Efficacy of Direct Injection of Etanercept into Knee Joints for Pain in Moderate and Severe Knee Osteoarthritis.
Efficacy of Direct Injection of Etanercept into Knee Joints for Pain in Moderate and Severe Knee Osteoarthritis.
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DOI：
10.3349/ymj.2015.56.5.1379
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发表时间：
2015-09
影响因子：
2.4
通讯作者：
Takahashi K
中科院分区：
文献类型：
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作者：
Ohtori S;Orita S;Yamauchi K;Eguchi Y;Ochiai N;Kishida S;Kuniyoshi K;Aoki Y;Nakamura J;Ishikawa T;Miyagi M;Kamoda H;Suzuki M;Kubota G;Sakuma Y;Oikawa Y;Inage K;Sainoh T;Sato J;Shiga Y;Abe K;Fujimoto K;Kanamoto H;Toyone T;Inoue G;Takahashi K
骨关节炎（OA）疼痛通常被认为是炎症性疼痛。然而，在膝关节骨性关节炎的最后阶段，当软骨下骨连接处被破坏时，膝关节的感觉神经纤维被明显破坏，这可以诱发神经性疼痛。一些作者报道了膝关节中的肿瘤坏死因子-α (tnf -α)在疼痛调节中起着至关重要的作用。本研究的目的是评估依那西普（一种TNFα抑制剂）对膝关节OA疼痛的疗效。在这项前瞻性研究中，对39例膝关节OA患者和2-4 Kellgren-Lawrence分级进行了评估。患者分为两组；透明质酸（HA）依那西普注射液。所有患者都接受了单次膝盖注射。采用视觉模拟评分法（VAS）和Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC）对注射前和注射后4周的疼痛进行评分，并进行组间比较。注射前，两组患者VAS、WOMAC评分比较，差异无统计学意义（p < 0.05）。与HA组比较，依那西普组在VAS评分1、2周及WOMAC评分4周时疼痛均有显著缓解（p<0.05）。两组均未观察到不良事件。骨关节炎膝关节内直接注射依那西普是治疗中重度骨关节炎患者疼痛的有效方法。此外，这一发现表明TNFα是诱发OA疼痛的一个因素。
Osteoarthritic (OA) pain is largely considered to be inflammatory pain. However, during the last stage of knee OA, sensory nerve fibers in the knee are shown to be significantly damaged when the subchondral bone junction is destroyed, and this can induce neuropathic pain. Several authors have reported that tumor necrosis factor-α (TNFα) in a knee joint plays a crucial role in pain modulation. The purpose of the current study was to evaluate the efficacy of etanercept, a TNFα inhibitor, for pain in knee OA. Thirty-nine patients with knee OA and a 2-4 Kellgren-Lawrence grading were evaluated in this prospective study. Patients were divided into two groups; hyaluronic acid (HA) and etanercept injection. All patients received a single injection into the knee. Pain scores were evaluated before and 4 weeks after injection using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and they were compared between the groups. Before injection, VAS and WOMAC scores were not significantly different between the groups (p>0.05). Significant pain relief was found in the etanercept group at 1 and 2 weeks by VAS, and at 4 weeks by WOMAC score, compared with the HA group (p<0.05). No adverse events were observed in either group. Direct injection of etanercept into OA knee joints was an effective treatment for pain in moderate and severe OA patients. Furthermore, this finding suggests that TNFα is one factor that induces OA pain.