth factors and cytokines that promote tissue healing and regeneration. Similarly, glucosamine has shown promise in preserving cartilage integrity and reducing inflammation, contributing to improved joint function and pain relief.¹¹

The results of this study have significant clinical implications for the management of knee OA. PRP emerges as a promising intervention for early symptomatic relief and disease modification, offering advantages over traditional oral medications such as glucosamine.¹²

The minimally invasive nature of PRP administration, coupled with its favorable safety profile, makes it an attractive option for patients seeking non-surgical treatment alternatives.

In our study comparing intra-articular PRP and oral glucosamine for managing OA knee symptoms in 30 cases each, both treatments demonstrated significant reductions in VAS and WOMAC scores, indicating effective pain relief and improved function. Predominantly female, our study population aged 34 to 73 years (mean age: 51.7 years), with most cases presenting grade 2 OA. PRP exhibited particular efficacy for mild-to-moderate cases, showing significant improvements after 4 months. Glucosamine yielded delayed yet significant results, notably after 4 months, with minimal side effects compared to NSAIDs. Importantly, PRP surpassed glucosamine in providing superior pain relief and enhancing quality of life. Overall, both treatments offer valuable options for managing OA knee symptoms, with PRP demonstrating superior efficacy in pain relief, quality of life enhancement, and disease progression prevention.

1. Hunter W. Of the structure and disease of articulating cartilages. Clin OrthopRelat Res. 1995 Aug;317(2):3-6.
2. Mankin HJ. The response of articular cartilage to mechanical injury. J Bone Joint Surg Am. 1982;64(3):460-6.
3. Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: Study of 25,124 knee arthroscopies. Knee.2007;14(4):177-82
4. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med.2013 Feb;41(2):356-64
5. E. Marx, Platelet-rich plasma: evidence to support its use, J. Oral Maxillofac. Surg. 62 (4) (2004) 489e496.
6. R. Bannuru, N.S. Natov, U.R. Dasi, C.H. Schmid, T.E. McAlindon, Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteo arthritisdmeta-analysis, Osteoarthr. Cartil. 19 (2011) 611e619
7. D. Altman, J.E. Rosen, D.A. Bloch, H.T. Hatoum, Safety and efficacy of retreatment with a bioengineered hyaluronate for painful osteoarthritis of the knee: results of the open-label extension study of the FLEXX Trial, Osteoarthr. Cartil. 19 (2011) 1169e1175.
8. Dawson J, Juszczak E, Thorogood M, Marks SA, Dodd C, Fitzpatrick R. An investigation of risk factors for symptomatic osteoarthritis of the knee in women using a life course approach. J Epidemiol Community Health. 2003 Oct;57(10):823–30.
9. Loeser RF. Age-related changes in the musculoskeletal system and the development of osteoarthritis. Clin Geriatr Med. 2010 Aug;26(3):371-86.
10. Burchard R, Huflage H, Soost C, Richter O, Bouillon B, Graw JA. Efficiency of platelet-rich plasma therapy in knee osteoarthritis does not depend on level of cartilage damage. Journal of orthopaedic surgery and research. 2019 Dec;14:1-6.