The Effect of NSAID Use on Dextrose Prolotherapy in Patients With Knee Osteoarthritis: A Prospective Case Series

Objective: The objective was to determine whether oral non–steroidal anti-inflammatory drugs (NSAIDs) affect the efficacy of dextrose prolotherapy (DPT) in patients with knee osteoarthritis, and if the combination of these treatments is safe and well-tolerated. Methods: Five patients with symptomatic knee osteoarthritis were included in this prospective case series. Participants underwent a series of three DPT injections at four-week intervals in their symptomatic knee(s) and were immediately prescribed a seven-day course of Ibuprofen after each injection. The main outcome measures included changes in the Knee Injury in Osteoarthritis (KOOS) questionnaire subscales (pain, symptoms, quality of life, sports and recreation function, and activities of daily living) and the Numeric Pain Rating Scale (NPRS). Results: There was a statistically significant improvement in the KOOS subscales of pain ( P < 0.0001), Symptoms ( P = 0.01), and Quality of Life ( P = 0.001) after 12 weeks. The KOOS subscales for Sports and Recreation function ( P = 0.06) and Activities of Daily Living ( P = 0.10) showed numerical improvement over time that fell short of statistical significance. There was a statistically significant improvement in the NPRS scores compared with baseline NPRS scores after 12 weeks ( P < 0.0001). In addition, NPRS scores were significantly lower at one-week follow-up after each DPT injection ( P = 0.01); ( P = 0.025); ( P < 0.0001). There were no reported adverse events. Conclusions: Concomitant use of NSAIDS with dextrose prolotherapy injections is safe and well-tolerated with no adverse events and results in improvements in pain, symptoms, and overall quality of life associated with chronic knee OA. Controlled trials of this treatment are warranted.