Conservative Management and Rehabilitation in the Older Runner With Knee Osteoarthritis: An Evidence-Based Review

Oral sodium hyaluronate relieves knee discomfort: A 12‑week double‑blinded, placebo‑controlled study

Sodium hyaluronate (SH) is a high molecular-weight polysaccharide composed of repeating polymeric disaccharides of D-glucuronic acid and N-acetyl-D-glucosamine. SH is present in every connective tissue and organ, with synovial fluid having the highest concentration of SH in the body. The effectiveness of oral SH on gonarthrosis is known; although, its influence on the knees of healthy individuals is not. However, as severe diseases may require surgery, it is better to take care of healthy knees before the onset of gonarthrosis. Therefore, the present study investigated the functionality of SH on the knee of healthy individuals. The present study was a randomized double-blind, placebo-controlled trial in which healthy adults (mean age: Placebo group, 61.50±1.59; SH group, 58.50±1.81), rated as grade ≤1 based on the Kellgren-Lawrence classification, were administered 111 mg/day SH for 12 weeks. The evaluation of visual analog scales were performed to assess the discomfort in the knees of the participants and were conducted at baseline, and then 6 and 12 weeks after the start of SH ingestion. Additionally, a locomotive syndrome risk test quantifying the mobility of the participants, a one-leg standing time with eyes open test evaluating the strength of the leg muscle as well as the ability to balance by measuring the time to stand on one leg and a blood test (interleukin-10, aspartate aminotransferase, alanine transaminase, γ-glutamyl transferase, lactate dehydrogenase, creatine kinase and C-reactive protein) were performed at baseline and then 12 weeks after the start of SH ingestion. A significant suppression of knee symptoms were demonstrated in the SH group compared with the placebo group in terms of the total visual analog scale scores for pain, stiffness and discomfort for the 31 healthy adult subjects. Significant suppression of symptoms was also demonstrated in the placebo group in terms of discomfort in the knees when descending stairs and pain in the knees after walking for a longer distance or duration than normal. No significant differences between the two groups were demonstrated in the locomotive syndrome risk test, one-leg standing time with eyes open test and the blood test. The results of the present study suggest the possibility that oral SH may help to maintain a healthy condition of the knees. The study protocol was registered with the University Hospital Medical Information Network Clinical Trial Registry in advance (registration no. UMIN000045980, November 4, 2021).

Celastrol ameliorates endoplasmic stress-mediated apoptosis of osteoarthritis via regulating ATF-6/CHOP signalling pathway

Objectives

Osteoarthritis (OA) is a common degenerative joint disease with the pathological features of the reduced cartilage cellularity. Celastrol, a compound from Tripterygium wilfordii, exerted therapeutic effects on arthritis, but the potential mechanism remains unclear.

Methods

Tunicamycin was used to establish a model of OA in vitro, and ACLT surgery model in rats was applied to verify the mechanism. Chondrocytes were isolated from the knee articular cartilage of rabbit. MTT and flow cytometry assay were used to detect cell viability and apoptosis rate. Haematoxylin–eosin staining was used to assess for the histopathological changes. The activity and expression of apoptosis-related factors and ERs (endoplasmic reticulum stress)-related factors were detected by ELISA, WB, PCR and IHC, respectively.

Key findings

Celastrol exhibited significant enhancement on cell viability and reduced the rate of apoptosis in Tm-exposed chondrocytes. Celastrol reduced enzyme activity and protein expression of caspase-3, caspase-6 and caspase-9, decreased Bip, Atf6, Chop and Xbp-1 expression both at protein and mRNA levels. Celastrol showed a more significant effect on cell apoptosis rate and mRNA expression in the combination with 4-PBA.

Conclusions

This study reveals that celastrol may prevent OA by inhibiting the ERs-mediated apoptosis. All these might supply beneficial hints for celastrol on OA treatment.