The Effect and Safety of Anti-inflammatories and Dextrose Prolotherapy Injections in Treating Knee Osteoarthritis

The Effect of Non-steroidal Anti-inflammatory Drug (NSAID) Use on the Efficacy of Dextrose Prolotherapy in the Treatment of Knee Osteoarthritis: A Randomized Controlled Trial

Our purpose is to expand upon the results of the pilot study performed at David Grant Medical Center (DGMC) which showed that concomitant non-steroidal NSAID use in adults with knee osteoarthritis (OA) undergoing a three-shot dextrose prolotherapy (DPT) injection series did not negate the efficacy of DPT. Additionally, it showed that giving both treatments simultaneously is safe and efficacious. The small sample size and design of the pilot study limited the conclusions that can be drawn on the concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) during DPT treatment.

This is a double-blinded, randomized, controlled trial that includes a subject population of males and females between the ages of 45-75 years who are DoD beneficiaries empaneled at DGMC with a history of chronic, symptomatic knee osteoarthritis in one or both knees, that meet study criteria.

Participants will have study inclusion/exclusion and knee films (within the past 2 years) reviewed by a study investigator to confirm eligibility to participate in the study. Eligible participants will be consented then randomized into treatment groups (ibuprofen, placebo) by the pharmacy. Participants will provide a baseline assessment of pain and dysfunction using the Numeric Pain Rating Scale (NPRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires. Participants will then have a series of three injections of 4mL of 25% dextrose mixed with 1% lidocaine into the knee under ultrasound guidance, performed at 0, 4 and 8 weeks (+/- 1 week) in addition to a 7-day supply of the study drug (ibuprofen, placebo) at these time points. NPRS and KOOS scores will be collected at 0, 4, 8 and 12 weeks. During the study period, participants will be counseled to avoid oral analgesics (other than what has been prescribed for them as part of the study) including NSAIDs, acetaminophen, or opioids, in addition to other procedures to treat their knee pain to include other injections, acupuncture, physical therapy, and surgery.

The primary outcome is to determine the effect of concomitant oral ibuprofen vs. placebo use on intra-articular knee injections using hypertonic dextrose and the determine the short and long-term outcomes in each treatment group (ibuprofen, placebo) using the NPRS and KOOS questionnaires to assess pain and function.

Study Overview

• Status: Recruiting
• Conditions: Knee Osteoarthritis (OA)
• Intervention / Treatment: Drug: Participants are given Ibuprofen 400 mg to take for 7 days on the day they receive a dextrose prolotherapy (DPT) injection. These procedures are repeated every 3-5 weeks for a total of 3 times.; Drug: Participants are given a placebo to take for 7 days on the day they receive a dextrose prolotherapy (DPT) injection. These procedures are repeated every 3-5 weeks for a total of 3 times.

• Study Type: Interventional
• Enrollment (Estimated): 68
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Alexander R Kim, MD; Phone Number: 707-423-3057; Email: Alexander.r.kim.mil@health.mil
• Study Contact Backup: Name: Carlton J Covey, MD

Study Locations

• United States
  • California
    • Travis AFB, California, United States, 94535
      • Recruiting
      • David Grant USAF Medical Center
      • Contact: Alexander R Kim, MD; Phone Number: 707-423-3057; Email: Alexander.r.kim.mil@health.mil

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Must be DoD Healthcare beneficiaries empaneled at DGMC
• Adults aged 45-75 years with a clinical diagnosis of Knee OA (either unilateral or bilateral) based on clinical and radiographic criteria as defined by the American College of Rheumatology (Altman 1987)
• Knee radiographs (within 2 years of start date) with Kellgren-Lawrence classification of 2-3
• Moderate to severe Knee pain for at least 3 months defined as a score of ≥4 using the NPRS (0-10) in response to the question "What is the average level of your left/ right knee pain in the past 3 months?"
• English speaking
• Not pregnant
• Not breastfeeding
• No allergy to dextrose, lidocaine, or sulfite

Exclusion Criteria:

• Previous knee replacement surgery
• Previous meniscus repair/debridement surgery or chondral replacement surgery
• Any intra-articular injection including steroid, prolotherapy or platelet rich plasms within the previous 3 months
• Significant effusion as defined by a ballotable patella
• Pregnancy or breastfeeding
• Current/ongoing medical problems obtained from chart review contraindicating NSAID use to include chronic kidney disease stage II or higher, acute interstitial nephritis, coronary artery disease requiring percutaneous coronary intervention (PCI) or bypass surgery; Major Adverse Coronary Event (MACE), body mass index (BMI) ≥40, inflammatory arthropathy (gouty arthritis, psoriatic arthritis, or septic arthritis), history of GI bleed.
• Non-English speaking
• Allergy to dextrose, lidocaine, or sulfite

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo group	Drug: Participants are given a placebo to take for 7 days on the day they receive a dextrose prolotherapy (DPT) injection. These procedures are repeated every 3-5 weeks for a total of 3 times.; The other group is given Ibuprofen when they receive their dextrose prolotherapy (DPT) injection
Active Comparator: Ibuprofen group	Drug: Participants are given Ibuprofen 400 mg to take for 7 days on the day they receive a dextrose prolotherapy (DPT) injection. These procedures are repeated every 3-5 weeks for a total of 3 times.; The other group is given a placebo when they receive their dextrose prolotherapy (DPT) injection

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Knee Injury in Osteoarthritis (KOOS) questionnaire scores	The KOOS questionnaire consist of a total of 23 items divided (unequally) among 5 subscales. The subscales include pain (5 items), symptoms (4 items), activities of daily living (ADL) (9 items), sport/recreation (3 items), and quality of life (QoL) (2 items). Each item is scored on a scale of 0-4. Zero is assigned to "never", "none," and "not at all" responses. Four is assigned to "always", "extreme," "totally," and "constantly" responses. Calculate mean scores for each subscale by adding the scores for each item (in the subscale) then dividing it by the total number of items (in the subscale). Then multiply the calculated mean scores (for each subscale) by 100, divide it by 4, then subtract it from 100. Total subscale scores range from 0 -100. 0 indicates extreme problems and 100 indicates no problems.	From enrollment to the end of treatment at 12 weeks
Change in Numeric Pain Rating Scale (NPRS) scores	The NPRS is a 1-item questionnaire assessing pain severity using a number which describes the level of knee pain over the last 24 hours. Participants are to put an "X" on a linear scale from 0-10. Zero (0) is no pain and 10 is the worst possible pain.	From enrollment to the end of treatment at 12 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Analgesic use	From enrollment to the end of treatment at 12 weeks
Use of other treatment modalities	From enrollment to the end of treatment at 12 weeks

Collaborators and Investigators

• Sponsor: David Grant U.S. Air Force Medical Center
• Investigators: Principal Investigator: Alexander R Kim, MD, David Grant USAF Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): March 31, 2025
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: March 28, 2025
• First Submitted That Met QC Criteria: March 28, 2025
• First Posted (Actual): April 4, 2025

Study Record Updates

• Last Update Posted (Actual): November 24, 2025
• Last Update Submitted That Met QC Criteria: November 20, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Osteoarthritis, Knee; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Inflammatory Agents; Peripheral Nervous System Agents; Enzyme Inhibitors; Antirheumatic Agents; Sensory System Agents; Analgesics, Non-Narcotic; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase Inhibitors; Ibuprofen
• Other Study ID Numbers: FDG20230042H

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes