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Background: Polyacrylamide hydrogel (PAAG) was evaluated recently to treat osteoarthritis (OA) in horses with highly encouraging results; however no long term field-study was done to explore its clinical efficacy and lasting effect. The objective of this study was to evaluate the efficacy of PAAG in improving clinical signs of OA in horses. We hypothesized that lameness grade would significantly improve and the effect would last at least 2 years in osteoarthritic joints treated with PAAG. Forty three horses older than 2 years with OA in only one joint based on clinical evaluation, intra-articular anaesthesia and imaging (radiography) were included in this study. Horses were injected with 2 ml of PAAG into the affected joint and were followed up at 1, 3, 6, 12 and 24 months. Efficacy of PAAG was evaluated by blinded clinical assessment of lameness. Adverse reactions to joint injection were assessed. Data relating to case details, type of activity, joint and limb involved, lameness duration, lameness grading, previous joint treatment, joint effusion grading, radiographic grading, and owner assessment were recorded. Factors associated with the outcome measure "lameness grading" were analyzed using generalized linear mixed model for logistic regression.
Results: At 1, 3, 6, 12 and 24 months follow-up, 59%, 69%, 79%, 81/% and 82.5% of horses were non-lame respectively. Reduction of joint effusion was observed over time. No side effect was observed in the treated joints. There was a significant decrease in lameness grade from baseline to 1, 3, 6, 12 and 24 months (P less than 0.0001) and a significant positive association with joint effusion (P less than 0.0001). Estimates for odds ratio (OR) showed that the effect of treatment increased over time (OR for lower lameness from month 1 to month 24 relative to baseline increased from 20 to 58).
Conclusions: PAAG significantly alleviated lameness and joint effusion in osteoarthritic joints. PAAG is a safe and lasting (at least 24 months) OA treatment in horses. PAAG is a promising new treatment for OA in horses.
Res Vet Sci. 2020 Nov 20;134:42-50.
Authors
Amanda Azambuja da Silva Xavier 1 , Patrícia Pinto da Rosa 2 , Laurett de Brum Mackmill 2 , Victor Fernando Buttow Roll 3
Abstract
For several years, hyaluronic acid (HyA) and, more recently, polyacrylamide hydrogel (PHyd) have been used to reduce lameness and pain caused by osteoarthritis. However, there is still a lack of scientific evidence of the efficacy of these substances to allow veterinary experts to make decisions about their use in horses. The objective of this study was to evaluate, through a systematic review and network meta-analysis (NMA), the efficacy of HyA, associated or not with other drugs, and PHyd in relieving lameness in horses with osteoarthritis. The searches for primary studies were conducted on four search platforms. The efficacy of HyA and PHyd was estimated through the relative risk difference method. Heterogeneity was observed in the efficacy of HyA, indicating long-term ineffectiveness of this drug when associated or not with anti-inflammatory drugs. In contrast, the results indicate that PHyd is an effective alternative therapy, with a long period of action in reducing lameness in horses with osteoarthritis. This study provides evidence that the application of PHyd and HyA is effective in reducing lameness caused by osteoarthritis in horses at different time periods, where PHyd has a longer time of action.
There are several more human prospective studies all which support the positive results seen above. noticeably there are very few adverse events associated with PAAG use. Occasionally I could find a report of mild heat, tenderness, and/or swelling but these all were treated successfully with a short course of NSAID's. There is one case of an exception in a person that is reported below.
There is one more important piece of information. In a study of goats using and induced arthritis model, PAAG was shown to marker reduce the amount of osteoarthritis and synovitis in the PAAG treated joints versus the untreated joints. Most of the treated joints did not show signs of lameness. While the study was small (6) the standardization of the joint disease and complete pathological examination of all the joints is unique and very strong evidence for the efficacy of this treatment.
Tnibar A, Persson A, Jensen HE, Svalastoga E, Westrup U, McEvoy F, et al. Evaluation of a polyacrylamide hydrogel in the treatment of induced osteoarthritis in a goat model: A pilot randomized controlled Study [abstract] Osteoarthritis and Cartilage. 2014;22:s477