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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Osteoarthritis of the knee is a degenerative condition that causes pain&#44; disability&#44; and comorbidities&#46; Injectable therapies are attracting attention due to their safer side effect profile and because they are less invasive than joint replacement&#46; Recent studies have proposed dextrose prolotherapy as a therapy for patients with knee osteoarthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The study by Shan Sit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> conducted in 2020 in China and the United States examined the efficacy of intra-articular hypertonic dextrose &#40;IHD&#41; prolotherapy versus normal saline injection for knee osteoarthritis&#46; Seventy-six patients were randomised &#40;1&#58;1&#41; to either the IHD or saline group for injections at weeks 0&#44; 4&#44; 8 and 16&#46; The WOMAC &#40;Western Ontario and McMaster Universities Arthritis Index&#41; pain and function score&#44; and visual analogue pain intensity scale at 52 weeks showed significant improvement in the IHD group versus the saline group&#46; IHD prolotherapy reduced pain and improved function and quality of life in patients with osteoarthritis compared to blinded saline injections&#46; The procedure was simple and safe&#44; and adherence and satisfaction were high&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The clinical trial by Sert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> conducted in 2020 in Turkey investigated the effects of dextrose prolotherapy in patients with osteoarthritis of the knee&#46; A trial included 66 patients who were assigned to a prolotherapy with dextrose &#40;PG&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&#44; saline &#40;SG&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41; or control &#40;CG&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41; group&#46; PG and SG injections were administered at 0&#44; 3 and 6 weeks&#46; A home exercise programme was prescribed for all three groups&#46; WOMAC scores for pain and activity and visual analogue scores decreased significantly in the PG compared to the SG and CG at 18 weeks&#46; WOMAC scores for stiffness and physical functioning reduced in the PG compared to the CG&#46; Therefore&#44; dextrose prolotherapy is effective in reducing pain&#44; improving functional status and quality of life in knee osteoarthritis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The review by Arias-V&#225;zquez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> conducted in 2019 in Mexico evaluated the efficacy and safety of dextrose prolotherapy in patients with knee osteoarthritis&#46; Ten studies were included with 328 patients treated with dextrose prolotherapy versus 348 controls&#46; In terms of pain reduction and improved function&#44; dextrose prolotherapy was more effective than local anaesthetic infiltration&#44; as effective as hyaluronic acid infiltration&#44; ozone&#44; or radiofrequency&#44; and less effective than erythropoietin&#44; with beneficial effects in the short&#44; medium&#44; and long term&#46; In addition&#44; there were no serious adverse reactions with prolotherapy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study by Farpour and Fereydooni<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in Iran in 2017 compared the effectiveness of intra-articular injection of dextrose versus periarticular injection&#46; Fifty-two patients were randomised to an intra-articular or to a periarticular injection group&#46; Prolotherapy was performed twice at two-week intervals&#46; The results showed that dextrose prolotherapy&#44; either by intra-articular or periarticular injection&#44; results in significant improvement and could be a cost-effective and economical treatment for osteoarthritis of the knee&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">After examining the studies presented above&#44; conducted in recent years in various countries &#40;China&#44; United States&#44; Turkey&#44; Mexico&#44; Iran&#41;&#44; the potential can be seen of dextrose prolotherapy in patients with osteoarthritis of the knee&#46; This treatment&#44; a priori&#44; appears to reduce pain and improve functional status&#44; quality of life and patient satisfaction&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Intra-articular drug delivery is an attractive approach to treating knee osteoarthritis&#44; as it can reduce some of the serious side effects associated with systemic drugs&#44; particularly in older patients&#46; However&#44; it should be noted that in different clinical studies&#44; the apparent efficacy of these intra-articular therapies is mainly due to several factors&#44; including the relevant placebo effect and methodological flaws&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> High-quality clinical data are needed&#44; therefore&#44; before recommending these treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The limitations of the studies included are the small sample size of two clinical trials&#59; Shan Sit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Sert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The study by Shan Sit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> included more patients with normal body mass index in the normal saline group than in the dextrose prolotherapy group&#44; and conversely&#44; the dextrose prolotherapy group had more overweight and obese patients than those in the NS group&#46; The lack of a control group &#40;i&#46;e&#46;&#44; usual-care group&#41; is another major design shortcoming&#46; Furthermore&#44; other factors such as over-the-counter medications&#44; weight loss and amount of exercise during the study were not analysed&#59; or that a high placebo effect weakens the quality of the data in the article by Shan Sit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The 18-week follow-up study by Sert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> has similar methodological flaws&#46; However&#44; Arias-V&#225;zquez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> conclude in their systematic review that &#8220;although HDP &#40;hypertonic dextrose prolotherapy&#41; seems to be a promising interventional treatment for knee OA&#44; more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention&#8221;&#46; It would have been better to conduct a meta-analysis&#44; but it is likely that the low quality and high variability of the data from the studies included did not allow this type of useful study to be conducted&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Recent studies have therefore suggested some clinical benefits of dextrose prolotherapy in the treatment of knee osteoarthritis&#44; however&#44; methodological shortcomings limit how useful they are for drawing valid conclusions&#46; More high-quality research is needed to determine the efficacy and safety of dextrose prolotherapy in patients with knee osteoarthritis&#46; Research will also be able to examine possible long-term complications&#44; explore its possible synergistic effect with other therapies&#44; assess the most appropriate number of sessions and analyse its cost-effectiveness&#46; Thus&#44; clinicians will be able to offer patients the best care based on the latest evidence&#46;</p></span>"
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Letter to the Editor
Prolotherapy with dextrose to reduce pain in osteoarthritis of the knee
Proloterapia con dextrosa para reducir el dolor en la osteoartritis de rodilla
Sandra Martínez-Pizarro
Unidad de Consultas Externas, Departamento de Enfermería, Hospital Comarcal La Inmaculada de Huércal Overa, Almería, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Osteoarthritis of the knee is a degenerative condition that causes pain&#44; disability&#44; and comorbidities&#46; Injectable therapies are attracting attention due to their safer side effect profile and because they are less invasive than joint replacement&#46; Recent studies have proposed dextrose prolotherapy as a therapy for patients with knee osteoarthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The study by Shan Sit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> conducted in 2020 in China and the United States examined the efficacy of intra-articular hypertonic dextrose &#40;IHD&#41; prolotherapy versus normal saline injection for knee osteoarthritis&#46; Seventy-six patients were randomised &#40;1&#58;1&#41; to either the IHD or saline group for injections at weeks 0&#44; 4&#44; 8 and 16&#46; The WOMAC &#40;Western Ontario and McMaster Universities Arthritis Index&#41; pain and function score&#44; and visual analogue pain intensity scale at 52 weeks showed significant improvement in the IHD group versus the saline group&#46; IHD prolotherapy reduced pain and improved function and quality of life in patients with osteoarthritis compared to blinded saline injections&#46; The procedure was simple and safe&#44; and adherence and satisfaction were high&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The clinical trial by Sert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> conducted in 2020 in Turkey investigated the effects of dextrose prolotherapy in patients with osteoarthritis of the knee&#46; A trial included 66 patients who were assigned to a prolotherapy with dextrose &#40;PG&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&#44; saline &#40;SG&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41; or control &#40;CG&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41; group&#46; PG and SG injections were administered at 0&#44; 3 and 6 weeks&#46; A home exercise programme was prescribed for all three groups&#46; WOMAC scores for pain and activity and visual analogue scores decreased significantly in the PG compared to the SG and CG at 18 weeks&#46; WOMAC scores for stiffness and physical functioning reduced in the PG compared to the CG&#46; Therefore&#44; dextrose prolotherapy is effective in reducing pain&#44; improving functional status and quality of life in knee osteoarthritis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The review by Arias-V&#225;zquez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> conducted in 2019 in Mexico evaluated the efficacy and safety of dextrose prolotherapy in patients with knee osteoarthritis&#46; Ten studies were included with 328 patients treated with dextrose prolotherapy versus 348 controls&#46; In terms of pain reduction and improved function&#44; dextrose prolotherapy was more effective than local anaesthetic infiltration&#44; as effective as hyaluronic acid infiltration&#44; ozone&#44; or radiofrequency&#44; and less effective than erythropoietin&#44; with beneficial effects in the short&#44; medium&#44; and long term&#46; In addition&#44; there were no serious adverse reactions with prolotherapy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study by Farpour and Fereydooni<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in Iran in 2017 compared the effectiveness of intra-articular injection of dextrose versus periarticular injection&#46; Fifty-two patients were randomised to an intra-articular or to a periarticular injection group&#46; Prolotherapy was performed twice at two-week intervals&#46; The results showed that dextrose prolotherapy&#44; either by intra-articular or periarticular injection&#44; results in significant improvement and could be a cost-effective and economical treatment for osteoarthritis of the knee&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">After examining the studies presented above&#44; conducted in recent years in various countries &#40;China&#44; United States&#44; Turkey&#44; Mexico&#44; Iran&#41;&#44; the potential can be seen of dextrose prolotherapy in patients with osteoarthritis of the knee&#46; This treatment&#44; a priori&#44; appears to reduce pain and improve functional status&#44; quality of life and patient satisfaction&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Intra-articular drug delivery is an attractive approach to treating knee osteoarthritis&#44; as it can reduce some of the serious side effects associated with systemic drugs&#44; particularly in older patients&#46; However&#44; it should be noted that in different clinical studies&#44; the apparent efficacy of these intra-articular therapies is mainly due to several factors&#44; including the relevant placebo effect and methodological flaws&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> High-quality clinical data are needed&#44; therefore&#44; before recommending these treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The limitations of the studies included are the small sample size of two clinical trials&#59; Shan Sit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Sert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The study by Shan Sit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> included more patients with normal body mass index in the normal saline group than in the dextrose prolotherapy group&#44; and conversely&#44; the dextrose prolotherapy group had more overweight and obese patients than those in the NS group&#46; The lack of a control group &#40;i&#46;e&#46;&#44; usual-care group&#41; is another major design shortcoming&#46; Furthermore&#44; other factors such as over-the-counter medications&#44; weight loss and amount of exercise during the study were not analysed&#59; or that a high placebo effect weakens the quality of the data in the article by Shan Sit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The 18-week follow-up study by Sert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> has similar methodological flaws&#46; However&#44; Arias-V&#225;zquez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> conclude in their systematic review that &#8220;although HDP &#40;hypertonic dextrose prolotherapy&#41; seems to be a promising interventional treatment for knee OA&#44; more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention&#8221;&#46; It would have been better to conduct a meta-analysis&#44; but it is likely that the low quality and high variability of the data from the studies included did not allow this type of useful study to be conducted&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Recent studies have therefore suggested some clinical benefits of dextrose prolotherapy in the treatment of knee osteoarthritis&#44; however&#44; methodological shortcomings limit how useful they are for drawing valid conclusions&#46; More high-quality research is needed to determine the efficacy and safety of dextrose prolotherapy in patients with knee osteoarthritis&#46; Research will also be able to examine possible long-term complications&#44; explore its possible synergistic effect with other therapies&#44; assess the most appropriate number of sessions and analyse its cost-effectiveness&#46; Thus&#44; clinicians will be able to offer patients the best care based on the latest evidence&#46;</p></span>"
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Article information
ISSN: 21735743
Original language: English
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