The Effect of Hyaluronic Acid Injection on TNF-Alpha and IL-1β in Knee Osteoarthritis

Investigation of the Effect of Hyaluronic Acid Injection on Tnf-Alpha and IL-1beta at DNA-Protein Level in Knee Osteoarthritis Patients and Comparison With Clinical Parameters: A Randomised Controlled Trial

In this study, the effect of intra-articular HA injection therapy on pre- and post-treatment TNF-alpha and IL-1beta levels and methylation changes in blood and synovial fluid in patients with knee osteoarthritis will be determined and compared with the placebo group. In addition, the effects of HA injection on pain, functional status and quality of life will be evaluated and these effects will be related to changes in TNF-alpha and IL-1-beta.

Inclusion Criteria:

• Diagnosis of knee osteoarthritis according to ACR (American College of Rheumatology) criteria
• Knee pain for more than 3 months
• Presence of knee pain resistant to conservative treatment for at least 3 months
• To be between the ages of 45-75
• Kellgren-Lawrence stage 2-3 gonarthrosis detected in the available knee direct radiographs of the patients

Exclusion Criteria:

• Patients with KL stage 1 and 4 OA
• Systematic diseases (severe cardiovascular disease, severe renal failure, severe hepatic failure, uncontrolled diabetes, cancer, immunosuppression, haematological diseases, systemic bone diseases)
• Bleeding tendency (acquired or inherited) [lNR>2 in a patient on Coumadin],
• Infection (systemic or local)
• Secondary knee osteoarthritis (inflammatory joint disease, post-traumatic, post-infectious, etc.)
• Major knee trauma within the last 1 year
• BMI >40
• History of total knee or hip arthroplasty within 1 year
• Pregnancy
• History of intra-articular injection within the last 6 months
• Patients with Hb less than 11 g/dl and Plt less than 150.000
• Presence of allergy to hyaluronic acid products