Objectives

Up to 50% of patients with symptomatic knee osteoarthritis (OA) present with neuropathic pain (NP) features. We assessed the impact of NP according to DN4 (Douleurs Neuropathiques 4 questions) score on the response to intra-articular (IA) hyaluronic acid (HA) injections and the effects of HA injections on NP.

Materials and Methods

We conducted a post hoc analysis from a multicenter, randomized, double-blind, noninferiority trial comparing the efficacy of 2 HA in symptomatic knee OA at 24 weeks. At baseline, demographic, anthropometric, radiologic data, and symptoms were recorded. The symptomatic effect of HA was assessed by VAS pain, patient global assessment (PGA), WOMAC, DN4, and OMERACT-OARSI response.

Results

A total of 187 patients were included. NP according to DN4 score was present in 20 patients (10.7%) at baseline. Most common positive DN4 items were tingling (36.9%) and burning (36.4%). NP was associated with WOMAC pain score (P = 0.02). The presence of NP at baseline did not affect the symptomatic improvement after HA injections according to the VAS pain (P = 0.71), PGA (P = 050), WOMAC pain (P = 0.89), WOMAC function (P = 0.52), and rate of OMERACT-OARSI responders (P = 0.21). The prevalence of patients with NP decreased by 50% (n = 10) at 24 weeks after HA injections. Most improved DN4 items were itching (90%), hypoesthesia to pinprick (88%), and burning (50%).

Conclusion

In our study, NP was associated with pain severity, but did not influence the response to IA HA. On the other hand, HA injections reduced some NP features, especially itching, sting hypoesthesia, and burning.

中文翻译：

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神经性疼痛的存在是否会影响膝骨关节炎患者对透明质酸的反应？

目标

高达 50% 的症状性膝关节骨关节炎 (OA) 患者存在神经性疼痛 (NP) 特征。我们根据 DN4（Douleurs Neuropathiques 4 个问题）评分评估了 NP 对关节内 (IA) 透明质酸 (HA) 注射的反应以及 HA 注射对 NP 的影响。

材料和方法

我们对一项多中心、随机、双盲、非劣效性试验进行了事后分析，比较了 2HA 在 24 周时对症状性膝关节 OA 的疗效。在基线时，记录人口统计学、人体测量学、放射学数据和症状。HA 的症状效应通过 VAS 疼痛、患者整体评估 (PGA)、WOMAC、DN4 和 OMERACT-OARSI 反应进行评估。

结果

共纳入 187 名患者。基线时 20 名患者 (10.7%) 存在根据 DN4 评分的 NP。最常见的 DN4 阳性项目是刺痛（36.9%）和灼热（36.4%）。NP 与 WOMAC 疼痛评分相关（P = 0.02）。根据 VAS 疼痛 ( P = 0.71)、PGA ( P = 050)、WOMAC 疼痛 ( P = 0.89)、WOMAC 功能 ( P = 0.52) 和OMERACT-OARSI 响应者的比率 ( P = 0.21)。NP 患者的患病率下降了 50%（n= 10) 在 HA 注射后 24 周。大多数改善的 DN4 项目是瘙痒 (90%)、针刺感觉减退 (88%) 和烧灼感 (50%)。

结论

在我们的研究中，NP 与疼痛严重程度相关，但不影响对 IA HA 的反应。另一方面，HA 注射减少了一些 NP 特征，特别是瘙痒、刺痛感觉减退和烧灼感。