OsteoarthritisPhase 2NCT00078351
Synvisc to Treat Osteoarthritis of the Temporomandibular Joint
A Phase 2 study testing High molecular weight hylan (Synvisc) injection in people with Osteoarthritis, run by National Institute of Dental and Craniofacial Research (NIDCR) at 1 site in United States.
Trial summary
This study will examine the effectiveness of injected hylan (Synvisc) for treating pain associated with osteoarthritis of the temporomandibular joint (jaw joint) and improving function of the joint. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Osteoarthritis
- What is being tested?
- High molecular weight hylan (Synvisc) injection
- Type of treatment
- Injection or infusion, Surgery or procedure
- How many people
- 60 participants
- Where
- 1 siteUnited States
- Study dates
- Feb 2004to Oct 2005
- Phase
- Phase 2
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- We will recruit patients with TMJ OA defined by the Research Diagnostic Criteria. Patients are required to have chronic preauricular pain for more than 3 months, even though they have received some palliative treatment (NSAIDs and/or stabilization splint therapy). Radiological imaging is indicated in addition to clinical evaluation to confirm the diagnosis of TMJ OA. Radiographic evidence of OA includes flattening of condyle, increased opacity of cortical bone of condyle, or osteophyte formation. Prior to being admitted to the study, patients will be screened with standard temporomandibular joint radiological imaging, including panoramic, tomographic and magnetic resonance imaging (MRI) studies. Radiological imaging will not be repeated at the end of the study unless medically indicated. The patients are required to have mouth opening limitation (less than normal) and moderate to severe joint pain aggravated by jaw movement. Patients who have undergone any TMJ surgery within the preceding 6 months will be excluded, as well as those who have taken analgesic, anti-inflammatory, steroids or narcotic medications during the last 15 days. Further exclusion criteria will be patients who have any TMJ growth disturbances. Patients with red, hot, swollen, tender TMJ, or those with history consist of infectious arthritis, crystal induced arthropathies, and musculoskeletal disorders will also be excluded. Patients with rheumatic disease will also be excluded, this will be determined by baseline blood tests (CBC, chem. 7, ESR, Rheumatoid factor).
- Patients will be screened for any positive history of liver or kidney dysfunctions. Any patients with a medical history of diabetes, congestive heart failure, any chronic infections will also be excluded. Subjects that have primary psychiatric disease or score above average in comparison with normative scores on Symptom Checklist (SCL-90R) will not be able to participate. Pregnant women will not be included in the study, this will be determined by a pregnancy test, and subjects will be required to use 2 forms of contraception for the first 3 weeks of the study (to cover the synvisc injections). It is a standard practice in chronic pain study not to include patients who are involved in litigation. Patients with sepsis or with known hypersensitivity to hyaluronan and any of its components will be excluded to the study.
Who cannot join
None listed.
Trial locations and contacts
1 site in 1 country.
United States1 site
National Institute of Dental And Craniofacial Research (NIDCR)
Bethesda, Maryland, 20892
About this study
Official title: The Effects of Viscosupplementation Using Synvisc in Symptomatic Osteoarthritis of the Temporomandibular Joint
This study will examine the effectiveness of injected hylan (Synvisc) for treating pain associated with osteoarthritis of the temporomandibular joint (jaw joint) and improving function of the joint. Hylan is a synthetic product very similar to a component of normal healthy joint fluid (synovial fluid), which is present in much lower quantities and is abnormal in osteoarthritis. Hylan injections have been beneficial in treating osteoarthritis of the knee.
Patients with temporomandibular (TMJ) joint pain of at least 3 months duration who have mouth opening limitation and moderate to severe joint pain made worse by joint movement may be eligible for this study. Patients must not have any TMJ growth disturbances and must not have had any TMJ surgery for 6 months before entering the study. Candidates are screened with questionnaires, a medical history, and a physical examination of the TMJs, including x-rays and magnetic resonance imaging.
Participants are randomly assigned to receive three injections, each a week apart, of either Synvisc or placebo (a salt-water solution) into the affected joint. Before the first injection, a sample of synovial fluid is collected from the joint by needle aspiration for laboratory analysis. Patients return for follow-up visits 3, 6, and 12 months after the last treatment for a clinical examination of the jaw joint and review of jaw joint symptoms. A second aspiration is requested at the 3-month visit, but is not mandatory. All injections and aspirations are done after anesthetizing the overlying skin and joint capsule to minimize pain or discomfort. Participants record their daily use of pain relief medication throughout the study.
Read the detailed description
The proposed clinical trial will evaluate the effects of high molecular weight hylan (Synvisc) injection in comparison with control treatment (saline injection) for osteoarthritis (OA) affecting the temporomandibular joint (TMJ). Patients with TMJ OA of at least three-month duration and who have not responded to conservative treatments will be included. Patients will be randomly assigned to either high molecular hylan injection or control. At baseline and follow up visits, clinical outcome measures will be assessed such as pain and range of motion. Positive findings in clinical outcome measures will provide evidence for the clinical utility of Synvisc in patients with painful TMJ OA. In addition to clinical outcome measures, a sample of synovial fluid from the affected joint will be obtained at the baseline visit and at 12 week follow up, and levels of tumor necrosis factor alpha (TNF alpha), Matrix metalloproteinase (MMP) and Tissue inhibitor of metalloproteinase (TIMP) will be analyzed. By studying the synovial fluid levels of TNF alpha, MMP and TIMP, we will assess the effects of viscosupplementation with Synvisc on the local inflammatory process and proteolytic activity in TMJ OA in comparison with control treatment. Positive findings in clinical symptoms and synovial fluid analysis will also provide implications of clinical utility of Synvisc in patients with painful TMJ OA. Furthermore, this analysis of synovial fluid may identify biomarkers associated with OA affecting the TMJ.
- Conditions
- Osteoarthritis
- Being tested
- High molecular weight hylan (Synvisc) injection
- Keywords
- Chronic Pain, Synvisc, Temporomandibular Joint, Osteoarthritis, TMD, Temporomandibular Joint Osteoarthritis, TMJ OA, Temporomandibular Joint Disease, TMJ
- Medical subject headings
- Osteoarthritis, Chronic Pain, Temporomandibular Joint Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
High molecular weight hylan (Synvisc) injectionProcedure or surgery
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Feb 2004 (estimated)
- Study startFeb 2004
- Study completionOct 2005
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for OsteoarthritisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Enrolment
- 60 participants
Sponsor and investigators
- Lead sponsor
- National Institute of Dental and Craniofacial Research (NIDCR)
- Sponsor type
- US National Institutes of Health
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00078351
- Sponsor's protocol ID
- 040111
- Other IDs
- 04-D-0111
- Status last verified
- Oct 2005
- First submitted
- 23 Feb 2004
- Last updated
- 4 Mar 2008
- Results posted
- No
Publications
Huskisson EC, Donnelly S. Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology (Oxford). 1999 Jul;38(7):602-7. doi: 10.1093/rheumatology/38.7.602.
PubMed 10461471Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991 Nov 15;115(10):787-96. doi: 10.7326/0003-4819-115-10-787.
PubMed 1834002Allison MC, Howatson AG, Torrance CJ, Lee FD, Russell RI. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med. 1992 Sep 10;327(11):749-54. doi: 10.1056/NEJM199209103271101.
PubMed 1501650
Study at a glance
From the registry record, last updated by the sponsor on 4 Mar 2008. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effects of Viscosupplementation Using Synvisc in Symptomatic Osteoarthritis of the Temporomandibular Joint
- ClinicalTrials.gov ID
- NCT00078351
- Acronym / sponsor ID
- 040111
- Conditions
- Osteoarthritis
- Keywords
- Chronic Pain, Synvisc, Temporomandibular Joint, Osteoarthritis, TMD, Temporomandibular Joint Osteoarthritis, TMJ OA, Temporomandibular Joint Disease
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 60 participants
- Lead sponsor
- National Institute of Dental and Craniofacial Research (NIDCR)US National Institutes of Health
- Study start
- Feb 2004
- Study completion
- Oct 2005
- First posted
- 24 Feb 2004 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study will examine the effectiveness of injected hylan (Synvisc) for treating pain associated with osteoarthritis of the temporomandibular joint (jaw joint) and improving function of the joint. Hylan is a synthetic product very similar to a component of normal healthy joint fluid (synovial fluid), which is present in much lower quantities and is abnormal in osteoarthritis. Hylan injections have been beneficial in treating osteoarthritis of the knee.
Patients with temporomandibular (TMJ) joint pain of at least 3 months duration who have mouth opening limitation and moderate to severe joint pain made worse by joint movement may be eligible for this study. Patients must not have any TMJ growth disturbances and must not have had any TMJ surgery for 6 months before entering the study. Candidates are screened with questionnaires, a medical history, and a physical examination of the TMJs, including x-rays and magnetic resonance imaging.
Participants are randomly assigned to receive three injections, each a week apart, of either Synvisc or placebo (a salt-water solution) into the affected joint. Before the first injection, a sample of synovial fluid is collected from the joint by needle aspiration for laboratory analysis. Patients return for follow-up visits 3, 6, and 12 months after the last treatment for a clinical examination of the jaw joint and review of jaw joint symptoms. A second aspiration is requested at the 3-month visit, but is not mandatory. All injections and aspirations are done after anesthetizing the overlying skin and joint capsule to minimize pain or discomfort. Participants record their daily use of pain relief medication throughout the study.
Detailed description
The proposed clinical trial will evaluate the effects of high molecular weight hylan (Synvisc) injection in comparison with control treatment (saline injection) for osteoarthritis (OA) affecting the temporomandibular joint (TMJ). Patients with TMJ OA of at least three-month duration and who have not responded to conservative treatments will be included. Patients will be randomly assigned to either high molecular hylan injection or control. At baseline and follow up visits, clinical outcome measures will be assessed such as pain and range of motion. Positive findings in clinical outcome measures will provide evidence for the clinical utility of Synvisc in patients with painful TMJ OA. In addition to clinical outcome measures, a sample of synovial fluid from the affected joint will be obtained at the baseline visit and at 12 week follow up, and levels of tumor necrosis factor alpha (TNF alpha), Matrix metalloproteinase (MMP) and Tissue inhibitor of metalloproteinase (TIMP) will be analyzed. By studying the synovial fluid levels of TNF alpha, MMP and TIMP, we will assess the effects of viscosupplementation with Synvisc on the local inflammatory process and proteolytic activity in TMJ OA in comparison with control treatment. Positive findings in clinical symptoms and synovial fluid analysis will also provide implications of clinical utility of Synvisc in patients with painful TMJ OA. Furthermore, this analysis of synovial fluid may identify biomarkers associated with OA affecting the TMJ.
Study design
- Primary purpose
- Treatment
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (2 listed)
- We will recruit patients with TMJ OA defined by the Research Diagnostic Criteria. Patients are required to have chronic preauricular pain for more than 3 months, even though they have received some palliative treatment (NSAIDs and/or stabilization splint therapy). Radiological imaging is indicated in addition to clinical evaluation to confirm the diagnosis of TMJ OA. Radiographic evidence of OA includes flattening of condyle, increased opacity of cortical bone of condyle, or osteophyte formation. Prior to being admitted to the study, patients will be screened with standard temporomandibular joint radiological imaging, including panoramic, tomographic and magnetic resonance imaging (MRI) studies. Radiological imaging will not be repeated at the end of the study unless medically indicated. The patients are required to have mouth opening limitation (less than normal) and moderate to severe joint pain aggravated by jaw movement. Patients who have undergone any TMJ surgery within the preceding 6 months will be excluded, as well as those who have taken analgesic, anti-inflammatory, steroids or narcotic medications during the last 15 days. Further exclusion criteria will be patients who have any TMJ growth disturbances. Patients with red, hot, swollen, tender TMJ, or those with history consist of infectious arthritis, crystal induced arthropathies, and musculoskeletal disorders will also be excluded. Patients with rheumatic disease will also be excluded, this will be determined by baseline blood tests (CBC, chem. 7, ESR, Rheumatoid factor).
- Patients will be screened for any positive history of liver or kidney dysfunctions. Any patients with a medical history of diabetes, congestive heart failure, any chronic infections will also be excluded. Subjects that have primary psychiatric disease or score above average in comparison with normative scores on Symptom Checklist (SCL-90R) will not be able to participate. Pregnant women will not be included in the study, this will be determined by a pregnancy test, and subjects will be required to use 2 forms of contraception for the first 3 weeks of the study (to cover the synvisc injections). It is a standard practice in chronic pain study not to include patients who are involved in litigation. Patients with sepsis or with known hypersensitivity to hyaluronan and any of its components will be excluded to the study.
Key exclusion criteria (0 listed)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| High molecular weight hylan (Synvisc) injection | Procedure or surgery | – |
Primary outcome
Not reported in the source record.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Mar 2008.
- Background: PubMed 10461471Huskisson EC, Donnelly S. Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology (Oxford). 1999 Jul;38(7):602-7. doi: 10.1093/rheumatology/38.7.602.
- Background: PubMed 1834002Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991 Nov 15;115(10):787-96. doi: 10.7326/0003-4819-115-10-787.
- Background: PubMed 1501650Allison MC, Howatson AG, Torrance CJ, Lee FD, Russell RI. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med. 1992 Sep 10;327(11):749-54. doi: 10.1056/NEJM199209103271101.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing High molecular weight hylan (Synvisc) injection in people with Osteoarthritis, run by National Institute of Dental and Craniofacial Research (NIDCR) at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Mar 2008. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00078351, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Mar 2008.