Læknablaðið : fylgirit - 01.05.1978, Page 93

Martti Nissila, M.D.
Rheumatism Foundation Hospital
18120 Heinola 12, Finland
Osmic acid has been used in the treatment of
synovial effusion of the knee for 25 years. In
many uncontrolled and two controlled studies
good results of 50-607o have been obtained with
a follow-up period of generally 1/2-1 year.
Side effects:
Osmic acid often causes a brief increase in
the inflammatory symptoms in the joint after
injection. This always disappears in a couple
of days. Sometimes there is a strong inflamma-
tory reaction, in which case it is necessary to
perform a puncture to alleviate pressure. Osmic
acid treatment has been given to nearly 4000
patients at the Rheumatism Foundation Hospital
during the past 15 years. Only one patient
developed a transitory kidney and liver irritation,
evidently of allergic origin, after the second
Osmic acid injection. The slight change in urine
sediment which lasts only few days, is somewhat
more common, and is mostly proteinuria and
hematuria.
Mizell and coworkers injected Osmic acid into
the knee of a healthy rabbit and found that it
causes necrotic changes in the articular cartilage.
For this reason a study was carried out at the
Rheumatism Foundation Hospital in which a
cartilage sample was taken of Rheumatoid arthri-
tis patients with a knee synovectomy. In the
THE EFFECT OF OSMIC ACID
ON ARTICULAR CARTILAGE
electron microscopic studies the patients were
divided into four groups:
1. Patients who had not received Osmic acid
treatment.
2. Patients who had received Osmic acid treat-
ment F-2 months before the operation.
3. Patients who had received Osmic acid treat-
ment 5-8 months before the operation, and
4. Patients who had recived Osmic acid treat-
ment over one year before the operation.
In the electron microscopic study, changes
were divided into four levels of severity:
1. Normal, only slight vacuolisation in the
cytoplasm of the cartilage cells. Dark
granules can also appear.
2. More vacuolisation.
3. Clear irregularity in the cartilage structure.
Rest of dead cartilage cells and even
Necrotic cells are found.
4. Clear scar tissue + cartilage.
The results show that Osmic acid does not
cause cartilage damage as shown by electronic
microscope examination. There is possibly some
kind ofreactionat the initial stages, but it is
corrected within half a year. No overall evalu-
ations can be given on the basis of this study.
A very thorough histological study was made of
10 patients with Rheumatoid arthritis, half of
THE EFFECT OF 0SMIC ACID ON RHEUMATOID ARTICULAR CARTILAGE
CHANGES RTG-GRADE
I II III IV I II III
No Osmic-acid
3 3
2 2 2
1-2 months after Osmic-
acid treatment 1-21 112
5-8 months after Osmic-
acid treatment 3 1 112
lt
2
Over 1 year after Osmic-
acid treatment
91
1
1
2