Comparison of Polynucleotide, Sodium Hyaluronate, and Crosslinked Sodium Hyaluronate for the Management of Painful Knee Osteoarthritis: A Multi-Center, Randomized, Double-Blind, Parallel-Group Study

Pain Med. 2023 May 2;24(5):496-506. doi: 10.1093/pm/pnac155.

Abstract

Objective: To compare the clinical effectiveness of sodium polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid for the management of painful knee osteoarthritis.

Design: Randomized, double-blind, parallel-group clinical trial.

Setting: Multicenter study.

Subjects: Patients with chronic painful knee osteoarthritis.

Methods: Ninety patients were selected and randomized into polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid groups (30 per group). Intra-articular injections of the viscosupplement for each group were administered to the patients three times at one-week intervals. The primary outcome was differences in changes of weight-bearing pain scores at 16 weeks between the groups. The secondary outcomes were changes in the intensity of knee pain during weight-bearing, walking, and rest, and functional disability, quality of life, and adverse events during the 16-week follow-up period.

Results: At 16 weeks, the polynucleotide group showed a higher reduction in pain score using a Visual Analog Scale score (0-100) than the classic hyaluronic acid (-17.6 [95% CI = -35.1 to -0.1]; P = .048) and crosslinked hyaluronic acid (-22.4 [95% CI = -41.5 to -3.3]; P = .016) groups. The polynucleotide and crosslinked hyaluronic acid groups showed an early-onset reduction in knee pain during weight-bearing, walking, and rest. All three groups showed reductions in functional disability and improved quality of life at 16 weeks without inter-group differences. No severe adverse events were reported throughout the study period.

Conclusion: Polynucleotide significantly relieves pain more and relieves pain faster in patients with knee osteoarthritis than classic and crosslinked hyaluronic acid, with improved health-related quality of life.

Keywords: Crosslinked Sodium Hyaluronate; Intra-Articular Injection; Knee Osteoarthritis; Polynucleotide Sodium; Sodium Hyaluronate.

Publication types

  • Randomized Controlled Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Double-Blind Method
  • Humans
  • Hyaluronic Acid* / therapeutic use
  • Injections, Intra-Articular
  • Knee Joint
  • Osteoarthritis, Knee*
  • Pain / chemically induced
  • Quality of Life
  • Treatment Outcome

Substances

  • Hyaluronic Acid