Comparative Study of the Effectiveness of Ultrasound-Guided Intra-Articular Injection of Dextrose Prolotherapy, Hyaluronic Acid and Corticosteroid in Thumb-Base Osteoarthritis Patients

Background: Hand osteoarthritis (OA) is a highly prevalent musculoskeletal disease, especially in older age groups.
Objective: To compare the efficacy of ultrasound (US)-guided intra-articular injection of dextrose (DX), hyaluronic acid (HA) and corticosteroids in patients with OA of the carpometacarpal Joint of the thumb.
Patients and Methods: This prospective cohort observational study was carried out on 45 patients fulfilled the American college of rheumatology criteria of OA in the hands, divided into three equal groups: Group I: treated by a single injection of 40 mg methylprednisolone mixed with 0.5 ml of local anesthetic, group II: treated with a single injection of 0.5 ml of sodium hyaluronate and group III: treated with three injections of 0.5 ml of 5% DX solution mixed with 0.5 ml of local anesthetic.
 Results: Visual analogue scale (VAS)for pain measurement showed significant improvement after 1 and 3 months compared to pre-treatment (P<0.05). Tenderness in the corticosteroid group showed significant difference after 1 month and 3 months (P<0.05). Morning stiffness in corticosteroid and sodium hyaluronate groups showed significant difference after 1 month and 3 months compared to visit 1 (P<0.05). Range of motion using goniometer in corticosteroid group was significantly improved after 1 month compared to visit 1 (P<0.05). Hand disability evaluation by COCHIN scale in corticosteroid and sodium hyaluronate groups showed significant difference after 1 month compared to visit 1 (P<0.05).
Conclusions: Sodium hyaluronate showed significant improvement regarding VAS score, tenderness grades, morning stiffness, range of motion and hand disability from baseline to 3-month evaluation.