Yonsei Med J.  2015 Sep;56(5):1379-1383. 10.3349/ymj.2015.56.5.1379.

Efficacy of Direct Injection of Etanercept into Knee Joints for Pain in Moderate and Severe Knee Osteoarthritis

• Ohtori S
• Orita S
• Yamauchi K
• Eguchi Y
• Ochiai N
• Kishida S
• Kuniyoshi
• Aoki Y
• Nakamura J
• Ishikawa T
• Miyagi M
• Kamoda H
• Suzuki M
• Kubota G
• Sakuma Y
• Oikawa Y
• Inage K
• Sainoh T
• Sato J
• Shiga Y
• Abe K
• Fujimoto K
• Kanamoto H
• Toyone T
• Inoue G
• Takahashi

• KMID: 2163632
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1379

Abstract

PURPOSE
Osteoarthritic (OA) pain is largely considered to be inflammatory pain. However, during the last stage of knee OA, sensory nerve fibers in the knee are shown to be significantly damaged when the subchondral bone junction is destroyed, and this can induce neuropathic pain. Several authors have reported that tumor necrosis factor-alpha (TNFalpha) in a knee joint plays a crucial role in pain modulation. The purpose of the current study was to evaluate the efficacy of etanercept, a TNFalpha inhibitor, for pain in knee OA.
MATERIALS AND METHODS
Thirty-nine patients with knee OA and a 2-4 Kellgren-Lawrence grading were evaluated in this prospective study. Patients were divided into two groups; hyaluronic acid (HA) and etanercept injection. All patients received a single injection into the knee. Pain scores were evaluated before and 4 weeks after injection using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and they were compared between the groups.
RESULTS
Before injection, VAS and WOMAC scores were not significantly different between the groups (p>0.05). Significant pain relief was found in the etanercept group at 1 and 2 weeks by VAS, and at 4 weeks by WOMAC score, compared with the HA group (p<0.05). No adverse events were observed in either group.
CONCLUSION
Direct injection of etanercept into OA knee joints was an effective treatment for pain in moderate and severe OA patients. Furthermore, this finding suggests that TNFalpha is one factor that induces OA pain.

Keyword

Etanercept; knee osteoarthritis; pain

MeSH Terms

Aged
Etanercept/*administration & dosage/therapeutic use
Female
Humans
Hyaluronic Acid/administration & dosage/*therapeutic use
Injections, Intra-Articular
Knee Joint/physiopathology
Male
Middle Aged
Neuralgia/drug therapy
Osteoarthritis, Knee/*drug therapy
Pain Measurement
Prospective Studies
Severity of Illness Index
Treatment Outcome
Tumor Necrosis Factor-alpha
Viscosupplements/administration & dosage/*therapeutic use
Visual Analog Scale
Etanercept
Hyaluronic Acid
Tumor Necrosis Factor-alpha
Viscosupplements

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