Effectiveness of intra-articular injections of sodium bicarbonate and calcium gluconate in the treatment of osteoarthritis

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SCIENCE
Effectiveness of intra-articular injections of sodium bicarbonate and calcium gluconate in the treatment of osteoarthritis
Key Take-Away: 
  • The effect of calcium gluconate on joint-space narrowing found to be more beneficial than glucosamine sulfate for  longer-term.
  • SBCG2 (Sodium bicarbonate and double dose of calcium gluconate) improved the knee joint space width more than SBCG1 (Sodium bicarbonate and calcium gluconate) at 3 and 18 months.

Osteoarthritis (OA) is a common joint disease that occurs as a consequence of cartilage degradation and involves a gradual development of pain, stiffness, and loss of motion. The prevalence of OA is 9.6% in men and 18% in women above 60 years having symptomatic OA primarily in knees and hips. 

ABSTRACT: 
Background: 

Osteoarthritis (OA) is a common joint disease that occurs as a consequence of cartilage degradation and involves a gradual development of pain, stiffness, and loss of motion. The prevalence of OA is 9.6% in men and 18% in women above 60 years having symptomatic OA primarily in knees and hips.

A novel therapeutic management of OA of the knee has focused on pain relief, preserving or improving the range of motion and preventing secondary functional disability along with joint damage. Apart from surgery, other therapies, such as non-pharmacological treatments mainly aiming to unload the joint and pharmacological therapies including analgesics, NSAIDs, opioids, hyaluronic acid (HA) or corticosteroid injections and various drugs especially disease modifying osteoarthritis drugs (DMARDs) are also used.

  • Rationale behind research
  1. Previous studies reported a beneficial effect of large doses of bicarbonate on certain chronic joint disease and calcium gluconate on arthritis or other rheumatic diseases alone.
  2. Therefore, a combination of these two compounds must be evaluated to treat knee OA patients.
  • Objective

To evaluate the effect of monthly sodium bicarbonate with a single (SBCG1) or double dose (SBCG2) of calcium gluconate injections on OA of the knee; as well as the efficacy and safety of both SBCG interventions in the long term

Methods: 

 

Study outcomes

  •  Primary outcome: WOMAC, Lequesne’s functional indexes and joint space width

Time-points

  •  Efficacy: Baseline, up to 12 months

 

Results: 

 

Baseline: Two treatment groups were well balanced with no statistically significant difference

  • Outcomes
    • WOMAC score
      • Pain scale: 81% in SBCG1 and 77% in SBCG2
      • Stiffness: 92 % in SBCG1 and 79% in SBCG2
      • Physical functioning: 90% in SBCG1 and 81% SBCG1

The mean score that decreased at 12 months was maintained 6 months after treatment suspension

Lequesne functional index scale

  • Pain scale: 74 % in SBCG1 and 69% in SBCG2
  • Walking Improvement: 74% in SBCG1 and 71% in SBCG2
  • Daily activities improvement: 65% in SBCG1 and 56% in SBCG2

Joint space width scale

  • A significant decrease in joint space with of -0.37 (95% CI: -0.64, -0.10) mm in SBCG1 was observed with no significant change in SBCG2 group: 0.15 (-0.33, 0.63) mm
  • The mean joint space change of SBCG2 was higher than SBCG2 after 4 and 18 months
Conclusion: 

Result indicates that a combination of sodium bicarbonate and calcium gluconate administered once in a month directly into the knee joint provides high reduction of pain and improvement in physical function.

This experimental treatment was developed upon previous works on the effect of large doses of bicarbonate on certain joint diseases because of its alkalinity. The beneficial effect of sodium bicarbonate and calcium gluconate is maintained for one year of continuous monthly administration and at least for 6 months after the administration is discontinued. When the dose of calcium gluconate is increased, it prevents further narrowing of joint-space and its effect over clinical symptoms of OA and joint space could be due to its effects on cartilage metabolism, including stimulation of anabolic activities.

BMC Musculoskeletal Disorders (2015) 16:114
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