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Gan X, Wang X, Huang Y, Li G, Kang H. Applications of Hydrogels in Osteoarthritis Treatment. Biomedicines 2024; 12:923. [PMID: 38672277 PMCID: PMC11048369 DOI: 10.3390/biomedicines12040923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
This review critically evaluates advancements in multifunctional hydrogels, particularly focusing on their applications in osteoarthritis (OA) therapy. As research evolves from traditional natural materials, there is a significant shift towards synthetic and composite hydrogels, known for their superior mechanical properties and enhanced biodegradability. This review spotlights novel applications such as injectable hydrogels, microneedle technology, and responsive hydrogels, which have revolutionized OA treatment through targeted and efficient therapeutic delivery. Moreover, it discusses innovative hydrogel materials, including protein-based and superlubricating hydrogels, for their potential to reduce joint friction and inflammation. The integration of bioactive compounds within hydrogels to augment therapeutic efficacy is also examined. Furthermore, the review anticipates continued technological advancements and a deeper understanding of hydrogel-based OA therapies. It emphasizes the potential of hydrogels to provide tailored, minimally invasive treatments, thus highlighting their critical role in advancing the dynamic field of biomaterial science for OA management.
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Affiliation(s)
- Xin Gan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Xiaohui Wang
- The Center for Biomedical Research, Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Yiwan Huang
- School of Materials and Chemical Engineering, Hubei University of Technology, Wuhan 430068, China;
| | - Guanghao Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Hao Kang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
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Rasmussen S, Petersen KK, Aboo C, Andersen JS, Skjoldemose E, Jørgensen NK, Stensballe A, Arendt-Nielsen L. Intra-articular injection of gold micro-particles with hyaluronic acid for painful knee osteoarthritis. BMC Musculoskelet Disord 2024; 25:211. [PMID: 38475764 PMCID: PMC10935980 DOI: 10.1186/s12891-024-07321-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Recently, in an open pilot study, we found up to two years, a potential pain-relieving effect of intra-articular gold micro-particles using the patient's synovial fluid for patients with knee osteoarthritis (KOA). During the study the excluded group of patients, due to multisite pain, co-morbidities, and other exclusion criteria., received intra-articular gold micro-particles using hyaluronic acid,. We aimed to identify if pre-treatment characteristics influence the global outcome two years after intra-articular treatment for painful KOA with gold microparticles using hyaluronic acid. METHODS Using hyaluronic acid as the carrier, 136 patients with KOA received intraarticular injections with 20 mg gold microparticles (72.000 particles, 20-40 μm in diameter). In the analysis, we included the Global Rating of Change Scale, Pain Detect Questionnaire (PDQ), Body Mass Index (BMI), and Kellgren & Lawrence score at the inclusion, Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) sub-scores for pain, stiffness, and function at inclusion and two years. RESULTS On the Global Rating Change Scale, 69.1% of patients reported a positive effect, 28.7% no effect, and 2.2% worse. PDQ and the three WOMAC subscores all improved at two years of follow-up. PDQ ≥ 13 (P = 0.028), BMI (P = 0.022) and Kellgren & Lawrence grade 4 (P = 0.028) at inclusion reduced the effect with a minor odds ratio compared to the baseline effect of treatment (P = 0.025). WOMAC subscores at inclusion did not influence the outcome (P > 0.5). CONCLUSIONS Severe osteoarthritis, obesity, and neuropathic pain, reduced the effect of intra-articular gold microparticles for knee OA. TRIAL REGISTRATION The study followed the principles of the Declaration of Helsinki and was approved by the local ethics committee of the North Denmark Region by 27/07/2016 (N-20,160,045). The regional data protection agency approved the project by 06/07/2016 (2008-58-0028, ID 2016 - 116) and registered in ClinicalTrial.Gov by 04/01/2018 (NCT03389906).
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Affiliation(s)
- Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, 249 Selma Lagerløfs Vej, Gistrup, 9260, Denmark.
- Department of Orthopedic Surgery, Sport and Arthroscopy, Aalborg University Hospital, Aalborg, Denmark.
| | - Kristian Kjaer Petersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Christopher Aboo
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Emilie Skjoldemose
- Department of Clinical Medicine, Aalborg University, 249 Selma Lagerløfs Vej, Gistrup, 9260, Denmark
| | - Nia Kristine Jørgensen
- Department of Clinical Medicine, Aalborg University, 249 Selma Lagerløfs Vej, Gistrup, 9260, Denmark
| | - Allan Stensballe
- Department of Clinical Medicine, Aalborg University, 249 Selma Lagerløfs Vej, Gistrup, 9260, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Xu Y, Wang JY, Meng T, Ma XW, Li H, Li K. Role of hydrogels in osteoarthritis: A comprehensive review. Int J Rheum Dis 2023; 26:2390-2401. [PMID: 37934919 DOI: 10.1111/1756-185x.14968] [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: 08/25/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
Osteoarthritis (OA) is a chronic, degenerative, and age-related disease. It is characterized by chronic inflammation, progressive articular cartilage destruction, and subchondral bone sclerosis. The current effective treatment for OA is limited. Hydrogel is a kind of unique carrier with well-known biocompatibility, softness, and high water content among various biomaterials. Hydrogels are developed for different biomedical applications, for instance, drug delivery, and tissue engineering. To date, a variety of hydrogels-based therapies have been used in OA patients or animal models. In this review, we comprehensively summarized the potential role of hydrogels in chondrocytes proliferation, apoptosis, and inflammatory component production and discussed the impact of hydrogels on OA development. The collection of this information will help better understand the present progress of hydrogels in OA.
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Affiliation(s)
- Yuan Xu
- College of Health Industry, Sichuan Tourism University, Chengdu, China
| | - Jing-Yan Wang
- College of Health Industry, Sichuan Tourism University, Chengdu, China
| | - Tian Meng
- College of Health Industry, Sichuan Tourism University, Chengdu, China
| | - Xue-Wei Ma
- College of Health Industry, Sichuan Tourism University, Chengdu, China
| | - Hao Li
- College of Health Industry, Sichuan Tourism University, Chengdu, China
| | - Kai Li
- College of Health Industry, Sichuan Tourism University, Chengdu, China
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Meehan RT, Gill MT, Hoffman ED, Coeshott CM, Galvan MD, Wolf ML, Amigues IA, Kastsianok LM, Regan EA, Crooks JL, Czuczman GJ, Knight V. Ultrasound-Guided Injections of HYADD4 for Knee Osteoarthritis Improves Pain and Functional Outcomes at 3, 6, and 12 Months without Changes in Measured Synovial Fluid, Serum Collagen Biomarkers, or Most Synovial Fluid Biomarker Proteins at 3 Months. J Clin Med 2023; 12:5541. [PMID: 37685608 PMCID: PMC10488758 DOI: 10.3390/jcm12175541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Prior studies have demonstrated improved efficacy when intra-articular (IA) therapeutics are injected using ultrasound (US) guidance. The aim of this study was to determine if clinical improvement in pain and function after IA hyaluronic acid injections using US is associated with changes in SF volumes and biomarker proteins at 3 months. METHODS 49 subjects with symptomatic knee OA, BMI < 40, and KL radiographic grade II or III participated. Subjects with adequate aspirated synovial fluid (SF) volumes received two US-guided IA-HA injections of HYADD4 (24 mg/3 mL) 7 days apart. Clinical evaluations at 3, 6, and 12 months included WOMAC, VAS, PCS scores, 6 MWD, and US-measured SF depth. SF and blood were collected at 3 months and analyzed for four serum OA biomarkers and fifteen SF proteins. RESULTS Statistical differences were observed at 3, 6, and 12 months compared to baseline values, with improvements at 12 months for WOMAC scores (50%), VAS (54%), and PCS scores (24%). MMP10 levels were lower at 3 months without changes in SF volumes, serum levels of C2C, COMP, HA, CPII, or SF levels of IL-1 ra, IL-4, 6, 7, 8, 15, 18, ILGFBP-1, 3, and MMP 1, 2, 3, 8, 9. Baseline clinical features or SF biomarker protein levels did not predict responsiveness at 3 months. CONCLUSIONS Clinical improvements were observed at 12 months using US needle guidance for IA HA, whereas only one SF protein biomarker protein was different at 3 months. Larger studies are needed to identify which SF biomarkers will predict which individual OA patients will receive the greatest benefit from IA therapeutics.
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Affiliation(s)
- Richard T. Meehan
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Mary T. Gill
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Eric D. Hoffman
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Claire M. Coeshott
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Manuel D. Galvan
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Molly L. Wolf
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Isabelle A. Amigues
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Liudmila M. Kastsianok
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - Elizabeth A. Regan
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
| | - James L. Crooks
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
- Department of Epidemiology, Colorado School of Public Health, CU Anschutz School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Gregory J. Czuczman
- Departments of Medicine, Clinical Labs, Radiology and Divisions of Rheumatology, Immunology/Complement Labs, and Biostatistics and Bioinformatics, National Jewish Health, Denver, CO 80206, USA; (M.T.G.); (E.D.H.); (C.M.C.); (M.D.G.); (M.L.W.); (I.A.A.); (E.A.R.); (J.L.C.); (G.J.C.)
- Radiology Imaging Associates, Englewood, CO 80112, USA
| | - Vijaya Knight
- Department of Pediatrics, Section of Allergy and Immunology, CU Anschutz School of Medicine, University of Colorado, Aurora, CO 80045, USA;
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Kotla NG, Mohd Isa IL, Larrañaga A, Maddiboyina B, Swamy SK, Sivaraman G, Vemula PK. Hyaluronic Acid-Based Bioconjugate Systems, Scaffolds, and Their Therapeutic Potential. Adv Healthc Mater 2023; 12:e2203104. [PMID: 36972409 DOI: 10.1002/adhm.202203104] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/04/2023] [Indexed: 03/29/2023]
Abstract
In recent years, the development of hyaluronic acid or hyaluronan (HA) based scaffolds, medical devices, bioconjugate systems have expanded into a broad range of research and clinical applications. Research findings over the last two decades suggest that the abundance of HA in most mammalian tissues with distinctive biological roles and chemical simplicity for modifications have made it an attractive material with a rapidly growing global market. Besides its use as native forms, HA has received much interest on so-called "HA-bioconjugates" and "modified-HA systems". In this review, the importance of chemical modifications of HA, underlying rationale approaches, and various advancements of bioconjugate derivatives with their potential physicochemical, and pharmacological advantages are summarized. This review also highlights the current and emerging HA-based conjugates of small molecules, macromolecules, crosslinked systems, and surface coating strategies with their biological implications, including their potentials and key challenges discussed in detail.
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Affiliation(s)
- Niranjan G Kotla
- Institute for Stem Cell Science and Regenerative Medicine (inStem), Bangalore, Karnataka, 560065, India
| | - Isma Liza Mohd Isa
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Aitor Larrañaga
- Department of Mining-Metallurgy Engineering and Materials Science, POLYMAT, Faculty of Engineering, University of the Basque Country (UPV/EHU), Bilbao, 48013, Spain
| | - Balaji Maddiboyina
- Department of Medical Writing, Freyr Solutions, Hyderabad, Telangana, 500081, India
| | - Samantha K Swamy
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, 9037, Norway
| | - Gandhi Sivaraman
- Department of Chemistry, Gandhigram Rural Institute (Deemed to be University), Gandhigram, Tamil Nadu, 624302, India
| | - Praveen K Vemula
- Institute for Stem Cell Science and Regenerative Medicine (inStem), Bangalore, Karnataka, 560065, India
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Conrozier T, Diraçoglù D, Monfort J, Chevalier X, Bard H, Baron D, Jerosch J, Migliore A, Richette P, Henrotin Y. EUROVISCO Good Practice Recommendations for a First Viscosupplementation in Patients with Knee Osteoarthritis. Cartilage 2023; 14:125-135. [PMID: 36443990 PMCID: PMC10416196 DOI: 10.1177/19476035221138958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Viscosupplementation (VS) with hyaluronic acid is widely used in the management of knee osteoarthritis. There is no clear recommendation on the decision-making to achieve VS. DESIGN Based on extensive research of the literature and expert opinion, the members of the EUROVISCO (European Viscosupplementation Consensus Group) task force were asked to give their degree of agreement with 60 issues, using a Delphi method. RESULTS The expert panel achieved unanimous agreement in favor of the following statements: It is recommended to assess pain on a visual or 10-point numeric scale before considering VS. VS can be considered for patients with pain scores between 3 and 8. A standard x-ray must be obtained before the decision of VS. If the x-ray is normal, osteoarthritis must be confirmed by MRI or computed tomography (CT) arthrogram before considering VS. The aims of VS are relieving pain, improving function, and reducing non-steroidal anti-inflammatory drug (NSAID) consumption. The use of VS must not be considered for treating an osteoarthritis flare. VS can be envisaged as a first-line pharmacological treatment in patients having a contra-indication to NSAIDs or analgesics. VS can be considered in patients with contra-indications to arthroplasty. In the case of severe comorbidities (diabetes, hypertension, gastrointestinal disorders, renal failure), VS can avoid the use of potentially dangerous treatments. VS can be considered in patients receiving antiplatelet agents, vitamin K antagonists, and direct factor Xa or thrombin inhibitors. Five other statements obtained a high level of consensus. CONCLUSION These recommendations, illustrated in a decision algorithm, have been established to help practitioners in the decision-making of knee VS.
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Affiliation(s)
- Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Demirhan Diraçoglù
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jordi Monfort
- Servei de Reumatología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Xavier Chevalier
- Department of Rheumatology, Henri Mondor Hospital, Paris XII University, Creteil, France
| | - Hervé Bard
- Rheumatology, Cabinet Médical Vaudoyer, Paris, France
| | - Dominique Baron
- Centre de Réadaptation Fonctionnelle de Lannion-Trestel, Trévou-Tréguignec, France
| | - Jörg Jerosch
- Department of Orthopedic, Johanna Etienne Hospital, Neuss, Germany
| | - Alberto Migliore
- U.O.S. of Rheumatology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Pascal Richette
- Université Paris Cité, UFR Médicale, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Paris, France
| | - Yves Henrotin
- MusculoSKeletal Innovative Research Lab, Université de Liège, CHU Sart Tilman, Liège, Belgium
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Shih PC, Lee YH, Tsou HK, Cheng-Chung Wei J. Recent targets of osteoarthritis research. Best Pract Res Clin Rheumatol 2023; 37:101851. [PMID: 37422344 DOI: 10.1016/j.berh.2023.101851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Abstract
Osteoarthritis is one of the most common diseases and poses a significant medical burden worldwide. Currently, the diagnosis and treatment of osteoarthritis primarily rely on clinical symptoms and changes observed in radiographs or other image modalities. However, identification based on reliable biomarkers would greatly improve early diagnosis, help with precise monitoring of disease progression, and provide aid for accurate treatment. In recent years, several biomarkers for osteoarthritis have been identified, including image modalities and biochemical biomarkers such as collagen degradation products, pro- or anti-inflammatory cytokines, micro RNAs, long non-coding RNAs, and circular RNAs. These biomarkers offer new insights in the pathogenesis of osteoarthritis and provide potential targets for further research. This article reviews the evolution of osteoarthritis biomarkers from the perspective of pathogenesis and emphasizes the importance of continued research to improve the diagnosis, treatment, and management of osteoarthritis.
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Affiliation(s)
- Po-Cheng Shih
- Department of Allergy, Immunology & Rheumatology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Heng Lee
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan; Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Miaoli County, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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Wang Z, Wang J, Zhang L, Meng X, Dai G, Wang Q. Diacerein plus glucosamine hydrochloride improves the safety and efficacy and inhibit inflammatory factors in the treatment of knee osteoarthritis. Am J Transl Res 2023; 15:548-555. [PMID: 36777840 PMCID: PMC9908446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/22/2022] [Indexed: 02/14/2023]
Abstract
OBJECTIVES The aim of this study is to elucidate the safety and efficacy of diacerein (DIA) plus glucosamine hydrochloride (GlcN·HCl) in the treatment of knee osteoarthritis (KOA) and their effect on inflammatory factors (IFs). METHODS Retrospectively, 116 KOA patients admitted between August 2018 and August 2021 were selected. Among them, 55 cases received DIA monotherapy (control group, Con) and 61 cases received DIA + GlcN·HCl (observation group, Obs). The efficacy, safety, scores of Lequesne Index, and Visual Analogue Scale (VAS), as well as the levels of IFs of the two groups were observed and compared. Further, Cox regression was used to perform an in-depth analysis of factors influencing the occurrence of complications in patients with KOA. RESULTS The analyses revealed a higher overall response rate and a lower adverse event rate in the Obs group compared with the Con group, with statistical significance. Decreased scores of Lequesne Index and VAS and levels of IFs were determined in the Obs after treatment, which were all significantly lower compared with those of the Con. Cox regression analysis identified that TNF-α, IL-1β, hs-CRP, and treatment mode affected the occurrence of complications in KOA patients. CONCLUSIONS DIA + GlcN·HCl can significantly inhibit the inflammation level in KOA, with definite curative effects and a favorable safety profile.
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Affiliation(s)
- Zhiyu Wang
- South China Hospital of Shenzhen UniversityShenzhen 518000, Guangdong, P. R. China
| | - Jianing Wang
- Gastrointestinal Surgery, Beidahuang Group General HospitalHarbin 150088, Heilongjiang, P. R. China
| | - Li Zhang
- Department of Orthopedics, Rehabilitation Hospital, National Research Center for Rehabilitation Technical AidsBeijing 102676, P. R. China
| | - Xiangning Meng
- Peking University First HospitalBeijing 100034, P. R. China
| | - Guangming Dai
- Department of Orthopedic Medicine, Third Affiliated Hospital of Inner Mongolia MedicalInner Mongolia 010050, P. R. China
| | - Quan Wang
- Inner Mongolia Bailige Medical Science and Technology Co., Ltd.Inner Mongolia 010010, P. R. China
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Hyder A, Tawfik BE, Elmohandes W. Efficacy of computer-guided versus conventional sodium hyaluronate injection in superior joint space in treatment of temporomandibular joint (TMJ) internal derangement: Comparative randomized controlled trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e321-e326. [PMID: 35545190 DOI: 10.1016/j.jormas.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES evaluate the feasibility and clinical outcomes of computer-guided sodium hyaluronate injection in superior joint space compared to conventional injection for the treatment of TMJ Internal Derangement (TMJ-ID). PATIENTS AND METHODS Randomized controlled trial conducted on 40 patients diagnosed with bilateral TMJ-ID divided into two groups. Group A treated with four computer-guided sodium hyaluronate injections in superior TMJ space with one-week intervals. Group B received similar injections but with the conventional method. The intraoperative assessment included total procedural time and patient convenience during the injection. The postoperative evaluation included maximum unassisted mouth opening (MUMO), modified Helkimo's clinical dysfunction index, and pain intensity on a visual analog scale (VAS). RESULTS Group A showed better improvement in maximum mouth opening and pain intensity than group B after a week of the second, third and fourth injection. At the six months, group A continued to show better improvement regarding maximum mouth opening, while improvement in pain and TMJ dysfunction was similar in both groups. There were differences between both groups regarding procedural time and patient convenience across the study except the time of the first injection, which was similar in both groups CONCLUSION: Using the virtual planning and injection guide for intra-articular TMJ injection is considered promising to increase the accuracy and efficacy of injectable material securing faster results besides rendering the procedure easily reproducible and simpler to both clinicians and patients. However, the authors could not ensure the long-term superiority of the computer-guided injection technique over the conventional one in light of the results of this study.
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Affiliation(s)
- AbdElKader Hyder
- Assistant Lecturer of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, 11884, ElNasr Road, Nasr City, Cairo, Egypt.
| | - Bahaa Eldin Tawfik
- Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
| | - Wael Elmohandes
- Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
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Chavda S, Rabbani SA, Wadhwa T. Role and Effectiveness of Intra-articular Injection of Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Systematic Review. Cureus 2022; 14:e24503. [PMID: 35651409 PMCID: PMC9135165 DOI: 10.7759/cureus.24503] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/30/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disease that causes persistent joint pain and stiffness of mainly the large peripheral weight-bearing joints. It is a leading cause of functional disability and poor quality of life. Various modalities of therapy are recommended by different research organizations at different stages of OA including non-pharmacological, pharmacological, and surgical interventions. Intra-articular injections of hyaluronic acid (HA) is widely used for over three decades in the treatment of OA. However controversies exist regarding its safety and efficacy, the number of injections and courses, type of preparation, duration of its effects, and combining it with other drugs or molecules. This study aimed to review the most recent data available in the published literature to address these. Electronic databases like Medline, Embase, ProQuest, and Google Scholar were searched for articles using keywords, intraarticular injections, hyaluronic acid, and osteoarthritis knee. The review was carried out as per PRISMA guidelines. Thirty-eight randomized control trials (RCTs) investigating the efficacy and safety of intra-articular injection of HA were included in the systematic review. Out of the 38 studies, 22 (57.9%) were double-blind, eight (21%) single-blind, three (7.9%) non-blind, four (10%) with simple randomization, and one (2.7%) was open-labeled. Total 5,025 patients were included in these studies. The mean age of the patients was 60.28 years and the osteoarthritis grade of the knee joint was 1 to 3. HA was studied as a test preparation in 19 (50%) while in another 19 (50%) it was studied as a control. In 24 (63.2%) studies, HA was used as high molecular weight preparation in eight (21%) as low molecular weight preparation while in six studies the information was not available. HA was used as a standalone preparation in 31 studies, in two studies it was injected with platelet-rich plasma (PRP) and with either low-level laser therapy (LLLT), triamcinolone (TA), betamethasone (CS), poly deoxyribonucleotide (PDRN) or dexamethasone (DX) in one study each. In the majority of the studies, HA was given as a single injection (52.6% studies) or weekly three injections (28.9% studies). In 13.2 %, it was given as weekly 5 injections and in 5.3% as weekly two injections. IA-HA injections have a limited role in the treatment of knee osteoarthritis in those patients who do not have sufficient pain relief with topical or oral medication and physical therapy. It is safe and effective except for minor side effects such as local pain and swelling lasting for a few days. Severe allergic reactions are extremely rare. They provide adequate pain relief and functional improvement for up to six months irrespective of a number of injections and type of preparations used. The combination formulations with corticosteroids or PRP or MSCs show better results than HA alone. Combining HA with newer molecules such as peptides or diclofenac for sustained and disease-modifying effects requires more studies in the future.
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Affiliation(s)
- Sumant Chavda
- Orthopedics, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, ARE
| | - Syed Arman Rabbani
- Pharmacology, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, ARE
| | - Tarun Wadhwa
- Clinical Pharmacy, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, ARE
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11
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Latourte A, Rat AC, Omorou A, Ngueyon-Sime W, Eymard F, Sellam J, Roux C, Ea HK, Cohen-Solal M, Bardin T, Beaudreuil J, Guillemin F, Richette P. Do Glucocorticoid Injections Increase the Risk of Knee Osteoarthritis Progression Over 5 Years? Arthritis Rheumatol 2022; 74:1343-1351. [PMID: 35289131 DOI: 10.1002/art.42118] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/25/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Recent findings have demonstrated that intraarticular (IA) glucocorticoid injections can be deleterious for knees with osteoarthritis (OA). This study was undertaken to assess, in a real-life setting, the risk of knee OA progression in patients who received IA glucocorticoid injections over a 5-year follow-up period. METHODS We used marginal structural modeling with inverse probability of treatment weighting to determine the causal association between IA glucocorticoid injections and the 5-year risk of disease progression in patients with symptomatic knee OA from the Knee and Hip Osteoarthritis Long-term Assessment cohort. OA progression was defined as an incident total knee replacement (TKR) and/or radiographic worsening (Kellgren/Lawrence [K/L] grade or joint space narrowing [JSN]). We also examined these outcomes in knees that received IA hyaluronan (IAHA) injections. RESULTS Among the 564 patients with knee OA included in the study sample, 51 (9.0%) and 99 (17.5%) received IA glucocorticoid or IAHA injections, respectively, and 414 (63.1%) did not receive any injection during follow-up. Compared to untreated knees, those treated with IA glucocorticoid injections had a similar risk of incident TKR (hazard ratio [HR] 0.92 [95% confidence interval (95% CI) 0.20, 4.14]; P = 0.91) or K/L grade worsening (HR 1.33 [95% CI 0.64, 2.79]; P = 0.44). IAHA injections had no effect on the risk of TKR (HR 0.81 [95% CI 0.14, 4.63]; P = 0.81) or K/L grade worsening (HR 1.36 [95% CI 0.85, 2.17]; P = 0.20). Similar results were obtained for JSN, and when TKR and radiographic outcomes were combined. CONCLUSION In this study, IA glucocorticoid injections for symptomatic knee OA did not significantly increase the 5-year risk of incident TKR or radiographic worsening. These findings should be interpreted cautiously and replicated in other cohorts.
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Affiliation(s)
- Augustin Latourte
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - Anne-Christine Rat
- Caen Normandie University, UMR-S 1075-Mobilités: Vieillissement, Pathologie, Santé COMETE, Caen, France, Rheumatology Department, CHU Caen, Caen, France, and Université de Lorraine, EA 4360, APEMAC, Nancy, France
| | - Abdou Omorou
- Université de Lorraine, EA 4360, APEMAC, and Inserm CIC 1433 Epidémiologie Clinique, CHRU Nancy, Université de Lorraine Vandoeuvre-lès-Nancy, Nancy, France
| | | | - Florent Eymard
- Rheumatology Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Jérémie Sellam
- Rheumatology Department, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Inserm UMRS_938, FHU PaCeMM, Paris, France
| | - Christian Roux
- Rheumatology Department, CHU Pasteur 2, LAMHESS EA6309, UMR7277 iBV CNRS, Nice Sophia Antipolis University, France
| | - Hang-Korng Ea
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - Martine Cohen-Solal
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - Thomas Bardin
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
| | - Johann Beaudreuil
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Physical Medicine and Rehabilitation department, Lariboisière-Fernand Widal hospital, Paris, France
| | - Francis Guillemin
- Université de Lorraine, EA 4360, APEMAC, and Inserm CIC 1433 Epidémiologie Clinique, CHRU Nancy, Université de Lorraine Vandoeuvre-lès-Nancy, Nancy, France
| | - Pascal Richette
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Rheumatology Department, AP-HP, Lariboisière Hospital, Paris, France
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12
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Rasmussen S, Kjaer Petersen K, Kristiansen MK, Andersen JS, Aboo C, Thomsen ME, Skjoldemose E, Jørgensen NK, Stensballe A, Arendt-Nielsen L. Gold micro-particles for knee osteoarthritis. Eur J Pain 2022; 26:811-824. [PMID: 35076138 PMCID: PMC9307026 DOI: 10.1002/ejp.1909] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/29/2021] [Accepted: 01/08/2022] [Indexed: 11/22/2022]
Abstract
Background This exploratory study investigates if intra‐articular injected gold microparticles in knee osteoarthritis (KOA) reduce immunomodulatory‐based pain via proteomic changes in the synovial fluid (SF) and serum. Methods Thirty patients with moderate KOA were included. Intraarticular injections with 20 mg gold microparticles (72.000 particles, 20–40 µm in diameter) using the patient's synovial fluid (SF) as carrier were performed. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores for pain, stiffness, and function were assessed at inclusion, 8 weeks and 2 years The PainDetect questionnaire, pain pressure threshold (PPT), temporal summation (TS), and conditioned pain modulation (CPM), and pain diary were assessed at inclusion and 8 weeks. Proteome analysis was performed on SF and blood samples before and after 8 weeks of treatment. Results A decrease in WOMAC scores (pain (p = 0.0001), stiffness (p = 0.0088), activity (p = 0.0001)), PainDetect (p = 0.0002) and increase in PPT (p = 0.001) and CPM (p = 0.021) and a decrease in TS (p = 0.03) were found after 8 weeks compared to inclusion assessments. At 2 years follow‐up compared to baseline there was a decrease in WOMAC scores (pain (p = 0.0001), stiffness (p = 0.007), activity (p = 0.0001)) and PainDetect (p = 0.0001). In SF, 28 different proteins were downregulated and 11 upregulated (p < 0.05) mainly associated immune response. Similarly, 31 proteins were downregulated and 1 upregulated in serum (p < 0.05) reflecting key immune response and anatomical structure development processes. No adverse effects related to the treatment were recorded. Conclusions Gold microparticles injected intra‐articular in KOA joints may provide pain relief and an inflammatory modulatory effect based on proteome changes found in SF and serum. A randomized, controlled, double‐blind study is needed to infer a conclusion. Significance This study indicates that intra‐articular gold may provide advantages in clinical practice for managing knee osteoarthritic pain. The use of intraarticular gold can add new knowledge to the treatment of inflammation and pain.
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Affiliation(s)
- Sten Rasmussen
- Department of Clinical Medicine, Aalborg University.,Department of Orthopedic Surgery, Sport and Arthroscopy, Aalborg University Hospital
| | - Kristian Kjaer Petersen
- Department of Health Science and Technology, Aalborg University.,Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | | | | | | | | | | | | | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg University.,Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital
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13
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Therapeutic Exercise and Conservative Injection Treatment for Early Knee Osteoarthritis in Athletes: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010069. [PMID: 35056377 PMCID: PMC8778069 DOI: 10.3390/medicina58010069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Recent evidence highlighted a higher prevalence of knee osteoarthritis (kOA) among young and former ex-professional athletes. Although the practice of a highly demanding sport is considered a predisposing factor for the knee joint cartilage degeneration, articular cartilage seems to positively respond to a moderate load increase. We aim to investigate recent evidence on the conservative management of early kOA in athletes, with a particular emphasis on therapeutic exercise and injection treatment, in order to highlight whether there are any indications that can influence clinical and rehabilitation practice. Materials and Methods: A scoping review was conducted, screening MEDLINE and PEDro databases for studies published over the past twenty years on the topic. Studies in English, with accessible abstracts, were included in the review. The PICO framework was used (P—patient: athletes, I—Intervention: conservative treatment with therapeutic exercise or injection therapies, C—Comparison: not needed, O—Outcomes: clinical outcomes). Clinical trials, randomized controlled trials, and longitudinal studies were considered. Results: Four studies were finally included in the review. Therapeutic exercise seems to have beneficial effects on prevention of cartilage degeneration, on pain reduction, and on physical function enhancement. On the other hand, in mild to moderate stages of kOA the intra-articular viscosupplementation with Hyaluronic Acid showed a medium to long-term improvement in joint pain and function. The Platelet Rich Plasma treatment also showed a significant improvement in pain and function up to 12 months. Conclusions: Despite the heterogeneity of the studies considered, a multimodal treatment combining therapeutic exercise and moderate aerobic activity (such as running) should be indicated to prevent kOA development. In cases of symptomatic kOA it may be indicated to add minimally invasive injection therapy that seems to contribute to the improvement of motor function and symptomatology.
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14
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Webner D, Huang Y, Hummer CD. Intraarticular Hyaluronic Acid Preparations for Knee Osteoarthritis: Are Some Better Than Others? Cartilage 2021; 13:1619S-1636S. [PMID: 34044600 PMCID: PMC8808930 DOI: 10.1177/19476035211017320] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This literature review summarizes evidence on the safety and efficacy of intraarticular hyaluronic acid (IAHA) preparations approved in the United States for the treatment of osteoarthritis of the knee. DESIGN A systematic literature search was performed in PubMed, Ovid MEDLINE, and SCOPUS databases. Only studies in which clinical outcomes of individual IAHA preparations alone could be assessed when compared to placebo, no treatment, other standard knee osteoarthritis treatments, and IAHA head-to-head studies were selected. RESULTS One hundred nine articles meeting our inclusion criteria were identified, including 59 randomized and 50 observational studies. Hylan G-F 20 has been the most extensively studied preparation, with consistent results confirming efficacy in placebo-controlled studies. Efficacy is also consistently reported for Supartz, Monovisc, and Euflexxa, but not for Hyalgan, Orthovisc, and Durolane. In the head-to-head trials, high-molecular-weight (MW) Hylan G-F 20 was consistently superior to low MW sodium hyaluronate preparations (Hyalgan, Supartz) up to 20 weeks, whereas one study reported that Durolane was noninferior to Supartz. Head-to-head trials comparing high versus medium MW preparations all used Hylan G-F 20 as the high MW preparation. Of the IAHA preparations with strong evidence of efficacy in placebo-controlled studies, Euflexxa was found to be noninferior to Hylan G-F 20. There are no direct comparisons to Monovisc. One additional IAHA preparation (ie, Synovial), which has not been assessed in placebo-controlled studies, was also noninferior to Hylan G-F 20. CONCLUSION IAHA efficacy varies widely across preparations. High-quality studies are required to assess and compare the safety and efficacy of IAHA preparations.
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Affiliation(s)
- David Webner
- Crozer-Keystone Health System,
Springfield, PA, USA,David Webner, Crozer-Keystone Health
System, 196 W. Sproul Road, Suite 110, Springfield, PA 19064, USA.
| | - Yili Huang
- Northwell Health, Zucker School of
Medicine at Hofstra/Northwell, Hempstead, NY, USA
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15
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Hyaluronan and Derivatives: An In Vitro Multilevel Assessment of Their Potential in Viscosupplementation. Polymers (Basel) 2021; 13:polym13193208. [PMID: 34641024 PMCID: PMC8512809 DOI: 10.3390/polym13193208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022] Open
Abstract
In this research work, viscosupplements based on linear, derivatized, crosslinked and complexed HA forms were extensively examined, providing data on the hydrodynamic parameters for the water-soluble-HA-fraction, rheology, sensitivity to enzymatic hydrolysis and capacity to modulate specific biomarkers’ expression in human pathological chondrocytes and synoviocytes. Soluble HA ranged from 0 to 32 mg/mL and from 150 to 1330 kDa MW. The rheological behavior spanned from purely elastic to viscoelastic, suggesting the diversity of the categories that are suitable for restoring specific/different features of the healthy synovial fluid. The rheological parameters were reduced in a diverse manner upon dilution and hyaluronidases action, indicating different durations of the viscosupplementation effect. Bioactivity was found for all the samples, increasing the expression of different matrix markers (e.g., hyaluronan-synthase); however, the hybrid cooperative complexes performed better in most of the experiments. Hybrid cooperative complexes improved COLII mRNA expression (~12-fold increase vs. CTR), proved the most effective at preserving cell phenotype. In addition, in these models, the HA samples reduced inflammation. IL-6 was down-regulated vs. CTR by linear and chemically modified HA, and especially by hybrid complexes. The results represent the first comprehensive panel of data directly comparing the diverse HA forms for intra-articular injections and provide valuable information for tailoring products’ clinical use as well as for designing new, highly performing HA-formulations that can address specific needs.
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16
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Peck J, Slovek A, Miro P, Vij N, Traube B, Lee C, Berger AA, Kassem H, Kaye AD, Sherman WF, Abd-Elsayed A. A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee. Orthop Rev (Pavia) 2021; 13:25549. [PMID: 34745480 PMCID: PMC8567800 DOI: 10.52965/001c.25549] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE OF REVIEW The purpose of this systematic review is to discuss emerging evidence in the field of viscosupplementation for chronic knee pain secondary to Osteoarthritis (OA). This review focuses on types of viscosupplementation that are clinically available currently, evidence to support their use, contraindications, and adverse events. RECENT FINDINGS OA, also known as degenerative joint disease, is the most common form of arthritis in the United States, affecting 54.4 million, or 22.7% of the adult population. The knee is the most common joint affected in OA, with up to 41% involvement, 30% in the hands, and 19% in the hips. The pathophysiology of OA is complex, with contributing factors including mechanical stress to the joint, as well as many person-specific factors such as genetic susceptibility, ethnicity, nutrition, and sex. Treatment modalities include weight control, exercise, non-steroidal and steroidal anti-inflammatory drugs, opioids, intra-articular platelet-rich plasma, placebo, corticosteroid injection, intra-articular viscosupplementation, and surgery. Viscosupplementation consists of injection of hyaluronic acid (HA) into affected joints, intending to restore the physiologic viscoelasticity in the synovial fluid (SF) in the absence of inflammation. HA has also been shown to downregulate pro-inflammatory factors, such as PGE2 and NFkB, and proteases and proteinases known to break down the joint matrix.The contraindications for HA injection are similar to any other injection therapy, and adverse events are usually mild, local, and transient. Viscosupplementation (VS) is effective over placebo and more effective than NSAIDs and corticosteroids in pain reduction and improved functionality; however, guidelines recommend neither for nor against its use, demonstrating variability in the existing evidence base.Current VS options divide primarily into native vs. cross-linked and low-molecular-weight vs. high-molecular-weight. Current treatment options include Hylan g-f-20, Sodium Hyaluronate preparations (Suparts Fx, Euflexxa, Gelsyn-3, Durolane, Hyalgen), single-use agents (Gel-One, Synvisc-One, Monovisc), and Hyaluronan (Orthovisc, Monovisc, Hymovic). They share a common safety profile, and all have evidence supporting their efficacy. Their specific details are reviewed here. SUMMARY OA is the most common form of arthritis. It is a chronic, debilitating illness with a high impact on the functionality and quality of life of a significant part of the population in the western world. Treatments include medical management, physical therapy, activity modification, injection, and surgery. VS effectively reduces pain, increases functionality, and delays surgery in the knee to treat osteoarthritis. While previous studies have demonstrated variable results, more evidence is becoming available generally supportive of the benefit of VS in the treatment of knee OA.
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Affiliation(s)
| | - Annabel Slovek
- Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix
| | - Paulo Miro
- University of Arizona College of Medicine-Phoenix, AZ
| | - Neeraj Vij
- University of Arizona College of Medicine-Phoenix, AZ
| | - Blake Traube
- University of Arizona College of Medicine-Phoenix, AZ
| | - Christopher Lee
- Creighton University School of Medicine-Phoenix Regional Campus, Phoenix, AZ
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | | | | | - Alaa Abd-Elsayed
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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17
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Wan J, Zhang G, Li X, Qiu X, Ouyang J, Dai J, Min S. Matrix Metalloproteinase 3: A Promoting and Destabilizing Factor in the Pathogenesis of Disease and Cell Differentiation. Front Physiol 2021; 12:663978. [PMID: 34276395 PMCID: PMC8283010 DOI: 10.3389/fphys.2021.663978] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/10/2021] [Indexed: 12/16/2022] Open
Abstract
Cells must alter their expression profiles and morphological characteristics but also reshape the extracellular matrix (ECM) to fulfill their functions throughout their lifespan. Matrix metalloproteinase 3 (MMP-3) is a member of the matrix metalloproteinase (MMP) family, which can degrade multiple ECM components. MMP-3 can activate multiple pro-MMPs and thus initiates the MMP-mediated degradation reactions. In this review, we summarized the function of MMP-3 and discussed its effects on biological activities. From this point of view, we emphasized the positive and negative roles of MMP-3 in the pathogenesis of disease and cell differentiation, highlighting that MMP-3 is especially closely involved in the occurrence and development of osteoarthritis. Then, we discussed some pathways that were shown to regulate MMP-3. By writing this review, we hope to provide new topics of interest for researchers and attract more researchers to investigate MMP-3.
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Affiliation(s)
- Jiangtao Wan
- Spine Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Guowei Zhang
- Spine Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Li
- Spine Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xianshuai Qiu
- Spine Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jingxing Dai
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Shaoxiong Min
- Spine Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Bernetti A, Agostini F, Alviti F, Giordan N, Martella F, Santilli V, Paoloni M, Mangone M. New Viscoelastic Hydrogel Hymovis MO.RE. Single Intra-articular Injection for the Treatment of Knee Osteoarthritis in Sportsmen: Safety and Efficacy Study Results. Front Pharmacol 2021; 12:673988. [PMID: 34122099 PMCID: PMC8195240 DOI: 10.3389/fphar.2021.673988] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Viscosupplementation by hyaluronic acid (HA) is recommended for non-surgical management of knee osteoarthritis (OA). This study investigated the efficacy and safety of a single i.a. (32 mg/4 ml) Hymovis MO.RE. injection, a new HA derivative hydrogel, for the treatment of adult regular sports players affected by knee OA arising from overuse injuries. Patients were prospectively enrolled if regularly practicing sports and diagnosed with Kellgren-Lawrence grade I-III OA. They received a single Hymovis MO.RE. intra-articular (i.a.) injection and were evaluated 30, 90, 180, and 360 days thereafter. The assessment involved measuring changes in knee function, pain, the activity of daily living (ADL), and quality of life (QOL) by using the Knee injury and Osteoarthritis Outcome Score (KOOS), GAIT analysis, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for knee pain (WOMAC A) and function (WOMAC C), and a visual analogue scale (VAS) pain score. The study involved thirty-one patients, 23 women and eight men, whose median age was 49. KOOS function subscore, as well as GAIT cadence and velocity, showed a statistically significant increase at each time-point after injection (p < 0.0001). WOMAC, KOOS pain, symptoms, ADL, and QOL scores also significantly improved at all control visits. No severe adverse events or treatment-related events were detected. A single Hymovis MO.RE. (32 mg/4 ml) intra-articular injection provides a rapid, lasting, and safe response in regular sports players affected by knee OA, possibly representing a viable therapeutic option for this demanding patient subgroup. Further investigations are necessary to confirm these findings.
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Affiliation(s)
- Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Federica Alviti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | | | | | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
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19
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Waluyo Y, Budu, Bukhari A, Adnan E, Haryadi RD, Idris I, Hamid F, Usman A, Johan MP, Zainuddin AA. Changes in levels of cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen in subjects with knee osteoarthritis after dextrose prolotherapy: A randomized controlled trial. J Rehabil Med 2021; 53:jrm00196. [PMID: 33904585 PMCID: PMC8814831 DOI: 10.2340/16501977-2835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the effects of dextrose prolotherapy in patients with knee osteoarthritis on the levels of serum cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen, and on the Western Ontario McMaster Universities Index and numerical rating scale score for pain. METHODS A randomized controlled trial, in which participants were randomly allocated into 2 groups, receiving injections of either hyaluronic acid or dextrose prolotherapy. The hyaluronic acid group received 5 injections, 1 each on weeks 1, 2, 3, 4 and 5, and the dextrose prolotherapy group received 3 injections, 1 each on weeks 1, 5 and 9. Serum cartilage oligomeric proteinase, urinary C-terminal telopeptide of type II collagen, Western Ontario McMaster Universities Index score, and numerical rating scale score for pain were measured at baseline and 3 weeks after the last injection. Comparative analysis was conducted using Wilcoxon test within groups and analysis of covariance (ANCOVA) test between groups. RESULTS A total of 47 participants (21 allocated to hyaluronic acid, 26 allocated to dextrose prolotherapy) completed the protocol. Both interventions resulted in significant improvements in numerical rating scale scores for pain, total Western Ontario McMaster Universities Index scores, and its subscales score. However, the dextrose prolotherapy outperformed hyaluronic acid in numerical rating scale score for pain and level of urinary C-terminal telopeptide of type II collagen, with score changes differences of 0.93 (p = 0.042) and 0.34 (p = 0.048), respectively. No significant changes in level of serum cartilage oligomeric proteinase were found in either group. CONCLUSION Dextrose prolotherapy is an alternative injection therapy for knee osteoarthritis, which was found to be associated with a significant reduction in urinary C-terminal telopeptide of type II collagen compared with hyaluronic acid injection. Neither injection method resulted in reduced serum cartilage oligomeric proteinase.
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Nouri Barkestani M, Naserian S, Uzan G, Shamdani S. Post-decellularization techniques ameliorate cartilage decellularization process for tissue engineering applications. J Tissue Eng 2021; 12:2041731420983562. [PMID: 33738088 PMCID: PMC7934046 DOI: 10.1177/2041731420983562] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022] Open
Abstract
Due to the current lack of innovative and effective therapeutic approaches, tissue engineering (TE) has attracted much attention during the last decades providing new hopes for the treatment of several degenerative disorders. Tissue engineering is a complex procedure, which includes processes of decellularization and recellularization of biological tissues or functionalization of artificial scaffolds by active cells. In this review, we have first discussed those conventional steps, which have led to great advancements during the last several years. Moreover, we have paid special attention to the new methods of post-decellularization that can significantly ameliorate the efficiency of decellularized cartilage extracellular matrix (ECM) for the treatment of osteoarthritis (OA). We propose a series of post-decellularization procedures to overcome the current shortcomings such as low mechanical strength and poor bioactivity to improve decellularized ECM scaffold towards much more efficient and higher integration.
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Affiliation(s)
| | - Sina Naserian
- INSERM UMR-S-MD 1197, Hôpital Paul Brousse, Villejuif, France.,Université Paris-Saclay, CNRS, Centre de Nanosciences et Nanotechnologies C2N, UMR9001, Palaiseau, France.,CellMedEx, Saint Maur Des Fossés, France
| | - Georges Uzan
- INSERM UMR-S-MD 1197, Hôpital Paul Brousse, Villejuif, France.,Paris-Saclay University, Villejuif, France
| | - Sara Shamdani
- INSERM UMR-S-MD 1197, Hôpital Paul Brousse, Villejuif, France.,CellMedEx, Saint Maur Des Fossés, France
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Raeissadat SA, Ghazi Hosseini P, Bahrami MH, Salman Roghani R, Fathi M, Gharooee Ahangar A, Darvish M. The comparison effects of intra-articular injection of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factor (PRGF), Hyaluronic Acid (HA), and ozone in knee osteoarthritis; a one year randomized clinical trial. BMC Musculoskelet Disord 2021; 22:134. [PMID: 33536010 PMCID: PMC7860007 DOI: 10.1186/s12891-021-04017-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 01/26/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Our study compare the short and long-term efficacy of the intra articular injections (IAIs) of hyaluronic acid (HA), platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), and ozone in patients with knee osteoarthritis (OA). METHODS In this randomized clinical trial, 238 patients with mild to moderate knee OA were randomized into 4 groups of IAIs: HA (3 doses weekly), PRP (2 doses with 3 weeks interval), PRGF (2 doses with 3 weeks interval), and Ozone (3 doses weekly). Our outcome measures were the mean changes from baseline (immediately from the first injections) until 2,6, and 12 months post intervention in scores of visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index. RESULTS A total of 200 patients enrolled in the final analysis. The mean age of patients was 56.9 ± 6.3 years, and 69.5% were women. In 2 months follow up, significant improvement of pain, stiffness, and function were seen in all groups compared to the baseline, but the ozone group had the best results (P < 0.05). In 6 month follow up HA, PRP, and PRGF groups demonstrated better therapeutic effects in all scores in comparison with ozone (P < 0.05). At the end of the 12th month, only PRGF and PRP groups had better results versus HA and ozone groups in all scores (P < 0.05). Despite the fact that ozone showed better early results, its effects begin to wear off earlier than other products and ultimately disappear in 12 months. CONCLUSIONS Ozone injection had rapid effects and better short-term results after 2 months, but its therapeutic effects did not persist after 6 months and at the 6-month follow up, PRP,PRGF and HA were superior to ozone. Only patients in PRP and PRGF groups improved symptoms persisted for 12 months. Therefore, these products could be the preferable choices for long-term management. TRIAL REGISTRATION Registered in the Iranian Center of Clinical Trials ( www.irct.ir ) in 11/11/2017 with the following code: IRCT2017082013442N17.
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Affiliation(s)
- Seyed Ahmad Raeissadat
- Clinical Development Research Center of Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parsa Ghazi Hosseini
- Clinical Development Research Center of Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasan Bahrami
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Salman Roghani
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mohammad Fathi
- Critical Care Fellowship, Department of Anesthesiology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Critical Care Quality Improvement Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Gharooee Ahangar
- Clinical Development Research Center of Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahtab Darvish
- Clinical Development Research Center of Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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