Advances in Osteoarthritis
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Osteoarthritis is a progressive condition that affects the bones and cartilage within the joints. Although it occurs most often in the hands, hips, and knees, osteoarthritis can also affect the body's spine. Currently, at least 30 million adults in the United States are living with osteoarthritis, making the condition the most prevalent form of arthritis. While there are a variety of ways in which people can manage this long-term, chronic condition, there is currently no cure for it. However, scientists may have now found a treatment that promises to stop the disease from progressing.
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New drugs for the treatment of osteoarthritis also emerged this year, including a small-molecule inhibitor of the Wnt signalling pathway. Flexion Therapeutics Inc. McAlindon, T. Effect of intra-articular triamcinolone versus saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial.
JAMA , — Yazici, Y. A novel Wnt pathway inhibitor, SM, for the treatment of moderate to severe osteoarthritis of the knee: results of a week, randomized, controlled, phase 1 study. Osteoarthritis Cartilage 25 , — OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 22 , — Bodick, N.
An intra-articular, extended-release formulation of triamcinolone acetonide prolongs and amplifies analgesic effect in patients with osteoarthritis of the knee: a randomized clinical trial. Bone Joint Surg. Conaghan, P. Phase 2b trial of a novel extended-release microsphere formulation of triamcinolone acetonide for intra-articular injection in knee osteoarthritis. However, they showed no efficacy for the patients with severe hip OA. Apart from that Intra-articular injection of low and high molecular weight HA was notably effective in relieving the pain, it was also associated with reduction of The conclusion of meta-analysis of 26 clinical trials indicated that HA injection would be consider as the best conservative line for hip OA with substantial pain relief and function amelioration.
However, there is no clear evidence to prove its ability to modify the morphological or radiological changes of the pathological hip [ 61 ]. A recent meta-analysis including nine clinical trials exploring the effectiveness of intra-articular HA injection for the treatment of ankle OA and to investigate the effects of modified regimens of HA.
Its results suggest that intra-articular HA administration can significantly reduce pain for patients with ankle OA. In addition, Intra-articular HA was likely superior to other conservative therapy. They suggested the use of multiple doses with an appropriate injection volume would achieve maximum therapeutic effects [ 62 ]. In , a pilot study examined the effectiveness of the intra-articular injection of Euflexxa in 22 patients with osteoarthritis of the subtalar joint [ 63 ].
The study showed that patients significantly experienced an improvement in American Orthopedic Foot and Ankle Society Ankle Hind foot scores and visual analog scale assessment as well as longer tolerated walking distance [ 63 ]. Likewise, a clinical trial was conducted to explore the effectiveness and safety of the HA-chondroitin sulfate medication Arthrum HCS [ 64 ]. They investigated one hundred and twelve patients and showed that Arthrum lowered the WOMAC sub score A in assessments at 1, 3 and 6-month intervals after treatment [ 64 ].
Additionally, the trial showed that patients had improved mobility and reduced their consumption of analgesics [ 64 ]. In addition, Xin et al.go site
Osteoarthritis: New compound may stop the disease
The study concluded that both drugs showed a significant reduction in VAS scores while not showing a significant difference in efficacy and safety [ 65 ]. Moreover, another clinical trial was conducted to see the safety and efficacy of Hyalubrix via an observational study of normal medical practice [ 66 ]. As with all novel disease treatments, animal studies are continuously being designed in order to determine the safety and efficacy of treatment. In , Tamura et al. Methotrexate has been one of the most widely used medications for rheumatoid arthritis and has recently been shown to help in osteoarthritis of the knee [ 69 ].
Their results showed that the intra-articular injection of DK showed similar anti-arthritic effects as oral methotrexate but eliminated the harmful side-effects that usually come with oral treatment [ 69 ]. A study performed by Ishikawa et al. They used subcutaneous air pouch rat model as well as knee joints of normal rabbits [ 70 ].
One Step at a Time: Advances in Osteoarthritis | Frontiers Research Topic
They concluded with showing that Gel did not induce any granulomatous inflammation nor a significant thickening of the fibrous belt often seen in the air pouch models [ 70 ]. This was compared to the hylan G-F 20 medication Synvisc which did the exact opposite and showed a granulomatous inflammation and thickening of the fibrous belt [ 70 ].
Additionally, nanoparticles composed of poly d , l -lactic acid PLA or poly d , l -lactic- co -glycolic acid PLGA covered by chemically esterified amphiphilic HA are being considered as drug carriers for treatment of OA [ 71 ]. A study using healthy rat models was designed to examine if the nanoparticles had a toxic effect on the model knees [ 71 ]. Zille et al. As stated before, HA treatment has shown many beneficial effects in studies and experiments such as intraarticular lubrication, anti-inflammatory, analgesic and chondroprotective effects, among others [ 20 ].
However, considering its cost it is not always the recommended treatment for OA patients. According to both the Osteoarthritis Research Society International guideline and the American College of Rheumatology guidelines, HA treatment is neither recommended or discouraged because of the inconsistency of clinical studies [ 73 , 74 ]. For a plethora of the studies both societies researched, a large placebo effect was seen which limited the scope of the data [ 73 , 74 ].
Despite the demonstrated efficacy and the safety of HA products, there are few associated side effects that mostly limited to local pain and swelling with frequent injections [ 76 ]. Further investigations are still required to obtain specially designated molecular mass HA to optimize the clinical effect and extend its applications.
In addition, more randomized controlled trials with a large sample to test not only the efficacy of HA versus the other established therapies of OA, but also the different products, dosages and the optimal number of injections. Osteoarthritis is a debilitating disease that affects a large portion of the population. As the general age of the population continues towards an older age, the prevalence of the disease is only going to go up.
Therefore, more research is needed in order to fully control the disease and its side effects. Hyaluronic acid is a potential bright spot for helping lower the side effects. Its effectiveness is due to the many methods of actions it deploys, including lubrication, anti-inflammatory and chondroprotective effects.
Treatment can be done both orally and through intra-articular injections. New products are continuously being developed that change the composition of the molecule as well as pairing it with other drugs to maximize the effect. Hyaluronic acid treatment shows a lot of potential that will hopefully be discovered through continued research. MH, and MEA provide clinical relevance and insight. All authors read and approved the final manuscript. All of the data and material presented and discussed in this review article is available in the published articles listed below in the reference section.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Skip to main content Skip to sections. Advertisement Hide. Download PDF. Clinical and Translational Medicine December , Cite as. Recent advances in hyaluronic acid based therapy for osteoarthritis.
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Open Access. First Online: 16 February Introduction Osteoarthritis OA is a degenerative joint disease that frequently affects the hands and weight bearing joints of the body [ 1 ].