Dear Prof. Tanchev,

I personaly, am svitched to mostly peroral therapy. This is due to technical and financial issues ( in Macedonia). Many of the younger doctors are for intraarticular aplications. I would prefer PRP or PGRF injections when indications are good, but I never, ever give to the patient any prognosis for the outcome... (Stil lacking evidence based data...)

Dear Prof  Panayot Tanchev

In my practice, in cases of advanced knee osteoarthritis, i have obtained better clinical results with intra articular injections in association to a physical therapy program. With peroral chondroprotectors the efficacy is delayed and generally patients are not satisfied. But as reported by Prof  Milan Samardziski, because of financial issues peroral treatment can be more appropriate.   

Dear Prof. Tanchev,

In my practice I prefer intraarticullar administration of hyaluronate acid substances - they work great /especially knee and ankle/, they are well tolerated by patients and affordable for them. Despite their 6-9 months efficiency /e.g. limited effect/ I can recommend a routine use. Multi-articullar involved patient may benefit form peroral drugs /and placebo effect may be noticed too/. I never use PRP or similar for i.a. administration - I always need to know, what am I doing - and this is not the case...

Only antiinflamatory effect, but  it works quite well and no side effects as antiinflamatory drugs as coxx2

Dear Panayot

My option is Intra articular injection associated with physical therapy

dear sir: although some years ago many trends were to use chondrogen agents  in osteoarthritis, but nowadays has very limited indications .because of poor results...

Unfortunately, my experience, as far as the long-term follow-up is concerned, coincides with that of Dr. Nouraei. Corticosteroids or chondroprotectives - at one year follow-up the outcomes are similar.

Dear prof. Tanchev

I use intraarticular injections of hyaluronic acid every 6-9 months, but inform the patient that the results may be unsatisfactory due to high severity of osteoarthritis.

Dear Dr. Laurino,

Of course this approach works because of the good early outcomes (pain, ROM). On the other hand the ratio expectations/ price in my country is not very favorable. Our patients pay from their own pocket. How about the financial aspect in your country. Is hyaluronic acid expensive ? Who pays the bill - the insurance or the patients themselves ?

Dear Professor Tanchev,

In Turkey, hyaluronic acid  preparations are not paid by insurance, patients pay the bill. My experience is that the short and long term efficacy of intraarticular corticosteroids injections is superior to intra articular hyaluronic acid.

We reported that even a 10 day spa therapy course in a spa resort may have beneficial short and medium term effects in terms of pain and function in severe knee osteoarthritis (Clin Rheumatol. 2007 Dec;26(12):2063-71.) 

Thank you, Dr. Karagulle, for your answer. My experience coincides with yours. However, one should not apply more than 3 - 4 intraarticular corticoids injections. Some colleagues abuse corticosteroids which causes local and general adverse effects.

I agree with the number of total intra-articular corticosteroid injections; 3-4/year.