Osteoartrit tedavisinde otolog zenginleştirilmiş serumun değerlendirilmesi

Amaç: Çalışmamızda retrospektif olarak otolog zenginleştirilmiş serum (OZS) tedavisinin osteoartritteki etkisinin bilateral diz enjeksiyonu ile değerlendirilmesi amaçlanmıştır.Yöntemler: Çalışmamıza yaş ortalaması 57.6 ± 8.21 yıl (41-70) olan 33 hasta (19 kadın, 14 erkek) 66 diz dahil edilmiştir. Çalışmamıza katılan hastaların diz osteoartritleri Kellgren-Lawrence sınıflamasına göre bilateral olarak evre 2-3 idi. Sekonder artrit, enflamatuar eklem hastalıkları, klinik olarak ilgili hematolojik veya anormal klinik kimya değerleri, eklem instabilitesi, son 6 ay içerisinde eklem içi kortikosteroid enjeksiyonu uygulanan, diabetes mellitus öyküsü, 30 kg/m2'dan büyük vücut kitle indeksi mevcut olan hastalar çalışmadan dışlandı. Her iki diz arasındaki VAS farklılığı 2 puandan fazla olan hastalar çalışmadan çıkarıldı. Üç hafta boyunca haftada iki kez toplamda 6 kez her iki diz eklem içine OZS enjekte edildi. Hastalar VAS ağrı skorlaması (hiç ağrı olmaması 0 olarak ve maksimum ağrı 10 olarak derecelendirildi), Diz Yaralanması ve Osteoartirit Skalası (DYOS) (puanlama 0 ile 100 arasında değişmektedir. 0 anormal derecede yüksek diz problemleri gösterirken, 100 problemsiz sağlıklı bir diz göstermektedir) ve Diz Cemiyeti Skorlaması (DCS) (Maksimum 100 puan olan skala ağrıya 50, stabiliteye 25 ve eklem hareket açıklığına 25 puan atanır) skalaları ile ilk enjeksiyon öncesi ve son enjeksiyondan 1 yıl sonra değerlendirildi.Bulgular: Hastaların tedavi öncesi ve 1. yıl takip VAS değerleri sırası ile 7.36±0.93 (aralık: 5-9) ve 3.27±1.23 (aralık: 1-6) idi. OZS tedavisi VAS skorunda istatistiksel olarak anlamlı düşme göstermiştir (p<0.01). Hastaların tedavi öncesi ve 1. yıl takip DYOS toplam değerleri sırası ile 42.39±13.38 (aralık: 21-65) ve 72.36±8.81 (aralık: 54-92) idi. Hastaların DYOS total skorunda istatistiksel olarak anlamlı yükselme saptanmıştır (p<0.01). Hastaların tedavi öncesi ve 1. yıl takip DCS değerleri sırası ile 42.79±10.26 (aralık: 14-61) ve 70.61±9.32 (aralık: 49-84) idi. Hastaların DCS değerlerinde istatistiksel olarak anlamlı yükselme saptanmıştır (p<0.01). Sonuç: Ağrılı diz osteoartriti olan hastalarda inra-artiküler OZS kullanımı ağrı şiddeti, DYS, DYOS ve DCS skorları açısından anlamlı iyileşmelere yol açmaktadır. Bu bulgular ışığında, OZS tedavisi osteoartritte etkili ve güvenli bir alternatif bir tedavi yöntemi olarak değerlendirilebilir.

Anahtar Kelimeler:

intra-artiküler enjeksiyon, otolog zenginleştirilmiş serum, diz osteoartriti, diz osteoartriti

Evaluation of the autologous conditioned serum in the treatment of osteoarthritis

Aim: The present study was a retrospective study aiming to determine the effect of the autologous conditioned serum (ACS) on osteoarthritis (OA); we made this analysis by injecting it to a symmetrically involved knee.Methods: The present study comprised 33 patients (19 females, 14 males) with 66 knees and a mean age of 57.6±8.21 (range: 41-70). The patients included in the study had radiologically verified bilateral grade 2-3 OA of the knee according to Kellgren-Lawrence classification. Secondary arthritis, inflammatory joint diseases, clinically relevant hematologic or abnormal clinical chemistry values, joint instability, intra-articular corticosteroid injection within the previous 6 months, history of diabetes mellitus and body mass index greater than 30 kg/m2 were the exclusion criteria. Patients who had VAS difference more than 2 points between their knees were excluded from the study. ACS was injected twice a week for a total of 6 times in both knee joints for 3 weeks. The patients were analyzed with the Visual Analog Scale (VAS) (no pain was graded 0 and maximal pain was graded 10), the Knee Injury and Osteoarthritis Score (KOOS) (scoring ranges between 0 and 100. 0 indicates abnormally high level of knee problems, while 100 indicates a healthy knee with no problems) and the Knee Society Score (KSS) (Of the maximum 100 points, a possible 50 points are assigned to pain, 25 points to stability, and 25 points for range of motion) before the administration of the first injection and again 1 year after the last injection. Results: The pre-treatment and 1-year follow-up VAS values of the patients were 7.36±0.93 (range: 5-9) and 3.27±1.23 (range: 1-6), respectively. ACS treatment showed a statistically significant decrease in VAS score (p <0.01). Pre-treatment and 1-year follow-up KOOS values of the patients were 42.39±13.38 (range: 21-65) and 72.36±8.81 (range: 54-92), respectively. There was a statistically significant increase in the KOOS values of the patients (p <0.01). The pre-treatment and 1-year follow-up KSS values of the patients were 42.79±10.26 (range: 14-61) and 70.61±9.32 (range: 49-84), respectively. There was a statistically significant increase in the KSS values of the patients (p <0.01). Conclusion: Intra-articular injection of ACS in patients with painful OA leads to significant improvements in pain severity, KOOS, KSS and DCS scores. In the light of these findings, ACS treatment may be considered as an effective and safe alternative treatment method in osteoarthritis.

Keywords:

Intra-articular injection, autologous conditioned serum, knee osteoarthritis,

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