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Jeyaraman N, Jeyaraman M, Ramasubramanian S, Yadav S, Balaji S, Patro BP, Gupta A. Autologous Conditioned Serum in Knee Osteoarthritis: A Systematic Review of Current Clinical Evidence. Cureus 2024; 16:e68963. [PMID: 39385904 PMCID: PMC11461807 DOI: 10.7759/cureus.68963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2024] [Indexed: 10/12/2024] Open
Abstract
Knee osteoarthritis (OA) significantly impacts global health, causing pain, disability, and socioeconomic burden. Traditional treatments often provide only temporary relief and can have adverse effects. Autologous conditioned serum (ACS) therapy, which enriches a patient's own blood with growth factors and anti-inflammatory cytokines, has emerged as a promising approach to manage knee OA, potentially offering pain reduction, improved function, and tissue regeneration. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched databases such as PubMed, Web of Science, and Cochrane using terms like "Autologous Conditioned Serum" and "knee osteoarthritis." Clinical studies were selected based on their focus on ACS's efficacy in knee OA, assessing outcomes like pain relief, functional improvement, and adverse events. Eighteen studies met the inclusion criteria, including randomized controlled trials, observational studies, and comparative analyses. The review included a wide range of study designs and outcomes, highlighting ACS's efficacy in reducing pain and enhancing knee function as evidenced by various patient-reported outcome measures Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Clinical Rating Score (KSCRS) with a follow-up of up to 11 years (range: 2-11 years). Comparative studies showed ACS to be as effective or superior to conventional treatments such as platelet-rich plasma, steroids, and hyaluronic acid, especially in cases of moderate synovitis. Minimal adverse effects such as peri-injection pain, rigidity, synovitis, transient sensation of redness/heat, and numbness in the knee/leg/toes were reported, underscoring ACS's safety. Some studies suggested ACS might also have disease-modifying effects, contributing to tissue repair and integrity. ACS therapy offers a promising alternative for knee OA management, demonstrating potential benefits in symptom alleviation, functional improvement, and safety. Indications of disease-modifying properties further highlight its therapeutic value. However, the need for standardized formulations and treatment protocols, long-term studies, and mechanistic understanding remain. Future research should focus on addressing these gaps to fully elucidate ACS's role in the treatment landscape of knee OA.
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Affiliation(s)
- Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | - Madhan Jeyaraman
- Orthopaedics, South Texas Orthopaedic Research Institute (STORI), Laredo, USA
- Clinical Research, Viriginia Tech India, Dr MGR Educational and Research Institute, Chennai, IND
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | | | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Sangeetha Balaji
- Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, IND
| | - Bishnu P Patro
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Ashim Gupta
- Regenerative Medicine, Future Biologics, Lawrenceville, USA
- Regenerative Medicine, BioIntegrate, Lawrenceville, USA
- Orthopaedics, South Texas Orthopaedic Research Institute (STORI), Laredo, USA
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Roda A, Paiva A, Rita C Duarte A. A Low Transition Temperature Mixture-based viscosupplementation complemented with celecoxib for osteoarthritis treatment. Int J Pharm 2024; 656:124088. [PMID: 38582102 DOI: 10.1016/j.ijpharm.2024.124088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024]
Abstract
Viscosupplementation consists of hyaluronic acid (HA) intra-articular injections, commonly applied for osteoarthritis treatment while non-steroidal anti-inflammatory drugs (NSAIDs) are widely administered for pain relief. Here, HA and a NSAID (celecoxib) were combined in a formulation based on a low transition temperature mixture (LTTM) of glycerol:sorbitol, reported to increase celecoxib's solubility, thus rendering a potential alternative viscosupplement envisioning enhanced therapeutic efficiency. The inclusion of glucosamine, a cartilage precursor, was also studied. The developed formulations were assessed in terms of rheological properties, crucial for viscosupplementation: the parameters of crossover frequency, storage (G') and loss (G'') moduli, zero-shear-rate viscosity, stable viscosity across temperatures, and shear thinning behaviour, support viscoelastic properties suitable for viscosupplementation. Additionally, the gels biocompatibility was confirmed in chondrogenic cells (ATDC5). Regarding drug release studies, high and low clearance scenarios demonstrated an increased celecoxib (CEX) release from the gel (6 to 73-fold), compared to dissolution in PBS. The low clearance setup presented the highest and most sustained CEX release, highlighting the importance of the gel structure in CEX delivery. NMR stability studies over time demonstrated the LTTM+HA+CEX (GHA+CEX) gel as viable candidate for further in vivo evaluation. In sum, the features of GHA+CEX support its potential use as alternative viscosupplement.
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Affiliation(s)
- Ana Roda
- LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, Caparica, 2829-516, Portugal.
| | - Alexandre Paiva
- LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, Caparica, 2829-516, Portugal
| | - Ana Rita C Duarte
- LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, Caparica, 2829-516, Portugal.
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Zhou Y, Patten L, Spelman T, Bunzli S, Choong PFM, Dowsey MM, Schilling C. Predictive Tool Use and Willingness for Surgery in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240890. [PMID: 38457182 PMCID: PMC10924247 DOI: 10.1001/jamanetworkopen.2024.0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
Importance Despite the increasing number of tools available to predict the outcomes of total knee arthroplasty (TKA), the effect of these predictive tools on patient decision-making remains uncertain. Objective To assess the effect of an online predictive tool on patient-reported willingness to undergo TKA. Design, Setting, and Participants This parallel, double-masked, 2-arm randomized clinical trial compared predictive tool use with treatment as usual (TAU). The study was conducted between June 30, 2022, and July 31, 2023. Participants were followed up for 6 months after enrollment. Participants were recruited from a major Australian private health insurance company and from the surgical waiting list for publicly funded TKA at a tertiary hospital. Eligible participants had unilateral knee osteoarthritis, were contemplating TKA, and had previously tried nonsurgical interventions, such as lifestyle modifications, physiotherapy, and pain medications. Intervention The intervention group was provided access to an online predictive tool at the beginning of the study. This tool offered information regarding the likelihood of improvement in quality of life if patients chose to undergo TKA. The predictions were based on the patient's age, sex, and baseline symptoms. Conversely, the control group received TAU without access to the predictive tool. Main Outcomes and Measures The primary outcome measure was the reduction in participants' willingness to undergo surgery at 6 months after tool use as measured by binomial logistic regression. Secondary outcome measures included participant treatment preference and the quality of their decision-making process as measured by the Knee Decision Quality Instrument. Results Of 211 randomized participants (mean [SD] age, 65.8 [8.3] years; 118 female [55.9%]), 105 were allocated to the predictive tool group and 106 to the TAU group. After adjusting for baseline differences in willingness for surgery, the predictive tool did not significantly reduce the primary outcome of willingness for surgery at 6 months (adjusted odds ratio, 0.85; 95% CI, 0.42-1.71; P = .64). Conclusions and Relevance Despite the absence of treatment effect on willingness for TKA, predictive tools might still enhance health outcomes of patients with knee osteoarthritis. Additional research is needed to optimize the design and implementation of predictive tools, address limitations, and fully understand their effect on the decision-making process in TKA. Trial Registration ANZCTR.org.au Identifier: ACTRN12622000072718.
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Lauren Patten
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Peter F. M. Choong
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M. Dowsey
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Kawde K, Pisulkar G, Salwan A, Jayasoorya A, Jadawala VH, Taywade S. A Comprehensive Review of Current Management Trends in Medial Compartment Arthritis of the Knee Joint. Cureus 2024; 16:e56666. [PMID: 38646379 PMCID: PMC11032692 DOI: 10.7759/cureus.56666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Medial compartment arthritis of the knee joint presents a significant clinical challenge, with diverse management options ranging from nonsurgical interventions to various surgical procedures. This comprehensive review synthesizes current evidence on the management trends in medial compartment arthritis, highlighting both nonsurgical approaches such as physical therapy, pharmacological interventions, and intra-articular injections as well as surgical interventions, including arthroscopic debridement, high tibial osteotomy, and knee arthroplasty. Through a comparative analysis of efficacy, complication rates, and patient outcomes, this review underscores the importance of tailoring treatment strategies to individual patient characteristics and preferences. Furthermore, emerging techniques and technologies promise to advance the field, necessitating ongoing research efforts to refine treatment algorithms and establish standardized guidelines. By adopting a multidisciplinary approach and integrating evidence-based practices, clinicians can optimize the management of medial compartment arthritis and enhance patient care outcomes.
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Affiliation(s)
- Kevin Kawde
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ankur Salwan
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Adarsh Jayasoorya
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vivek H Jadawala
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shounak Taywade
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Healthcare Utilization and Knee Osteoarthritis Symptoms among Urban Older Malaysian. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073777. [PMID: 33916628 PMCID: PMC8038539 DOI: 10.3390/ijerph18073777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/21/2022]
Abstract
Knee osteoarthritis (OA) is a prevalent chronic disorder in the older population. While timely management is important to minimize the consequences of knee OA, information on the utilization of healthcare services among this population remains limited. Therefore, the objectives of this study were to determine the healthcare utilization and its associated factors in older persons with knee OA. Cross-sectional data from 1073 participants aged 60 years and above from the Malaysian Elders Longitudinal Research (MELoR) study were included. The utilization rate of healthcare services was quantified. Factors related to the utilization of healthcare services were determined using logistic regression analysis. Healthcare utilization among participants with knee OA was significantly higher than those without knee OA (p < 0.01). Outpatient usage was higher (p < 0.01) in comparison to inpatient and pharmacotherapy. Being married and having an income were significantly associated with seeking outpatient care (OR: 11.136, 95% CI: 1.73–52.82, p < 0.01) and pharmacotherapy (OR: 10.439, 95% CI: 1.187–91.812, p < 0.05), while females were less likely to utilize inpatient care services (OR: 0.126, 95% CI: 0.021–0.746, p < 0.05). The higher rate of healthcare utilization among older persons with knee OA indicates the increased healthcare needs of this population, who are commonly assumed to suffer from a benign disease.
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New Molecular Targets in the Therapy of Arthrosis Patients. ARS MEDICA TOMITANA 2020. [DOI: 10.2478/arsm-2019-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction: Arthrosis represents the progressive degeneration of the joint cartilage, accompanied by the narrowing of the articular space and inflammation, which affects 70% of the population after the age of 60. Research purpose: This paper reviews the opportunity of using proinflammatory cytokine inhibitors as a means of stopping the progress of arthrosis. Material and method: As a result to a research into various clinical trial registers (Arthritis Clinical Trials, Clinical Research and Drug Information) and on specialized e-platforms, 5 randomized, multicentric double-blind clinical studies have been identified, which monitored the efficiency of various biological molecules in the treatment of arthrosis (etanercept, adalimumab, litikizumab, fasinumab and tanezumab). Results: The current pharmacological interventions consist mainly in the prescription of analgesics (acetaminophen, opioid analgesics), non-steroidal and chondroprotective anti-inflammatories. The proinflammatory cytokine inhibitors are already widely used in the inflammatory joint diseases, such as the rheumatoid polyarthritis. Their introduction into the treatment of arthrosis blocks the disease’s etiopathogenic mechanisms. Discussions: Arthrosis physiopathology involves a series of systemic, biological, biochemical factors, molecular and enzymatic processes that generate minimum inflammation. IL-1b and TNF-α are two major cytokines produced by the synovial cells and chondrocytes, which are involved in the destruction of the cartilage matrix by stimulating the production of proteolytic enzymes (MMP and aggrecanase). Conclusions: The utilisation of proinflammatory cytokine inhibitors in arthrosis represents a therapeutic option that requires studies in order to establish whether the introduction of proinflammatory cytokine inhibitors in arthrosis therapy might slow down the disease’s etiopathogenic mechanisms.
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