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DeMoya CD, Joenathan A, Lawson TB, Felson DT, Schaer TP, Bais M, Albro MB, Mäkelä J, Snyder BD, Grinstaff MW. Advances in viscosupplementation and tribosupplementation for early-stage osteoarthritis therapy. Nat Rev Rheumatol 2024; 20:432-451. [PMID: 38858605 DOI: 10.1038/s41584-024-01125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/12/2024]
Abstract
Joint kinematic instability, arising from congenital or acquired musculoskeletal pathoanatomy or from imbalances in anabolism and catabolism induced by pathophysiological factors, leads to deterioration of the composition, structure and function of cartilage and, ultimately, progression to osteoarthritis (OA). Alongside articular cartilage degeneration, synovial fluid lubricity decreases in OA owing to a reduction in the concentration and molecular weight of hyaluronic acid and surface-active mucinous glycoproteins that form a lubricating film over the articulating joint surfaces. Minimizing friction between articulating joint surfaces by lubrication is fundamental for decreasing hyaline cartilage wear and for maintaining the function of synovial joints. Augmentation with highly viscous supplements (that is, viscosupplementation) offers one approach to re-establishing the rheological and tribological properties of synovial fluid in OA. However, this approach has varied clinical outcomes owing to limited intra-articular residence time and ineffective mechanisms of chondroprotection. This Review discusses normal hyaline cartilage function and lubrication and examines the advantages and disadvantages of various strategies for restoring normal joint lubrication. These strategies include contemporary viscosupplements that contain antioxidants, anti-inflammatory drugs or platelet-rich plasma and new synthetic synovial fluid additives and cartilage matrix enhancers. Advanced biomimetic tribosupplements offer promise for mitigating cartilage wear, restoring joint function and, ultimately, improving patient care.
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Affiliation(s)
- Christian D DeMoya
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Anisha Joenathan
- Division of Materials Science and Engineering, Boston University, Boston, MA, USA
| | - Taylor B Lawson
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - David T Felson
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
| | - Thomas P Schaer
- PENN VET Institute for Medical Translation, University of Pennsylvania School of Veterinary Medicine New Bolton Center, Kennett Square, PA, USA
| | - Manish Bais
- Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Michael B Albro
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Janne Mäkelä
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Brian D Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital Boston, Boston, MA, USA.
| | - Mark W Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, MA, USA.
- Division of Materials Science and Engineering, Boston University, Boston, MA, USA.
- Department of Chemistry, Boston University, Boston, MA, USA.
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Link TM, Joseph GB, Li X. MRI-based T 1rho and T 2 cartilage compositional imaging in osteoarthritis: what have we learned and what is needed to apply it clinically and in a trial setting? Skeletal Radiol 2023; 52:2137-2147. [PMID: 37000230 DOI: 10.1007/s00256-023-04310-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 04/01/2023]
Abstract
Cartilage MRI-based T1rho and T2 compositional measurements have been developed to characterize cartilage matrix quality and diagnose cartilage damage before irreversible defects are found, allowing intervention at an early, potentially reversible disease stage. Over the last 2 decades, this technology was investigated in numerous studies and was validated using specimen studies and arthroscopy; and longitudinal studies documented its ability to predict progression of degenerative disease and radiographic osteoarthritis (OA). While T1rho and T2 measurements have shown promise in early disease stages, several hurdles have been encountered to apply this technology clinically. These include (i) challenges with cartilage segmentation, (ii) long image acquisition times, (iii) a lack of standardization of imaging, and (iv) an absence of reference databases and definitions of abnormal cut-off values. Progress has been made by developing deep-learning based automatic cartilage segmentation and faster imaging methods, enabling the feasibility of T1rho and T2 imaging for clinical and scientific trial applications. Also, the Radiological Society of North America (RSNA) Quantitative Imaging Biomarker Alliance mechanism was used to establish standardized profiles for compositional T1rho and T2 imaging, and multi-center feasibility testing is work in progress. The last hurdles are the development of reference databases and establishing a definition of normal versus abnormal cartilage T1rho and T2 values. Finally, effective treatments for prevention and slowing progression of OA are required in order to establish T1rho and T2 as imaging biomarkers for initiating and monitoring therapies, analogous to the role of dual X-ray absorptiometry (DXA) bone mineral density measurements in the management of osteoporosis. KEY POINTS: • T1rho and T2 cartilage measurements have been validated in characterizing cartilage degenerative change using histology and arthroscopy as a reference. • They have also been shown to predict progression of cartilage degeneration and incidence of radiographic OA. • Advances have been made to facilitate clinical and trial application of T1rho and T2 by improved standardization of imaging and by establishing deep learning-based automatic cartilage segmentation. • Effective treatments with disease-modifying OA specific drugs may establish T1rho and T2 cartilage compositional measurements as biomarkers to initiate and monitor treatment.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Ave, A-367, San Francisco, CA, 94143, USA.
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Ave, A-367, San Francisco, CA, 94143, USA
| | - Xiaojuan Li
- Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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da Costa SR, da Mota e Albuquerque RF, Helito CP, Camanho GL. The role of viscosupplementation in patellar chondropathy. Ther Adv Musculoskelet Dis 2021; 13:1759720X211015005. [PMID: 34035839 PMCID: PMC8127754 DOI: 10.1177/1759720x211015005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/13/2021] [Indexed: 12/26/2022] Open
Abstract
Patellar chondropathy has a high incidence in the general population, being more common in patients younger than 50 years, female and recreational athletes, and overweight and obese patients. The most common complaints are pain, limited mobility, crepitus, difficulty climbing and descending stairs, and joint instability, usually showing unsatisfactory results with anti-inflammatory, physiotherapy, rehabilitation, and many other conservative treatment methods. The presumed hyaluronic acid (HA) disease-modifying activity may include effects on cartilage degradation, endogenous HA synthesis, synoviocyte and chondrocyte function, and other cellular inflammatory processes. Currently, HA is widely used as a safe and effective conservative treatment for osteoarthritis in the knee and other joints. HA improves the physiological environment in an osteoarthritic joint and the shock absorption and lubrication properties of the osteoarthritic synovial fluid, thus restoring the protective viscoelasticity of the synovial HA, reducing the pain, and improving the mobility. The complete mechanism of HA in the joint is not fully understood, but a wide range of actions in the joint is recognized. Its anti-inflammatory, analgesic, and chondroprotective action is related to the modulation of the intra- and extracellular inflammation cascade. HA has been shown to be safe and effective in the treatment of pain related to patellar chondropathy.
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Affiliation(s)
- Sergio Ricardo da Costa
- PhD Program for Musculoskeletal System Sciences, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP 05403-010, Brazil
| | - Roberto Freire da Mota e Albuquerque
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camilo Partezani Helito
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilberto Luis Camanho
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Abstract
Osteoarthritis is a common condition that affects many individuals resulting in pain, reduced mobility, and decreased function. Corticosteroids have been a mainstay of osteoarthritis treatment. Studies have shown that they provide short-term pain improvement and can be used for osteoarthritis flares. Hyaluronic acid injections have extensively been studied in knee osteoarthritis but to a lesser degree in other joints. Despite some debate between societies, a large number of recent studies have shown hyaluronic acid to be a viable treatment option showing longer-term improvement in both pain and function.
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Affiliation(s)
- Nina A Yaftali
- Primary Care Sports Medicine, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison, 3rd Floor, Chicago, IL 60612, USA
| | - Kathleen Weber
- Department of Orthopaedics, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison, 3rd Floor, Chicago, IL 60612, USA.
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Injections for Knee Osteoarthritis: Corticosteroids, Viscosupplementation, Platelet-Rich Plasma, and Autologous Stem Cells. Arthroscopy 2018; 34:1730-1743. [PMID: 29656808 DOI: 10.1016/j.arthro.2018.02.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/10/2018] [Accepted: 02/13/2018] [Indexed: 02/08/2023]
Abstract
This article reviews the benefits of corticosteroid, viscosupplementation, platelet-rich plasma, and autologous mesenchymal stem cell injections for the treatment of patients with knee osteoarthritis. Integrating injections into both clinical and surgical practices is complicated given existing health insurance reimbursement policies. This review describes the outcomes associated with these interventions and appropriate methods of navigating the existing reimbursement pathways to help providers implement these treatments into their practices.
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Link TM, Neumann J, Li X. Prestructural cartilage assessment using MRI. J Magn Reson Imaging 2016; 45:949-965. [PMID: 28019053 DOI: 10.1002/jmri.25554] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022] Open
Abstract
Cartilage loss is irreversible, and to date, no effective pharmacotherapies are available to protect or regenerate cartilage. Quantitative prestructural/compositional MR imaging techniques have been developed to characterize the cartilage matrix quality at a stage where abnormal findings are early and potentially reversible, allowing intervention to halt disease progression. The goal of this article is to critically review currently available technologies, present the basic concept behind these techniques, but also to investigate their suitability as imaging biomarkers including their validity, reproducibility, risk prediction and monitoring of therapy. Moreover, we highlighted important clinical applications. This review article focuses on the currently most relevant and clinically applicable technologies, such as T2 mapping, T2*, T1ρ, delayed gadolinium enhanced MRI of cartilage (dGEMRIC), sodium imaging and glycosaminoglycan chemical exchange saturation transfer (gagCEST). To date, most information is available for T2 and T1ρ mapping. dGEMRIC has also been used in multiple clinical studies, although it requires Gd contrast administration. Sodium imaging and gagCEST are promising technologies but are dependent on high field strength and sophisticated software and hardware. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:949-965.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
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