Ultrasound guided intra-articular botulinum toxin injection for treatment of the osteoarthritic knee pain: expert opinion.

Allam Abdallah El-Sayed 1,2*, Galluccio Felice 3

1: Department of physical medicine Rheumatology and rehabilitation Tanta University Hospital Egypt

2: Faculty of medicine Tanta university

3: Department of rheumatology, department of clinical and experimental medicine AOU Careggi Florence Italy

*Corresponding author Correspondence to: allmovish@gmail.com.

Publication data:

Submitted: October 23,2019

Accepted: February 27,2020

Online: March 15,2020

This article was subject to full peer-review

This is an open access article distributed under the terms of the Creative Commons Attribution Non- Commercial License 4.0 (CCBY-NC) allowing to share and adapt.

Share: copy and redistribute the material in any medium or format.

Adapt: remix, transform, and build upon the licensed material.

the work provided must be properly cited and cannot be used for commercial purpose.

Osteoarthritis is the most common form of arthritis and cause of joint pain and disability [1]. The prevalence, burden and socioeconomic impact of osteoarthritis of the knee is considerable and growing [2]. Knee pain is the most cardinal symptom of the osteoarthritic knee and is associated with a high degree of impaired function and daily activities [3]. Intra-articular injection provides a safe and cost effective control of knee pain with improvement of function and activities of daily living [4]. Ultrasound guidance improves the accuracy of the intra-articular injection in knee joint and clinical outcomes and lowers health care costs [5]. Botulinum toxin targets many neuropeptides leading to reduction of pain, peripheral sensitization and in turn reduction of the central sensitization. Also, botulinum toxin plays an anti- inflammatory role by reduction of the neurogenic inflammation [6]. The following table summarizes how to use botulinum toxin in clinical practice according to authors experience. However, further large-scale multicenter randomized controlled trials are needed to confirm effectiveness and determine the exact position of this intervention in the therapeutic armamentarium for the osteoarthritic knee pain.

BMI = Body Mass Index

References:

[1] Damen J, van Rijn RM, Emans PJ, Hilberdink WKHA, Wesseling J, Oei EHG, et al. Prevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort. Arthritis Res Ther. 2019; 21:4.

[2] Emery CA, Whittaker JL, Mahmoudian A, Lohmander LS, Roos EM, Bennell KL, et al. Establishing outcome measures in early knee osteoarthritis. Nat Rev Rheumatol. 2019; 15:438-48.

[3] Conoghan PG, Cook AD, Hamilton JA, Tak PP. Therapeutic options for targeting inflammatory osteoarthritis pain. Nat Rev Rheumatol. 2019; 15:355-63.

[4] Tapasvi S, Mohanty SS, Vedavyasa Acharya KK, Bhattacharya K, et al. Viscosupplementation for Management of Knee Osteoarthritis from an Indian Perspective: An Expert Consensus Report. Pain Ther. 2019; 8:217-231.

[5] Berkoff DJ, Miller LE, Block JE. Clinical utility of ultrasound guidance for intra-articular knee injections: a review. Clin Interv Aging. 2012 ;7 :89-95.

[6] Khenioui H, Houvenagel E, Catanzariti JF, Guyot MA, Agnani O, Donze C. Usefulness of intra-articular botulinum toxin injections. A systematic review. Joint Bone Spine. 2016; 83:149-54.

Full Text Article Open Access

Publication data:

References: