Ahmet ASLAN, Nevres Hürriyet AYDOĞAN, Hüseyin YORGANCIGİL, Mücahit İLHAN, İrfan ALTUNTAŞ, Remzi Arif ÖZERDEMOĞLU

Gonartrozda farklı eklem içi ilaç uygulamalarının antioksidan sistem ve lipid peroksidasyonu üzerine etkisi

Oksidatif stres ve lipid peroksidayonu diz osteartrinin (gonartroz) patogenizinde rol oynayabilir. Bu çalışmada, osteoartritli dizlerde lipid peroksidasyonu ve antioksidan savunma sisteminin hastalık mekanizmasındaki rolü ve farklı eklem içi tedavilerin lipid peroksiyonu ve antioksidan enzim aktivitesi üzerine etkilerini araştırdık. Amerikan Romatoloji Koleji ölçütlerine göre gonartroz tanısı alan 75 hasta rastgele eşit 5 gruba ayrıldı. Birinci gruba sadece eklem içi serum fizyolojik verilerek kontrol grubu kabul edildi. İkinci gruba yüksek molekül ağırlıklı hyaluronik asit (HA, hylan G-F 20) eklem içi haftada bir üç kez uygulandı. Üçüncü gruba metil prednizolon asetat bir kez eklem içi verildi. Dördüncü gruba düşük molekül ağırlıklı HA, hyaluronan eklem içi haftada bir beş kez uygulandı. Beşinci gruba tenoksikam bir kez eklem içi verildi. Eklem sıvısı ve hemolizatta serbest radikallerin lipid peroksidasyon ürünü malondialdehit (MDA) ve antioksidan enzimler; superoksit dismutaz (SOD), katalaz (CAT), glutatyon peroksidaz (GSH-Px) düzeyleri tedavi öncesi ve sonrasında ölçülerek karşılaştırıldı. Farklı eklem içi uygulamalarla tedavi sonrası her bir grupta sinovial sıvıdaki MDA düzeylerinin kontrol grubuna göre anlamlı düzeyde azaldığı tespit edildi. Hemolizat MDA, SOD, GSH-Px ve CAT seviyelerinde tedavi öncesine göre anlamlı fark gözlenmedi. Sinoviyal sıvıda CAT aktivitesine rastlanmadı. Sinoviyal sıvıdaki SOD ve GSH-Px aktivitelerinde tedavi öncesine göre artış görüldü fakat bu artış istatistiksel olarak anlamlı değildi. Gonartroz tedavisinde farklı eklem içi uygulamalar sinoviyal sıvıda lipid peroksidasyonunu azaltabilir. Gelecekte, gonartrozda tedavinin etkinliğini değerlendirmede klinik ölçütlere ek olarak MDA gibi biyokimyasal ölçümlerin de rutin olarak kullanılabilmesine yönelik daha ileri araştırmalar yapılabilir.

The effect of different intraarticular drug applications to the antioxidation system and lipid peroxidation in gonarthrosis

Oxidative stress and lipid peroxidation may have a role in pathogenesis of knee osteoarthritis (gonarthrosis). In this study, we investigated both the role of disease mechanisms, lipid peroxidation and antioxidant defense system and the effects of different intraarticular therapies on antioxidant enzyme activity and lipid peroxidation in gonarthrosis. A total of 75 patients with knee pain who were diagnosed as gonarthrosis according to the American College of Rheumatology (ACR) criteria were included in this study, and randomly and equally divided into 5 groups. Only intraarticular salin was applied to the control group (Group 1). Intraarticular high molecular weight hyaluronic asit (HA, hylan G-F 20) treatment was given to Group 2 for 3 weeks. Intraarticular metil prednizolon acetate were administered to Group 3. Intraarticular low molecular weight HA, hyaluronan treatment was given to Group 4 for 5 weeks. Intraarticular tenoxicam treatment was given to Group 5. Blood and synovial fluid samples were taken from all the patients for biochemical analysis, and the following parameters were measured: Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and malondialdehyde (MDA). After the treatment synovial fluid MDA levels were significantly decreased in each group according to control group. No significant change was found in MDA, SOD, GSH-Px and catalase activities in hemolysate. CAT enzymatic activity was not present in synovial fluid. Synovial fluid SOD and GSH-Px activities were increased after the treatment but this augmentation was not significant statistically. In gonarthrosis, different intraarticular therapies may diminish lipid peroxidation in synovial fluid. In the future, to assess the effectiveness of gonarthrosis treatment in addition to clinical criteria, such as the MDA to be used as a routine biochemical measurements can be made for further research.

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